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Long-term care billing guidelines provide a rigid framework for long-term care providers—like nursing homes, skilled nursing, and assisted living facilities—to ensure that they provide medical and personal care services to those who can no longer live independently. 

The CMS regularly assesses payment structures and long-term care billing guidelines to ensure accurate reimbursements for services rendered and high-quality care. In the aftermath of the pandemic, some fundamental payment flaws were brought to light, including underfunding, fragmentation across sites, and payment variations in different states on account of the inefficient allocation of resources, limited access to care in remote areas, inadequate quality of care, and inequities in healthcare access.

A facility administrator is reviewing the latest changes in long-term care billing guidelines.
Long-term care billing guidelines provide a rigid framework for long-term care providers.

This led the Biden administration to review the current long-term care payment system, resulting in a new $400 billion infrastructure plan to assist low-income families in paying for long-term care services, making home and community-based services more affordable and accessible. 

Among recent assessments in long-term care billing and payment structures, there has been a push to increase the salary of caregivers, who are severely underpaid and undervalued. Currently, some earning as little as $12 per hour, making them among some of the lowest-paid workers in America. 

By improving the salary of caregivers, the government hopes to create a fairer infrastructure that will improve staffing and retention while reducing adverse patient outcomes due to insufficient staffing. These factors are significant because they impact a facility’s financial stability. Studies show that strong financial performance is connected with better patient care and safety, leading to the continuation of providing high-quality services applicable to Medicare reimbursement claims. 

All of these factors are driving change in the long-term care industry payment system. Here we will explore the latest updates in long-term care billing guidelines and how long-term care facilities can improve their billing processes to stay on top of billing updates. 

The Latest Medicare SNF Billing Updates

New efforts by the CMS have significantly improved residents’ safety and quality of care while reducing overcrowding by promoting moral responsibility and ensuring residents are treated with respect and dignity. The CMS has also addressed staffing levels by introducing new minimum staffing requirements and incorporating the electronic Payroll-Based Journal (PBJ) staffing data to ensure surveyors record and submit staffing levels during their inspections.

In addition to safety measures and improving the quality of care, the CMS has made significant revisions to the payment system and long-term care billing guidelines. Below are some of the latest CMS changes to improve Medicare SNF billing.

A resident in a long-term care facility is reviewing the latest revisions to Medicare SNF Billing including changes to the PPS payment rates.
The latest revisions to Medicare SNF Billing include reviewing the Prospective Payment System (PPS).
  • Adjusted SNF payment rates under a Prospective Payment System (PPS): The PPS payment policies for SNFs were finalized in 2022. The CMS estimates that Medicare Part A payments will increase by approximately $904 million, or 2.7%, in FY 2023. The increase is primarily due to a 5.1% update to the payment rates, which includes a 3.9% SNF market basket increase and a 1.5% market basket forecast error adjustment. However, in 2023, the recalibrated parity adjustment will decrease SNF PPS rates by 2.3%, or $780 million, over two years. 
  • Recalibrated Patient-Driven Payment Model (PDPM) parity adjustment: Effective October 1, 2019, Medicare adopted the PDPM. And in 2022, the CMS found approximately 5% or $1.7 billion of unintended payment increases due to the implementation of PDPM. This led the CMS to recalibrate the PDPM parity adjustment rule to reduce the overall spending to a budget-neutral amount of 4.6%. Using data from patients unaffected by the COVID-19 PHE (Public Health Emergency), and data from months with fewer COVID-19 cases, the CMS has factored in a new recalibrated parity adjustment factor. 
  • Decreased permanent cap on wages: SNF PPS payments are typically unstable due to yearly wage index decreases, which affects all long-term care providers. So the CMS finalized a 5% cap on the annual wage index decrease, hoping to provide more stability in SNF PPS payments. 
  • Updated consolidated billing: As of January 1, 2021, the list of services subject to consolidated billing was updated. Consolidated billing means that the facility is responsible for billing Medicare for certain services provided by outside providers. This change aims to reduce confusion and administration for SNFs by clarifying which services are subject to consolidated billing. Click here to view the full list of services excluded from consolidated billing.
  • Increased Medicare Part A deductible: The Medicare Part A deductible amount has increased incrementally. In 2021, the hospital deductible per benefit period was $1,484; in 2022, this increased to $1,556. The latest increase in 2023 is $1,600 per benefit period. 

It is worth noting that Medicare rules and regulations can be complicated and are often subject to change. Caregivers should visit the CMS website regularly or see a knowledgeable billing professional to stay up to date on the latest developments.

Click here to see how our long-term care software can improve your billing process.

4 Ways SNF Billing Guidelines Are More Easily Met With Elder Care Software

Staying on top of the latest SNF billing guidelines and changes can be confusing. As a result, many long-term care facilities adopt elder care software because the automated systems have proven to improve documentation and billing accuracy, leading to fewer billing errors and claim denials and helping you stay in compliance with long-term care billing guidelines.

  1. Accurate and timely documentation

To meet the billing guidelines for long-term care facilities, caregivers must take accurate and timely nursing documentation notes like focused DAR, narrative, and SOAPIE progress notes. This documentation is entered into the long-term care software, ensuring care and changes in condition are detailed and updated in real-time it and that they meet Medicare and Medicaid billing requirements.

  1. Improved coding accuracy

Medicare SNF billing is often too difficult to do manually, which is why many facilities have already adopted the use of long-term care EHR software systems to assist with coding accuracy. A practical nursing home software system helps facilities identify appropriate billing codes by notifying caregivers with helpful alerts for missing or incomplete documentation, ultimately reducing errors and inconsistencies that can lead to claim denials or audits.

  1. Efficient billing processes

One of the most significant advantages of using eMAR software is the streamlined billing processes that allow facilities to automate SNF consolidated billing and submit reimbursement claims quicker and more efficiently. Nursing home EHR systems can create and submit claim forms, track claim statuses and send automatic updates for denied or rejected claims. This saves facilities considerable time and resources, allowing staff to focus more on providing quality care.

  1. Compliance with regulations

Consistently staying in compliance with regulations means staying on top of changes and updates. Fortunately, long-term care EMR software can be programmed in accordance with the latest updates, ensuring all entered information meets regulations.

How To Stay On Top of Long-Term Care Billing Guidelines

A nurse using the facility's long-term care software to stay on top of the latest SNF billing guidelines.
Long-term care software can help facilities stay on top of SNF billing guidelines.

Senior care software is a great way for long-term care facilities to better remain in compliance with long-term care billing guidelines. Thanks to accurate and timely documentation, improved coding accuracy, and efficient billing processes, long-term care facilities usually see better financial outcomes and more complete reimbursements.

Furthermore, as the long-term care industry continues to adopt new regulations that impact the financial stability of facilities, it has become imperative to adopt long-term care EHR technology that not only streamlines the billing process but also keeps the organization up-to-date with the latest regulations and guidelines.

For more on recent trends in long-term care, read our blog and subscribe to the LTC Heroes podcast.