Mastering Billing and Collections for Long-Term Care Facilities

Efficient billing and collections are critical for the financial health of any long-term care facility. With the complexity of long-term care billing and the constant changes in healthcare regulations, facilities often face challenges in maintaining cash flow, reducing receivables, and managing their revenue cycle effectively. As operations managers and finance teams seek solutions to optimize these processes, the role of revenue cycle management (RCM) becomes more significant than ever. In this post, we’ll explore best practices for mastering billing and collections, and how outsourcing collections can be a game-changer for long-term care facilities.

The Importance of Efficient Billing and Collections

Long-term care billing is a multi-step process that requires meticulous attention to detail. From verifying patient eligibility to coding claims correctly and ensuring timely submissions, any misstep can lead to delays in payments or denials that can be costly to resolve. A well-managed billing and collections process ensures that long-term care facilities receive payment for the services they provide, maintain financial stability, and avoid the pitfalls of lost revenue due to inefficiencies.

Key challenges include:

  • Frequent changes in healthcare regulations: Medicare and Medicaid guidelines are constantly evolving, making compliance crucial but difficult to manage.
  • Increased complexity of claims: Long-term care facilities often deal with various payer types, including private insurers, Medicare, and Medicaid, each with its own set of rules.
  • Manual errors and inefficient processes: Without the right tools or expertise, mistakes in claims processing can lead to denied or delayed payments.
  • Aging receivables: Outstanding balances that accumulate over time can significantly strain cash flow, limiting a facility’s ability to operate effectively.

To stay ahead, it is crucial for facilities to adopt best practices in billing and collections.

Best Practices in Long-Term Care Billing and Collections:

To optimize revenue cycle management, long-term care facilities are recommended to implement the following best practices:

  • Comprehensive Staff Training
    Your billing team should be well-versed in the latest coding standards, payer requirements, and healthcare regulations. Ongoing education ensures that staff stay current and can process claims with greater accuracy, reducing rejections and resubmissions.
  • Regular Audits and Reconciliation
    Implementing regular audits of your billing processes can help catch errors early, preventing claims denials and unnecessary delays. Reconciliation of accounts should also be done frequently to ensure that collections are aligned with what was billed.
  • Invest in Advanced Technology
    Leveraging specialized billing software designed for long-term care facilities can streamline the entire revenue cycle. Automation tools reduce manual errors, track claims in real time, and provide analytics to identify trends in denials or delays.
  • Prompt and Accurate Documentation
    Accurate documentation is the foundation of successful billing. Ensuring that all patient records, services provided, and clinical documentation are properly logged will minimize discrepancies when submitting claims.
  • Monitor KPIs
    Facilities should track key performance indicators (KPIs) related to billing and collections, such as the percentage of denied claims, the time it takes to collect payments, and the aging of receivables. Monitoring these metrics helps identify problem areas and implement corrective actions quickly.
  • Proactive Collections Strategy
    Establishing a proactive collections approach involves engaging patients early, providing clear explanations of their financial responsibility, and following up on outstanding balances before they age into unmanageable debt.

The Benefits of Outsourcing Collections

While in-house teams can handle billing and collections to a certain extent, the growing complexity of long-term care billing often makes outsourcing an attractive option. Outsource collections to a receivable solutions specialist to reap the following benefits:

Access to Expertise 

Outsourcing to a specialist ensures that your facility benefits from the expertise of professionals who are well-versed in the nuances of long-term care billing. They have deep knowledge of payer rules and regulations, reducing the chances of costly errors.

Improved Cash Flow 

By entrusting a receivable solutions specialist with your collections, your facility can focus on its core services while the specialist ensures timely follow-up on outstanding accounts. This not only reduces the days in accounts receivable but also improves cash flow and financial predictability.

Compliance and Risk Management 

Third-party collections experts are usually well-versed in regulatory compliance, particularly with regard to HIPAA, Medicare, and Medicaid rules. This ensures that your facility remains compliant, avoiding the risk of fines or penalties due to billing errors or lapses in data security.

Scalability 

As your facility grows or faces periods of high demand, outsource collections partners can scale up their efforts to meet your needs, allowing you to maintain efficiency even during peak times. This flexibility is invaluable in maintaining smooth revenue operations without overburdening in-house staff.

Focus on Core Activities 

Outsourcing allows your internal team to focus on patient care and other key administrative tasks. By letting a receivable solutions specialist handle billing and collections, you can reduce the workload on your team, improving overall productivity and job satisfaction.

Advanced Analytics 

Many outsource collections providers offer detailed reporting and analytics that provide insights into your revenue cycle performance. These reports help pinpoint issues such as high denial rates, common claim errors, and areas for improvement, allowing you to make data-driven decisions to enhance your billing processes.

Conclusion

For long-term care facilities, efficient billing and collections are critical to financial success. By implementing best practices in billing, investing in the right technology, and considering outsourcing collections to a receivable solutions specialist, facilities can improve cash flow, reduce aging receivables, and focus on delivering quality care to their residents. Mastering your revenue cycle management isn’t just about staying afloat—it’s about thriving in an increasingly complex healthcare landscape.

If your facility is struggling with billing complexities or collections, it may be time to explore the benefits of outsourcing. A receivable solutions specialist could be the key to unlocking financial efficiency and ensuring your long-term care facility’s success.


Founded in 2006, LTC Ally serves the long-term care industry with an unbound dedication to improving back office and financial operations. With a mission to reduce burdens and increase peace of mind, LTC Ally set out to revolutionize the way facilities handle their revenue cycle management. With a full suite of financial, case management, and contracting solutions for healthcare providers, LTC Ally is your partner in long-term care and skilled nursing.

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