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Skilled Nursing Facility Billing Services

Skilled nursing facility billing operates under the Patient-Driven Payment Model (PDPM) with MDS-driven case-mix classification, consolidated billing requirements, and the critical Part A vs Part B distinction that determines how every service is reimbursed.

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HIPAA Compliant
AAPC Certified
4.9/5 Rating
300+ Practices
PDPMPayment Model
MDSAssessment
100-DayBenefit Period
NTAScoring

Why Skilled Nursing Facility Billing Requires Specialty Expertise

SNF billing under PDPM uses the Minimum Data Set (MDS) assessment to classify patients across five payment components: PT, OT, SLP, nursing, and non-therapy ancillary (NTA). Each component has its own case-mix group and reimbursement rate. Consolidated billing rules require the SNF to bill for virtually all services during a Part A stay, and the 100-day benefit period creates coverage-window management challenges.

Common Skilled Nursing Facility CPT Codes

Our coders handle these skilled nursing facility codes daily. This is not an exhaustive list.

Code
Description
PDPM
Payment Model
MDS
Assessment
100-Day
Benefit Period
NTA
Scoring

Skilled Nursing Facility Billing Challenges We Solve

Common billing problems in skilled nursing facility and how our team handles them.

PDPM Case-Mix Optimization

Five separate payment components each driven by different MDS items — errors in any component reduce that portion of reimbursement.

Consolidated Billing Compliance

SNFs must bill for nearly all services during a Part A stay, including outside therapies, labs, and radiology. Unbundling violations trigger audits.

Part A vs Part B Transition

When Part A benefits exhaust or the patient no longer qualifies for skilled care, the billing switches to Part B — missing the transition date causes denials.

NTA Scoring Accuracy

Non-therapy ancillary classification depends on specific diagnoses and MDS items. Missed NTA qualifiers leave significant revenue on the table.

Common Skilled Nursing Facility Denial Reasons

We prevent these before submission and appeal aggressively when they occur.

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Five separate payment components each driven by different MDS items — errors in any component reduce that portion of reimbursement
!
SNFs must bill for nearly all services during a Part A stay, including outside therapies, labs, and radiology
!
When Part A benefits exhaust or the patient no longer qualifies for skilled care, the billing switches to Part B — missing the transition date causes denials
!
Non-therapy ancillary classification depends on specific diagnoses and MDS items

Revenue Opportunities Most Skilled Nursing Facility Practices Miss

NTA scoring optimization is the most commonly missed revenue opportunity in SNF billing. The NTA component reimburses for high-cost ancillary services based on diagnosis and MDS scoring. Facilities that systematically capture all qualifying NTA diagnoses and MDS items see $20-60 per patient per day in additional NTA reimbursement. For a 100-bed facility with 70% Medicare occupancy, a $30/day NTA improvement generates $766,500 annually. PDPM variable per-diem adjustments represent another opportunity. PDPM applies decreasing per-diem adjustments to PT, OT, and SLP components over the course of the stay. Understanding the adjustment schedule allows SNFs to optimize admission timing and discharge planning to maximize reimbursement during the highest-paying early days of each stay.

Payer-Specific Skilled Nursing Facility Billing Tips

Medicare Part A SNF billing follows PDPM exclusively, with reimbursement determined by MDS assessment and the five-component classification. Medicare Administrative Contractors review SNF claims for medical necessity, and Targeted Probe and Educate (TPE) audits are common for SNF providers with high denial rates. Medicare Advantage plans cover SNF stays but may impose different authorization requirements, network restrictions, and length-of-stay criteria outside the standard 100-day benefit period. UnitedHealthcare Medicare Advantage and Humana frequently require concurrent review and may deny continued stays based on their own medical necessity criteria rather than Medicare guidelines. Medicaid covers long-term care in SNFs with state-specific per-diem rates that are significantly below Medicare rates. Dual-eligible patients require coordination between Medicare Part A (short-term skilled) and Medicaid (long-term custodial) billing.

Skilled Nursing Facility Billing Best Practices

Practical tips from our coding team to maximize reimbursement and minimize denials.

1
Review every MDS Section GG (functional status) and Section I (active diagnoses) before claim submission. These sections drive PDPM classification across multiple payment components, and missing a single active diagnosis can reduce NTA reimbursement by $30-80 per day.
2
Track the 100-day benefit period for every Part A resident. Medicare covers up to 100 days of skilled nursing per benefit period — days 1-20 at full coverage, days 21-100 with a daily coinsurance ($204.50 in 2026). Bill secondary insurance for the coinsurance.
3
Consolidated billing means the SNF must include all Part A services on its claim, even when provided by outside entities. Failure to bundle outside labs, radiology, or therapy results in duplicate billing violations.
4
When a resident transitions from Part A to Part B, immediately verify which services become separately billable under Part B. Therapy, physician visits, and certain supplies shift to individual claim submission.
5
Implement a triple-check process: clinical review of MDS, billing review of UB-04, and final reconciliation before submission. This catches 90% of SNF billing errors before they become denials.

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What We Handle for Skilled Nursing Facility Practices

PDPM case-mix classification across all five components
MDS review for coding accuracy and reimbursement optimization
Consolidated billing compliance management
Part A to Part B transition billing
100-day benefit period tracking
NTA scoring optimization
SNF ABN management for non-covered services
Triple-check process for claim accuracy

Why Choose Go Medical Billing for Skilled Nursing Facility

SNF billing requires simultaneous mastery of PDPM classification, consolidated billing rules, and benefit period management. Our team performs MDS-driven billing reviews that capture revenue across all five PDPM components.

We serve skilled nursing facility practices in all 50 states, starting at 2.49% of collections. Our credentialing team handles payer enrollment, and our A/R specialists recover aging claims.

Skilled Nursing Facility Billing by State

We handle skilled nursing facility billing in all 50 states. Select your state for location-specific payer details, Medicaid rules, and Medicare MAC policies.

CaliforniaTexasFloridaNew YorkPennsylvaniaIllinoisOhioGeorgiaNorth CarolinaMichiganNew JerseyVirginiaMassachusettsArizonaTennesseeMarylandIndianaMissouriWisconsinColorado
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Related Resources

Medical Billing & Coding ServicesA/R Recovery ServicesCredentialing & ContractingCase Studies & ResultsPricing

Frequently Asked Questions

Yes. We review every MDS assessment for clinical accuracy across all five PDPM components — PT, OT, SLP, nursing, and NTA — to ensure maximum appropriate reimbursement per patient per day.
We track benefit periods and skilled-care qualification for every resident, coordinate the transition billing when Part A ends, and ensure all Part B services are billed separately under the correct provider numbers.

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Stop losing revenue to skilled nursing facility coding errors and preventable denials. Call 888-701-6090 for a free billing assessment.

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