Your Guide to Skilled Nursing A/R Management

Quality Healthcare Resources
June 21, 2022
May 5, 2023
Polaris Group Profile
Polaris Group
May 5, 2023

Whether you have a full accounting team or a billing department of one, read on for three steps to better A/R health.

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Between the end of SNF waivers and the upcoming 4.6% PDPM reimbursement cut, skilled nursing operators face financial pressure from all sides. Unfortunately, there’s another, hidden challenge impacting SNF finances: aging A/R.

Facilities across the country are sitting on tens of thousands of dollars in unpaid claims. It’s hard to stay on top of your current billing and deal with denials when you have back-office staffing shortages, complex payer contracts, and ripple effects from COVID disruptions. However, there are realistic and actionable steps you can take today to collect the dollars you’re owed. Whether you have a full accounting team or a billing department of one, read on for three steps to better A/R health:  

Step #1: Prioritize your aging claims

Your goal is to collect as much as possible, as efficiently as possible. Instead of jumping from claim to claim or thinking of your aging as one big bucket, prioritize aged claims to maximize your return on staff time and effort.

Priority 1: Claims aged to the timely filing limit

Your first priority is to work claims that are close to the insurance provider’s timely filing limit. Claims aged past the limit require more time, documentation, and expertise to get paid, especially if they involve level one or level two appeals. Start by documenting your timely filing limits for each payer, communicating those limits to staff, assessing which claims within each payer bucket are closest to timely filing, and working claims according to age.

Priority 2: New aging in the 30-, 60-, and 90-day column

Once you’ve made sure nothing ages past the timely filing limit, focus on new aging in the 30-, 60-, and 90-day column. Your goal is to resolve or make progress on every claim before it rolls to a new bucket. When you look at the aging, do you see the same claim with the same note rolling from 30 to 60 to 90? Has the claim been reprocessing so long that it’s rolled over? Tricky claims may require multiple pieces of internal documentation and several phone calls to the provider, all of which take time (25 minutes to 2 hours, on average). Make sure you’re making progress and have a plan, so claims are either quickly resolved or you have enough time to resolve issues before the filing limit.

Priority 3: Use your own prioritization (dollars, payer, etc.)

There are no unimportant claims but think about how you can maximize your dollars for time spent. You could prioritize claims with a higher dollar amount, payers you know are easier to get paid, or payers that you know take more time to pay. Regardless of your prioritization method, make sure your team has a systematic way to work your aging. You want to see financial progress and that it’s worth investing time in A/R follow-up.

Step #2: Set a goal and be disciplined

Too often A/R feels like a project that can be pushed to tomorrow. However, the best way to think about A/R is as an always-on process and regular part of your daily operations.  

The best way to prevent mounting A/R is to set the expectation that billing staff work on issues as they’re posting cash. The claim is young, its history is recent, and the issue is fresh. However, if your team isn’t working claims when you post cash and aren’t able to work A/R daily, you need to set another schedule or standard for A/R management.

Here are three examples of good, better, and the best way to set expectations and help your team manage their time:

Good: I’m going to work on my aging once a week.

This person knows they need to work on their aging, but they risk pushing it later and later into the week since they haven’t defined the day or time.

Better: I’m going to work on my aging every Thursday for a few hours.

This person made A/R management a structured part of their week, but it still feels like an afterthought or “if I have time”.

Best: I’m going to work on my aging every Thursday from 9 to 11.

This person has a dedicated block of time within their week for focused work on A/R.  

Step #3: Find the root cause as efficiently as possible

Every claim is a little different but what really moves the needle on collecting unpaid claims is process and documentation. Always ask your team: are we solving the problem today? Or are we really putting it off for tomorrow?

Do your own research

Try to collect as much information on the claim as possible before you call the payer. Did you use the right revenue codes? What about ancillaries? Are all your authorizations in place? Fixing issues on your end and analyzing the claim before you call the payer will help you ask more specific questions and confirm that the information the customer service representative tells you is correct.

Don’t take “resubmit” as an immediate answer

Your customer service representative might not be able to quickly tell you why your claim was denied. However, resubmitting it won’t get you closer to that information. You’re just kicking the can down the road and closer to the timely filing limit. Start by diagnosing the reason the claim was originally denied so you can correct the issue.

Escalate appropriately

Encourage your team to speak with a manager if they aren’t getting the information that they need from their payer rep. They might need to step out of the claims process and speak with provider relations if progress isn’t being made. Encourage them to ask tough questions. Their time and the facility’s money are valuable.

Document everything

Documentation helps teams stay organized and make progress on claim. Take notes on who you talked to, when, what they said, and next steps. Be sure to include the call reference number, fax confirmation numbers, and any other unique identifiers, too. These details are particularly important if you file for an appeal. Documentation helps prove you followed procedures and deserve to be paid.

You need an A/R management strategy to maximize your revenue and cash flow

Every facility has some level of aging. Revenue cycle management is complex and there’s always room for better training, processes, and technology. However, you can’t afford not to be paid for the critical care you provide. Yesterday was the best time to work on your A/R. Get started or get professional assistance today.

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