What Percentage of Primary Care AR Is Uncollectible — and What Does the MGMA Benchmark Say?

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  In most high-performing practices, 3%–5% of primary care accounts receivable (AR) may become uncollectible, according to MGMA benchmark comparisons. When that percentage climbs higher, it signals breakdowns in revenue integrity, denial management, or patient collection workflows. For primary care practices operating on tight margins, even a 2% shift in uncollectible AR can significantly impact profitability and long-term financial stability. Understanding Uncollectible AR in Primary Care Uncollectible AR includes claims or patient balances that remain unpaid and are eventually written off as bad debt. In primary care, this typically happens due to: Insurance eligibility errors Missed the timely filing limits Weak denial follow-up High patient deductible balances Documentation gaps Coding inaccuracies Without strong primary care billing services , these issues compound over time, quietly reducing net collections. What MGMA Benchmarks Reveal While MGMA does not publis...
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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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