BLOG • Feb 19, 2025
Unlocking Revenue Potential: Why CARC Codes Are Essential for Denial Management
RCM CARC
🟢 SNF Billing Services
End-to-End SNF Billing Services Built for Revenue Certainty
Billing services for nursing homes & long‑term care facilities that are fast and powerful
Schedule a Call6,450
Total Patient Days Billed
45 Days
Average Payment Cycle
9.2%
Claims Underpayment Rate
Overview
Overview of Skilled Nursing Facility Billing
Skilled nursing home billing supports continuous medical or nursing care for residents, including individuals with disabilities or illnesses. It requires expertise from qualified health personnel—registered nurses, licensed practical nurses, physical therapists, occupational therapists, and speech‑language pathologists—and typically covers ongoing conditions ordered by a physician
Minimize Complicated Medicare Rules
Medicare coverage for nursing facilities often involves shifting restrictions that can complicate reimbursements. Even the smallest coding error can result in lost payments. Our specialized billing approach precisely records and documents every claim, following it through until you receive full compensation
Challenges in Skilled Nursing Facility Billing
• Consolidated Billing Requirements: SNFs must understand what Medicare A covers (and what it does not). Uncovered services under Medicare A might still be billable under Medicare B; recognizing these details is crucial. • Per Diem Payments: SNFs are reimbursed a fixed daily rate under Medicare A, which they must use to pay contracted service providers. • Prospective Payment System (PPS): Under PPS, SNFs submit a consolidated claim to Medicare A for per diem reimbursement, requiring careful adherence to coverage rules.
Reducing Overdue Payments with Our SNF Billing Solutions
• Authorization or referral issues • Out‑of‑network claims and deductibles • EDI rejections or wrong diagnoses • PIP (Personal Injury Protection) cases • Terminated insurance or COB (Coordination of Benefits) problems
Common Issues Faced by Nursing Facilities
• Inaccurate coding leads to claim rejections. • Limited clarity on which services are covered by Medicare A vs. Medicare B. • Fixed or per diem payments do not always cover actual costs. • Rejected claims and underpayments resulting in revenue leakage. • Difficulty documenting all necessary medical and non‑medical activities for reimbursement.
Benefits of ASP‑RCM Solutions for SNFs
• Authorization or referral issues • Out‑of‑network claims and deductibles • EDI rejections or wrong diagnoses • PIP (Personal Injury Protection) cases • Terminated insurance or COB (Coordination of Benefits) problems
Operations
SNF Billing Operations: Streamlined & Patient‑Focused
By centralizing every aspect of the revenue cycle—from claim submission to final payment—we help sustain facility profitability while keeping patient care at the forefront
Expert Medical Billing & Collections
We excel at managing a spectrum of skilled care claims (Medicare Part A, Part B, replacements, and commercial plans), driving both successful reimbursement and process improvements
Hospice & Medicaid Billing
Our team expertly handles Medicaid applications, Hospice billing, and Medicaid Coinsurance (MXA), ensuring no eligible service goes unbilled and no reimbursement opportunity is missed
Services for Business Offices
We go beyond standard billing. Our services include managing trust funds, handling aging clean‑up, processing resident communications, and taking care of private pay collections, payment posting, and Medicaid applications
Enhanced Liquidity & Flexible Pricing
Whether you need a flat monthly fee, commission‑based structure, or hourly charges, ASP‑RCM provides long‑term solutions for billing, collections, business office support, and specialized past‑due collection projects
Comprehensive Denial Management
Our dedicated denial management strategies address authorization lapses, coding errors, out‑of‑network issues, and more. By analyzing root causes and implementing proactive solutions, we reduce AR days and increase revenue capture
Continuous Improvement & Compliance
We monitor evolving Medicare regulations, payer policies, and SNF guidelines to refine processes regularly. This ensures you remain compliant, competitive, and prepared for new mandates—all while safeguarding your revenue stream
Testimonials
Client Success Stories
FAQ
Frequently asked questions
Once we have safely received your patient and encounter data, we code, review, and send claims to payers. We also manage appeals and denials, track payments, and provide frequent updates. Our procedure is designed to be effective and open.
Our qualified coders and billing specialists evaluate every claim stringently. We employ quality control procedures, coding audits, and cross-referencing with payer requirements to guarantee accuracy and lower the possibility of denials.
Our denial management team examines every refused claim to identify the underlying reason. We quickly fix any problems and submit claims again, and where needed, we collaborate with payers on appeals to ensure you get the most money back.
Our pricing policy is adaptable and customized to meet every customer's demands. Usually, we charge a set fee based on volume or a portion of collections. Contact us for a quote tailored to your clinic's particular needs.
Indeed. Our specialty is smooth transfers from internal procedures or other billing businesses. To guarantee that all data is moved safely, our staff will collaborate closely with you and offer training as required.
Resources
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