Accurate billing is essential for Skilled Nursing Facilities (SNFs) to maintain strong financial performance. With ongoing changes in Medicare rules, PDPM requirements, and payer documentation expectations in 2025, even small errors can lead to denials, repayment demands, or compliance issues. At Konnext Solutions, we help post-acute care providers navigate these challenges so they can focus on patient care instead of billing setbacks.
What Are SNF Billing Guidelines?
SNF billing guidelines are structured rules defined by Medicare and private payers to ensure claims are submitted correctly. These include:
- Admission and eligibility checks
- PDPM coding and classification
- Timely claim submission
- Tracking of Medicare benefit periods
- Documentation standards for audits
Following these requirements closely helps SNFs avoid costly denials and revenue loss.
Key Billing Priorities in 2025
PDPM Accuracy Under Review
The Patient-Driven Payment Model (PDPM) is designed around clinical needs instead of therapy minutes. In 2025, CMS audits are becoming more frequent. SNFs must ensure:
- MDS assessments are complete and accurate
- Diagnosis coding matches supporting documentation
Timely Billing Matters
Medicare requires claims within one year of the service date. Even a one-day delay may result in rejection. Timely submissions also help:
- Reduce AR days
- Improve cash flow stability
Benefit Period Tracking
Medicare Part A covers up to 100 days per benefit period (20 fully covered, 80 partially covered). Proper tracking is crucial to avoid:
- Billing for non-covered services
- Compliance risks and revenue setbacks
Consolidated Billing Compliance
SNFs remain responsible for billing most services, even those provided by outside vendors. Mistakes here can create:
- Coordination of benefits errors
- Compliance concerns
Common Billing Pitfalls
Even experienced billing teams face issues that cause delays or denials. Frequent mistakes include:
- Incomplete or outdated MDS assessments
- Incorrect HIPPS codes
- Missing therapy documentation
- Billing Part B services during Part A stays
- Lack of supporting physician documentation
How Konnext Solutions Helps
Konnext Solutions offers end-to-end revenue cycle management designed for Skilled Nursing Facilities. Our services include:
- PDPM coding validation and audits
- Alignment of MDS data with claims
- Real-time claims monitoring and AR reporting
- Dedicated account managers for personalized support
- Flexible billing models to meet operational needs
We go beyond processing claims, we protect your compliance and revenue at every step.
Strengthen Your SNF Billing in 2025
With CMS audits tightening and payer rules changing, SNFs can’t afford mistakes in billing and documentation. Partnering with Konnext Solutions ensures compliance, reduces denials, and strengthens revenue. Let us handle the complexity so your team can focus on patient care.
Konnext Solutions, Your trusted partner in credentialing and medical billing.
