What Clean Claim Rate Should a Dermatology Billing Partner Actually Guarantee You?

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Choosing a dermatology billing partner based only on a promised clean claim rate can be misleading. A billing company may tell you that it maintains a 95%, 97%, or even 99% clean claim rate. But before accepting that number, you need to know how the rate is measured, what claims are included, and whether those clean claims are actually being paid correctly . For dermatology practices, this matters because a claim can pass an initial billing check and still face problems related to medical necessity, modifiers, procedure coding, payer policies, or underpayment. A clean claim rate should therefore be viewed as one part of the revenue cycle, not the entire performance picture. What Clean Claim Rate Should a Dermatology Billing Partner Guarantee? A reasonable contract target is 97% or higher , provided the billing partner clearly defines the metric and measures it consistently at the payer level. The percentage itself, however, is only part of the agreement. A dermatology practice should a...
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Basics of Medicare Consolidated Billing for SNFs

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Need for Consolidated Billing for SNFs

Prior to the Balanced Budget Act of 1997 (BBA), a Skilled Nursing Facility (SNF) could elect to furnish services to a resident in a covered Part A stay, either, directly using its own resources; through the SNF's transfer agreement hospital; or under arrangements with an independent therapist (for physical, occupational, and speech therapy services). In each of these circumstances, the SNF billed Medicare Part A for the services.

However, the SNF also had the further option of ‘unbundling’ a service altogether; that is, the SNF could permit an outside supplier to furnish the service directly to the resident, and the outside supplier would submit a bill to Medicare Part B, without any involvement of the SNF itself.

This practice created several problems, including the following:

  • Potential for duplicate (Parts A/B) billing if both the SNF and outside supplier billed;
  • An increased out-of-pocket liability incurred by the beneficiary for the Part B deductible and coinsurance even if only the supplier billed; and
  • A dispersal of responsibility for resident care among various outside suppliers adversely affected quality (coordination of care) and program integrity

Then Balanced Budget Act of 1997 (BBA), was enacted, containing a Consolidated Billing (CB) requirement for SNFs. Under the CB requirement, an SNF itself must submit all Medicare claims for the services that its residents receive. Conceptually, SNF CB resembles the bundling requirement for inpatient hospital services that's been in effect since the early 1980s, assigning to the facility itself the Medicare billing responsibility for virtually the entire package of services that a facility resident receives, except for certain services that are specifically excluded.

To get more information about Medicare Consolidated Billing for SNFs click here: https://bit.ly/3vmPAjQ. Get in touch with us at: info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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