Understanding the Costs of a Skilled Nursing Stay 

By Your Health Magazine Contributor

Your Health Magazine Contributor

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Understanding the Costs of a Skilled Nursing Stay 

Skilled nursing care usually follows a hospital admission, putting the patient and family in a position where they must make certain decisions in a very limited time. In addition to the treatment plan, the family must address issues like insurance, cost, and the needed documentation to set up billing procedures. The billing team usually includes external specialists like CareBiller, who help the facility with administrative issues. Families can also make things easier when they know what to ask and what documents to collect.  

Financial arrangements deserve early attention because coverage can depend on the patient’s plan, the services provided, and requirements that continue after admission. 

Confirm the Type of Stay 

“Nursing home” might refer to several types of care. One might require skilled nursing and rehabilitation in the aftermath of surgery. Another person may need help with activities of daily living.  

This kind of care may vary in payment arrangements. For example, if insurance pays for the rehabilitation period but not for longer-term assistance with activities of daily living, the arrangement may differ.  

Ask the admissions staff what care is offered, what services the payer covers, and what will happen if a person needs more time in the facility.  

An estimated discharge date helps you plan, although the situation may change. 

Clarify the Insurance Requirements Before Admission 

The insurance card is the first way the facility verifies coverage. The business office must verify that the coverage includes the selected services, that the facility is in-network, and get necessary approvals. 

Medicare Advantage and other managed care plans might have an authorization process for the skilled nursing care provided by the facility. This could apply to certain days and specific services and would need to be updated throughout the stay.  

It is recommended to ask whether the approval was completed and how any news will be provided. It can also help to identify the source of the coverage change.  

Eligibility and authorization provide vital information; however, it cannot ensure that all charges will be settled. Payment is also determined by the terms of coverage and the claim submitted. 

Ask for a Written Explanation of Expected Charges 

A written estimate gives the family a reference after the admission discussion. It should state the charges the patient is expected to pay and the assumptions used to create the estimate.  

Therapy, transportation, drugs, and other services may be billed differently depending on the length of stay and insurance coverage.  

Additionally, the estimate must indicate all optional charges. The cost of a private room or convenience services may be an extra cost that insurance will not reimburse.  

Do note that estimates are subject to revision. Ensure you understand how the facility will inform the patient or representative if the expected liability changes. 

Keep Insurance and Contact Information Updated 

It is possible for a patient to have more than one form of coverage at the same time.  

Inform the facility of all forms of insurance that apply to the patient, even those that may not seem relevant to the current admission. This helps the billing department know which ones can be billed and in what order.  

Inform the facility about any changes to the cards in a timely manner. A change in insurance may have occurred before the family received the letter.  

Another piece of important information is contact information. The facility needs to know who can receive billing information and who is assisting with the paperwork. The facility may need proper authorization before staff can discuss the bill with a relative. 

Prepare for Reviews During the Stay 

Insurance issues could merit additional evaluation as treatment continues. For example, a managed care payer may request updated clinical data before approving extra days. 

Ask the business office what reviews are needed and whether the family needs to provide anything. Keep copies of all documentation sent out, and note the date and recipient.  

An RFI can be confusing, so don’t miss the deadline. Staff can help with administrative issues, but legal and financial planning may be outside their expertise. 

Check Bills Alongside Insurance Statements 

An insurance company’s explanation of benefits shows how it handled the claim. This document usually gives the amount charged, amount allowed, amount paid, and any stated patient responsibility. It is typically not a bill.  

Compare the two documents. Compare the patient’s name, dates of service, amount already paid, and the reason for the remaining balance.  

If the balance is unusual, determine whether another insurance company needs to handle the claim, whether there is a mistake, and whether the patient currently owes the balance.  

Different doctors may issue individual bills for services provided during the same hospital visit. Always identify the biller before declaring the documents duplicates.