Nursing home billing Codes: Tips & Common Mistakes to Avoid

How to Maximize Your Reimbursement With the Right Nursing Home Billing Codes

Nursing Home Billing

The most commonly used code set is the Health Insurance Prospective Payment System (HIPPS) code set, which determines how much a nursing home facility receives in payment for its services. These codes are based on RUGs or Resource Utilization Groups that describe the type of care or services provided by the nursing home.  

 

Knowing what these codes are, understanding how they work, and ensuring that you have them correctly entered into your billing system can help ensure that you receive all of the reimbursements due to you from Medicare and other health insurance providers.  

 

In this article, we'll discuss these important coding systems and tips on making sure your billing for nursing home services get processed accurately and quickly for . 

Overview of Nursing Home Billing Codes 

Nursing home billing codes describe the type of services your facility provides and how they are charged. They are based on a set of codes established by the Health Insurance Prospective Payment System (HIPPS), which determines how much a nursing home is paid for each service.  

 

The most commonly used code set is Resource Utilization Groups (RUGs), which describe the type of care or services provided and determine how much a nursing home is paid for each service.  

 

Understanding these codes and making sure they are correctly entered into your billing system can help ensure that you get all of the reimbursements due to you from Medicare or other health insurance providers.  

Tips for Ensuring Accurate Claims Processing

 

Understanding how billing codes work and making sure they are entered correctly into your system is essential for getting all of the reimbursements you are due. Taking advantage of billing software can help streamline the process and make claims processing easier and more accurate.  

With the right care, you can ensure that your nursing home gets full-service reimbursement.  

 

1. Make sure all codes are correctly entered into your system: Double-check to make sure that all of the codes relevant to a particular claim are properly entered.  

 

2. Keep up-to-date with coding system changes: The HIPPS code set is updated annually, and it’s important to stay abreast of any changes. This will help ensure that all of your claims are correctly coded and the reimbursements you receive reflect the current coding system. 

 

3. Check with your billing staff to make sure they are familiar with HIPPS codes: Your billing staff should be knowledgeable about the code set so that they can accurately enter the relevant codes into your system. 

 

4. Take advantage of billing software: Billing software can help simplify the process of entering codes and make sure that all claims are correctly coded and processed accurately. 

How to Maximize Your Reimbursement with the Right Coding System 

The fact is coding errors can lead to significant revenue losses for nursing homes. To avoid this problem, it’s important to have a thorough understanding of the HIPPS code set and make sure that all codes are correctly entered into your billing system.  

 

It is also important to stay abreast of any changes to the code set and make sure that your billing staff is familiar with it. Finally, taking advantage of billing software can help streamline the process and improve accuracy.  

Benefits of using a Professional Billing Service to Ensure Accuracy in Claims Submission 

Using a professional billing service can help ensure that all of the necessary codes are entered correctly into your system and that all claims are valid from a regulatory perspective. This can help to avoid costly errors and result in higher reimbursement rates.  

 

A professional billing service also allows you to focus on providing high-quality care while they take care of the administrative aspects of claims processing. This saves time and helps ensure that all reimbursements are received in a timely manner.  

The following is the list of potential benefits of using a professional billing service: 

 

• Accurate and timely claims processing  

• Avoid costly coding errors  

• Focus on providing quality care instead of administrative tasks  

• Stay up-to-date with regulatory changes to ensure compliance  

• Receive higher reimbursement rates.  

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Common Mistakes Made When Submitting Nursing Home Bills 

 

Submitting accurate claims is essential for ensuring that your nursing home facility receives all of the reimbursements it is due. Unfortunately, there are a number of potential mistakes that can be made when submitting bills.  

 

The most common mistakes include the following:  

 

I. Overbilling: Entering too many codes or billing for services not provided   

II. Underbilling: Not entering enough codes or not billing for all of the services provided  

III. Incorrect coding: Entering the wrong codes or entering them in the wrong order  

IV. Duplicate billing: Billing twice for the same service.  

Final Thoughts 

Accurate billing and coding are essential for ensuring that your nursing home facility receives the maximum reimbursement for its services. By staying up-to-date with HIPPS codes, taking advantage of billing software, and using a professional billing service, you can ensure that all of your claims are correctly entered and avoid costly mistakes in the future.   

 

For more information on maximizing your reimbursement, get in touch with HMS USA LLC to discuss how better services can help your nursing home facility to get the most out of its billing and coding.