Thought Leadership

Ensuring Sustainable Revenue Cycle Health At Skilled Nursing Facilities

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healthcare eligibility and enrollment services for skilled nursing facilities

With a focus on cutting costs, today’s payers are looking closely at site of care when it comes to treatment options. Hospitals are among the most expensive sites of care, prompting a general shift towards skilled nursing facilities (SNF) as an alternative. According to Becker’s Hospital Review, the average cost of most hospital stays is more than $2,000 per day. On the flipside, SNF stays typically amount to less than a quarter of that.

While nursing homes are often the preferred site of care, treatment at such facilities can ignite financial complications. Nursing homes typically require incoming residents to possess viable means to pay for their care, and most of these patients rely on Medicaid to foot the bill. Paradoxically, in most states, Medicaid will not accept a new applicant until after they have been admitted into a nursing home.

Consequently, many patients experience difficulty securing entry into nursing facilities – whether due to pending Medicaid status or the absence of a distinct payer source altogether. In preparing to transfer a patient from the hospital to the SNF, failure to address a patient’s “unfunded” status foreshadows long-term financial risks to all parties involved, as well as a laborious process to then designate Medicaid as the payer.

Utilizing a service level agreement (SLA), hospitals and nursing facilities can work together to constructively approach such situations, mitigating financial risk across the board. Essentially, the SLA functions as a contractual agreement linking together the hospital and nursing facility while the patient pursues Medicaid coverage pending admission. Meanwhile, in accordance with the SLA, eligibility and enrollment services are managed by a third-party vendor, like Savista.

The hospital’s contracted eligibility and enrollment partner can adeptly navigate the intricacies of Medicaid’s Institutional Care Program (ICP), which helps patients pay for the cost of care during their stay at a nursing facility. The partner’s healthcare eligibility and enrollment specialists will work directly with patients and their families to submit all necessary applications and supporting documentation as required.

Promoting effective collaboration between providers and nursing facilities, the SLA ensures a smooth transition for patients moving from one setting to another, strengthening partnerships between various sites of care and helping SNFs achieve higher patient admissions. Moreover, in the hands of the eligibility and enrollment partner, the streamlined Medicaid application process supports timely collections and minimizes the potential for revenue leakage.

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