Master PDPM & MDS for
Skilled Nursing Facilities
SNF billing leaves no room for error. We align your MDS 3.0 data with PDPM classifications, strictly manage consolidated billing rules, and ensure your facility is fully compensated for the complex care you provide.
MDS & Claim Alignment
We execute a rigorous "Triple Check" process to ensure the MDS, therapy logs, and UB-04 claim perfectly match before submission, preventing costly Medicare ADRs.
Why Skilled Nursing Needs Specialized Billers
Under the Patient-Driven Payment Model (PDPM), reimbursement relies entirely on accurate ICD-10 coding and clinical characteristics documented in the Minimum Data Set (MDS). A generic biller who doesn't understand the intricacies of Part A vs. Part B therapy, consolidated billing exclusions, or Variable Per Diem (VPD) adjustments will cost your facility millions in lost revenue.
PDPM & MDS Alignment
Your reimbursement is driven by the primary diagnosis and patient characteristics. We review the MDS 3.0 assessments to ensure all comorbidities (NTA, Speech, Nursing) are captured to maximize your case-mix.
Consolidated Billing Mgmt
Under Part A, the SNF must bill for almost all services (labs, x-rays, pharmacy). We track outside vendor invoices and manage exclusions to ensure you aren't absorbing costs that should be billed directly.
3-Day Qualifying Stay Check
Medicare Part A requires a prior 3-day consecutive inpatient hospital stay. We strictly verify admission dates and status (Inpatient vs. Observation) to prevent massive retroactive claim denials.
Securing Revenue from
Admission to Discharge
We proactively manage the high-risk financial aspects of skilled nursing, ensuring strict compliance with Medicare regulations and maximizing your case-mix index.
Eligibility & Benefit Periods
Before admission, we verify the patient’s available Medicare Part A days (1-100), remaining benefit period, and primary payer status to ensure coverage is active.
The Triple Check Process
Before month-end billing (UB-04), we cross-reference the MDS assessment, Therapy Logs, and the clinical chart to ensure 100% alignment and compliance.
Part A vs. Part B Split
Once a patient exhausts their Part A 100-day limit or goes off-skill, we seamlessly transition billing to Medicare Part B for ongoing ancillary therapy services.
ADR & ZPIC Defense
SNFs face intense Medicare scrutiny. If an Additional Documentation Request (ADR) is triggered, we compile your nursing notes and therapy minutes rapidly to defend your payment.
Stop Losing Facility Revenue
to PDPM Mismatches
Partner with certified SNF billers who understand the exact mechanics of MDS 3.0, Triple Check compliance, and Medicare Part A/B rules. Contact Valeria Healthcare Solutions today.