The many hats of SNF business office personnel
Editor’s note: This article has been adapted from one of HCPro’s classic long-term care titles, The Comprehensive Guide to Nursing Home Administration, by Brian Garavaglia, PhD, FACHCA.
Business personnel handle the important tasks of billing, covering private insurances, Medicaid reimbursement, Medicare reimbursement, as well as other forms of receivables.
In addition, these staff members are instrumental in working with the administrator on issues such as aging. Their area is often quite arcane in nature, given that each type of insurance has its own set of rules. Business office personnel also work with the families who pay the bills for residents as well as state intermediary personnel to help set up Medicaid reimbursement.
Another area that billing personnel are intricately involved in is the month-end financial closings and demand billing issues. During the closing of each month, a demand billing month closing form should be completed by the admissions personnel in collaboration with the MDS coordinator. It should address any demand billing issues for the month, with each month’s forms kept on file. A copy should also be submitted to the administrator, informing him or her of the demand bill status for the month.
Office staff are responsible for accurate billing, documenting accounts receivables, and accurately communicating all charges to residents’ family members on a monthly billing statement. In some facilities, business office personnel also deal with the account payables. Often interfacing with family members, payments are frequently brought to these staff members, which can then be placed in the cash receipts ledger and subsequently posted to the appropriate resident account.
The business office personnel need to understand and document the type of payment, with explicit accuracy, that is received from each resident. This is important to prevent any false claims or inappropriate submissions to state, federal, third-party payers, or private pay individuals.
Accurate trust fund management may be an important part of this position, although it does not necessarily have to be done by the business office.
However, whoever is chosen to disburse and receive trust monies must accurately document the transactions in the patient ledger based on an accrual accounting system procedure. This is an area that surveyors pay close attention to, examining whether the facility is maintaining pinpoint accuracy in managing the money of the residents. The administrator should work with the business office at the end of each month to make sure that there is a proper reconciliation between the facility trust account and bank statement.
With the management of the daily trust comes the mandated information that must be provided to the residents, families, or legal representatives at least quarterly—the financial statement of their funds. On a quarterly basis, the business office personnel need to submit a letter to all responsible parties that indicates an accurate accounting balance of resident trusts for that quarter. This will include any quarterly interest that has been accrued. This should be done in collaboration with the administrator, who, as chief financial officer of the facility, should allocate interest to the resident’s accounts.
The business office personnel should meet with the administrator at the end of each month’s closing to address the aging accounts area. This is very crucial, because accounts that are left unchecked for too long often cannot be collected on, and writing off large amounts of money can be problematic. Therefore, it’s very important to make sure the administrator is kept up to date on:
- How the business office targets delinquent accounts
- The number of days, on average, it takes to collect on accounts owed to the facility
- How the office is attempting to keep the collection period as close to 30 days as possible