Astron Quality Assurance – Your Trusted Partner in Outsourced SNF Billing Excellence.

Elevate Care, Maximize Revenue – Let’s Streamline Your Success Together!

At Astron Quality Assurance, we specialize in providing comprehensive outsourcing services tailored specifically to the intricate world of SNF billing, including the Patient-Driven Payment Model (PDPM). Our expertise and dedication ensure that SNFs can navigate the complexities of billing and revenue cycle management with ease, maximizing revenue and achieving financial stability.

In today’s healthcare environment, SNFs face a myriad of challenges, from ensuring accurate documentation to maximizing reimbursements and maintaining compliance with ever-changing regulations. These challenges can often be overwhelming, diverting valuable time and resources away from providing quality care to residents. That’s where we step in. Our dedicated team specializes in providing comprehensive billing solutions tailored to meet the specific needs of SNFs, allowing you to focus on what matters most – delivering exceptional care to your residents.

HERE’S A CLOSER LOOK AT WHAT OUR COMPREHENSIVE SKILLED NURSING FACILITY BILLING SERVICES INCLUDES:

1. Billing and Claims Generation: Leveraging our expertise in the PDPM framework, we meticulously generate accurate claims for services rendered at SNFs. Our team ensures that each claim reflects the unique characteristics of the patient’s stay, maximizing reimbursement under the PDPM system.

2. Claims Scrubbing and Validation: Before submission, each claim undergoes rigorous scrubbing and validation processes tailored to PDPM requirements. We utilize advanced software tools to ensure that claims contain accurate patient assessments, clinical characteristics, and billing codes to support appropriate reimbursement.

3. Electronic Claims Submission: We streamline the submission process by electronically transmitting claims to various payer types, including Medicare, Medicaid, and commercial insurance companies. Our EDI capabilities facilitate seamless communication with payers, expediting reimbursement and reducing administrative burden.

4. Payment Posting and Reconciliation: Our team meticulously posts and reconciles payments received from different payer sources, including Medicare Part A, Part B, Managed Care Organizations (MCOs), and private insurers. We reconcile payments against the PDPM classification and ensure accurate revenue recognition for each patient stay.

5. Accounts Receivable Management: We proactively manage accounts receivable by monitoring aging reports and following up on outstanding claims with payers. Our team conducts thorough investigations into unpaid or denied claims, facilitating prompt resolution and maximizing collections to optimize cash flow.

6. Patient Billing and Follow-Up: In addition to payer billing, we manage patient billing processes, including invoicing, statements, and follow-up on outstanding balances. Our goal is to facilitate transparent communication with patients regarding their financial responsibilities and ensure timely resolution of billing inquiries or disputes.

7. Regulatory Compliance and Auditing: We assist SNFs in maintaining compliance with PDPM regulations and conducting regular audits to ensure accurate documentation and billing practices. Our team stays abreast of updates to PDPM guidelines and provides ongoing support to mitigate compliance risks and avoid penalties.

OUR PROCESS:

1. Verification and Intake: We begin by verifying patient insurance coverage and collecting necessary demographic and insurance information. This ensures that we have accurate data to initiate the billing process.

2. Coding and Documentation Review: Our certified coders meticulously review medical records and documentation to ensure accurate coding and compliance with regulatory requirements. We identify any discrepancies or missing information and work with healthcare providers to address them promptly.

3. Claims Submission: Once coding and documentation review are complete, we submit claims electronically to insurance payers. Our advanced billing software allows for efficient claims submission, reducing turnaround time and minimizing denials.

4. Reimbursement Management: We monitor claim status and follow up on outstanding claims to ensure timely reimbursement. Our team investigates any claim denials or rejections, resolving issues and resubmitting claims when necessary.

5. Payment Posting and Reconciliation: Payments received from insurance payers and patients are posted accurately to patient accounts. We reconcile payments against billed amounts and identify any discrepancies for further investigation.

6. Collections: In cases where payments are overdue, we initiate collections procedures to recover outstanding balances. Our experienced collections team follows ethical practices and maintains positive relationships with patients while pursuing payment.