All about long term care Billing rules & regulations in 2024:

Posted by William Jones on November 29th, 2023

Long term care is a lucrative business today.  


Nursing homes, skilled nursing, and assisted living facilities-all fall under long term care. Playing a crucial role in offering medical and personal care services to individuals who can no longer live independently, long term billing in fact is quite a complex affair to deal with. 
As the landscape of long term care billing guidelines is continually evolving, shaped by assessments, policy changes, and the ever present need for quality care it demand resources to be constantly updated.  

With efforts are being made to increase caregiver salaries, addressing the issue of severely underpaid and undervalued caregivers, some earning as little as per hour. This push for improved salaries is expected to enhance staffing, retention, and patient outcomes, directly impacting the financial stability of long-term care facilities. This is why today many long term care providers are looking for alternative solution. 

Latest Updates in Medicare SNF Billing: 

Studies show a strong correlation between financial performance and the quality of patient care and safety, reinforcing the importance of financial stability for Medicare reimbursement claims. As the long-term care industry undergoes these changes, it becomes crucial for facilities to adapt and improve their billing processes to stay compliant with the latest guidelines. 

in fact, the Centers for Medicare & Medicaid Services (CMS) recently has implemented significant changes to Medicare SNF billing, focusing on resident safety, quality of care, and payment system revisions. Here are some key updates: 

Adjusted SNF payment rates under PPS -  

  • The CMS estimates a 4 million increase in Medicare Part A payments, primarily due to a 5.1% update to payment rates. 

  • The recalibrated parity adjustment will decrease SNF PPS rates by 2.3% over two years. 

Recalibrated PDPM parity adjustment - 

  • The CMS recalibrated the PDPM parity adjustment rule to reduce unintended payment increases, achieving budget neutrality. 

Decreased Permanent Cap on Wages -  

  • A 5% cap on the annual wage index decrease was finalized to provide stability in SNF PPS payments. 

Updated consolidated billing -  

  • The list of services subject to consolidated billing was updated as of January 1, 2021, to reduce confusion and administration for SNFs. 

Increased Medicare Part A deductible - 

  • The Medicare Part A deductible amount increased to $ 1,600 per benefit period in 2023. 

  • It is crucial for caregivers and billing professionals to stay updated on these changes by regularly visiting the CMS website or consulting knowledgeable billing professionals. 

Sunknowledge - streamlining your LTC billing: 

Staying compliant with the latest LTC billing guidelines can be challenging, prompting many long-term care facilities to adopt elder care software. These automated systems have proven to enhance documentation and billing accuracy, reducing errors, claim denials, and ensuring compliance with long-term care billing guidelines however at times can come with a cost. This is why today providers are looking for alternative cost effective solution - outsourcing. 

 Helping you bridging the gaps, outsourcing is the most convenient solution for long term care billing operation for next few years, mainly due to - 

  • Accurate and timely documentation - outsourcing solution like Sunknowledgeensuresaccurate and timely nursing documentation, meeting Medicare and Medicaid billing requirements. 

  • Improved coding accuracy - assisting facilities in identifying appropriate billing codes, reducing errors and inconsistencies, Sunknowledge experts avoid all these problems that lead to denials or audits. 

  • Compliance with regulations - Sunknowledge is programmed to align with the latest updates, ensuring all entered information meets regulations. 

  • Efficient billing processes - Streamlined billing processes automate LTC consolidated billing, allowing facilities to submit reimbursement claims quicker and more efficiently. The expert today is known for slashing the operational expenses by 80 %. 

Staying on top of billing guidelines for financial stability and regulatory compliance. Sunknowledge Services Inc. today proves to be a valuable asset, offering accurate documentation, coding precision, efficient billing, and compliance with evolving regulations. It not only streamlines the billing process but also keeps organizations up-to-date with the latest guidelines, ensuring they provide high-quality care while maintaining financial viability. 

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William Jones

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William Jones
Joined: May 7th, 2019
Articles Posted: 46

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