Specialized SNF Billing Services That Keep Your Facility Financially Healthy
Skilled nursing facility billing is among the most regulated and documentation-intensive in all of healthcare. Between PDPM classifications, Medicare coverage rules, Medicaid rate structures, and MDS coordination, a single misstep can cost your facility thousands. Theiatrics handles every piece of it so your team can focus on resident care.
SNF Services and Payers We Bill For
Other Service
Optimize Operations for Maximum Efficiency
Contact us to explore how our consulting can position your business as a frontrunner.
What Makes SNF Billing Services Different From Other Medical Billing?
Skilled nursing facility billing operates under a completely different framework than physician practice billing or hospital outpatient billing. SNFs primarily deal with institutional claim forms, per-diem Medicare reimbursement under the Patient-Driven Payment Model (PDPM), Medicaid fee-for-service rates that vary by state, and a web of coverage rules that determine whether any given day of care is billable at all.
The qualifying hospital stay requirement, the distinction between skilled and custodial care, the 100-day Medicare benefit period, and the three-midnight rule are all concepts that SNF billing specialists must understand deeply. Getting any of these wrong results in denied claims, repayment demands, or compliance exposure that can take months to resolve.
On top of that, SNF billing is tightly connected to clinical documentation. The Minimum Data Set (MDS) assessments that your clinical team completes directly determine your PDPM payment categories and rates. If MDS timing is off, if diagnoses are coded incorrectly, or if the clinical documentation does not support the billing, your facility is at risk for both payment shortfalls and audit findings.
Theiatrics brings the specialized expertise that SNF billing demands. We work alongside your clinical and administrative teams to ensure every claim reflects the actual care provided, is coded correctly, and is submitted on time to the right payer.
Understanding PDPM and Why It Matters for Your SNF Revenue
Physical Therapy Component
The PT component rate is determined by the resident’s functional score and primary diagnosis category. Accurate ICD-10 coding and functional assessment documentation are essential to ensure the facility receives the correct PT per-diem rate for each resident’s clinical needs.
Occupational Therapy Component
Similar to PT, the OT component is driven by functional scoring and clinical classification. Both therapy components are calculated separately under PDPM, which means errors in either diagnosis coding or MDS functional scoring can undercut reimbursement for both disciplines simultaneously.
Speech-Language Pathology Component
The SLP component is particularly sensitive to accurate comorbidity coding. Cognitive impairment indicators, swallowing disorders, and tracheostomy or ventilator status all affect SLP payment rates. Missing these diagnoses in the MDS or claim means leaving reimbursement on the table.
Non-Therapy Ancillary Component
The NTA component covers high-cost supplies and medications and is weighted heavily in the first three days of a Medicare stay. This makes accurate NTA scoring at admission especially important. Underscoring a resident’s comorbidities at this stage can cost a facility hundreds of dollars per day in lost reimbursement.
How Theiatrics helps: Our billing specialists review every PDPM classification for accuracy before the first interim claim is submitted. We cross-reference the MDS data, the physician orders, and the clinical documentation to ensure diagnoses are complete, comorbidities are captured, and the PDPM case-mix index reflects the true complexity of each resident’s care needs. When we find gaps, we work with your clinical team to correct them through proper documentation channels before billing is affected.
SNF Billing Across All Payer Types
Medicare Part A
The most complex SNF payer by far. Medicare Part A reimburses on a per-diem basis under PDPM for up to 100 days per benefit period. Billing requires UB-04 claims, correct PDPM classification, and precise coverage period tracking. We manage qualifying stays, interim claims, and final claims for every Medicare Part A resident.
PDPM-Based ReimbursementMedicare Advantage Plans
Medicare Advantage plans follow Medicare eligibility rules but each plan has its own prior authorization requirements, coverage rules, and reimbursement rates. We manage prior authorization requests, concurrent reviews, and claim submission for all Medicare Advantage plans your facility contracts with.
Prior Auth RequiredMedicaid
Medicaid covers long-term custodial care that Medicare does not, making it essential for most SNFs. Medicaid rates and rules vary significantly by state. We understand the fee-for-service and managed care Medicaid structures in every state where your facility operates and manage billing accordingly.
State-Specific RulesMedicaid Managed Care
Many states have transitioned Medicaid long-term care into managed care organizations. Each MCO has its own contract, rates, prior auth processes, and claim timelines. Our team manages these relationships and ensures claims are submitted according to each MCO’s specific requirements.
MCO ContractsCrossover Claims
Dual-eligible residents covered by both Medicare and Medicaid generate crossover claims where Medicare pays first and Medicaid covers the coinsurance and cost-sharing. These claims require precise coordination of benefits to ensure both payers are billed correctly and no revenue is left uncollected.
Dual-Eligible ResidentsCommercial & LTC Insurance
Some residents carry commercial health insurance or long-term care (LTC) insurance policies. We manage verification of benefits, prior authorizations, claim submission, and appeals for commercial and LTC payers, ensuring these often-overlooked revenue sources are fully captured.
LTC Policy BillingOur Complete SNF Billing Services
Eligibility & Benefits Verification
We verify Medicare, Medicaid, and commercial insurance eligibility at admission and throughout the stay, confirming qualifying hospital stays, benefit periods remaining, and coverage limits before the first claim is submitted.
PDPM Classification & Coding
Correct PDPM classification is the foundation of accurate Medicare billing. We review ICD-10 diagnosis codes, clinical category assignments, and comorbidity flags to ensure every resident is classified at the appropriate payment level.
MDS Coordination
We work closely with your MDS coordinators to align billing with assessment data. Timing errors and data inconsistencies between the MDS and billing systems are among the most common causes of SNF claim denials, and we prevent them proactively.
UB-04 Claim Preparation & Submission
SNF claims require institutional UB-04 forms with precise revenue codes, condition codes, occurrence codes, and value codes. Our billing team prepares and submits these claims electronically with all required fields completed accurately.
Prior Authorization Management
Medicare Advantage and Medicaid managed care plans require prior authorization for SNF admissions and concurrent reviews to continue coverage. We manage the entire authorization process from initial request through concurrent extensions.
Denial Management & Appeals
When a claim is denied, we analyze the reason, correct the root issue, and resubmit within 48 hours. For clinical necessity denials, we prepare detailed appeal letters with supporting documentation to overturn the decision.
AR Follow-Up & Collections
Aging accounts receivable quietly drains cash flow at many SNFs. Our team works all unpaid and underpaid claims systematically, following up with Medicare, Medicaid, and commercial payers until every balance is resolved.
Audit Support & ADR Response
We help facilities respond to Additional Development Requests (ADRs), RAC audits, CERT reviews, and TPE audits. Our team compiles documentation, prepares audit responses, and assists with appeals when claims are denied post-payment.
Revenue Cycle Reporting
You receive regular reports on claim submission rates, denial trends, payer mix analysis, days in AR, and collection performance so you always have a clear and accurate picture of your facility’s financial position.
SNF Billing Challenges We Solve Every Day
Qualifying Hospital Stay Issues
Medicare Part A SNF coverage requires a qualifying inpatient hospital stay of at least three consecutive days. Observation status stays and short admissions do not qualify. Billing Medicare Part A without a qualifying stay results in full claim denial and potential compliance exposure.
How we help: We verify qualifying status at admission by confirming inpatient days directly with the referring hospital before the first claim is submitted.
PDPM Undercoding
Many SNFs consistently receive lower Medicare reimbursement than they are entitled to simply because diagnoses are not fully captured in the MDS or the primary diagnosis is not selected correctly. Undercoding the NTA component in the first three days is especially costly.
How we help: We conduct PDPM accuracy reviews for every new Medicare admission and work with your MDS team to ensure all diagnoses and comorbidities are documented and coded correctly.
MDS Assessment Timing Errors
The MDS has strict assessment windows that must be completed on time for Medicare billing to proceed correctly. Missing or late assessments can result in incorrect per-diem rates, unallowable billing periods, and audit findings that require complex corrections.
How we help: We track MDS assessment windows for every Medicare resident and alert your clinical team when assessments are approaching their deadline to prevent timing violations.
Prior Authorization Denials
Medicare Advantage and Medicaid managed care plans deny SNF claims when prior authorization was not obtained or when concurrent review was not completed in time to extend coverage. These denials are often not recoverable after the authorization window closes.
How we help: We manage all prior authorization requests and concurrent reviews proactively, tracking approval expiration dates and submitting extensions before coverage lapses.
Insufficient Medical Necessity Documentation
Medicare and many managed care payers require clear documentation that skilled nursing care is medically necessary for each day billed. Vague or incomplete clinical notes are the most common reason SNF claims are denied or reversed in post-payment audits.
How we help: We identify documentation gaps before submission and flag them to your clinical team with specific guidance on what is needed to support each billed service.
Non-Covered Days Billed in Error
Billing Medicare for days when a resident no longer meets the criteria for skilled care, or for days beyond the 100-day benefit period, creates significant compliance risk and results in repayment demands with interest when discovered in audits.
How we help: We monitor every Medicare resident’s benefit period and skilled care status continuously, ensuring billing stops at the correct point and Private pay or Medicaid billing transitions smoothly.
Why Skilled Nursing Facilities Choose Theiatrics
The True Cost of Poor SNF Billing
Many skilled nursing facilities accept a level of revenue leakage that they would never tolerate in their clinical operations. Uncaptured PDPM points, unbilled non-covered day transitions, unworked Medicare Advantage denials, and missed Medicaid crossover claims add up to significant annual losses that most facilities never fully quantify.
When a facility consistently undercodes the NTA component in the first three days of a Medicare stay, for example, they might lose $50 to $150 per resident per stay. For a 100-bed facility with 200 Medicare admissions per year, that represents $10,000 to $30,000 in avoidable revenue loss from a single coding error alone.
Theiatrics exists to find and fix these gaps. Our SNF billing review process is designed to identify every recoverable revenue opportunity and put in place the processes to capture it going forward.
Ready to Strengthen Your SNF Revenue Cycle?
Let Theiatrics handle the complexity of skilled nursing facility billing so your administrative team can focus on running your facility. Schedule a free consultation and we will assess your current revenue cycle at no cost.
Schedule My Free Audit →Answers to What SNF Billing Providers Ask Us Most
Answers to the questions SNF administrators and billing directors ask us most when they are evaluating outsourced billing support for their facility.
📞 Call Our Charge Team
Find Lost Revenue Before Claims Are Filed
We review recent encounters, identify missed or undercoded charges, and show exact revenue impact — before you commit to anything.
90 days of encounters reviewed
Codes matched with documentation
Exact dollar value identified
From certified specialists
100% risk-free audit
5900 Balcones Drive Ste 7988, Austin, Texas, 78731, USA
Follow Us On
Follow us on our socials to stay updated with our services and get excited offers
© 2026 Theiatrics. All Rights Reserved