Your Nursing and MDS staff are too expensive for denial management

Let's be honest - if you're running a SNF in 2025, you're spending way too much time fighting for reimbursement that should've been straightforward in the first place.

I was talking with a Nursing Director in Oregon last week who told me her facility had delivered excellent care to a resident, followed the care plan perfectly, documented everything meticulously... and still got hit with a NaviHealth-driven denial claiming the stay wasn't medically necessary after day 8. Sounds familiar?

This isn't just a Medicare Advantage problem anymore - it's happening across your entire census.

The multi-payer nightmare we're all facing

If you've been in the SNF world more than a year, you know exactly what I'm talking about:

• Medicare Advantage is a special kind of headache: The Senate investigation finally validated what we've known for years - MA plans systematically deny SNF stays regardless of necessity. UHC's denial rate jumped nine-fold. When's the last time NaviHealth actually explained their algorithm?
• Traditional Medicare isn't much better: Your MDS coordinator spends hours making sure PDPM coding is perfect, then Palmetto or Noridian comes back with "documentation doesn't support the services billed". The 5-Claim Probe reviews are showing error rates between 9% and 27%, and re-certification issues continue to plague even the most diligent facilities.
• Medicaid eligibility has become a nightmare: Two years post-PHE, eligibility remains a nightmare. Your business office chases family paperwork while your state's portal crashes. Meanwhile, you're carrying tens of thousands in receivables that may never convert.
• Commercial payers keep changing the rules: Every quarter it seems like another commercial insurer changes their documentation requirements or authorization process without telling anyone. Your admissions coordinator needs a spreadsheet just to keep track of which payer needs what form.

What this is really costing your facility

We all know the impact, but let's put some real numbers to it:

• Your MDS coordinator is being wasted: Your $40/hour MDS coordinator spends 30% of their time on technical denials instead of assessments - that's $2,500+ wasted monthly.
• Your AR days are through the roof: Average AR days now hit 55-60 across all payers, with denied claims stretching beyond 90 days. That's cash you can't use for anything.
• Your census coordinator can't fill beds: When your admissions team battles insurance companies, they're not talking to hospital discharge planners. Each empty bed: $400-600 daily in lost revenue.
• The hidden cost of administrative burnout: When was the last time an MDS nurse or billing specialist stayed 18+ months? Denial battles are driving away your best people.

How some SNFs are actually winning this fight

Here's what's interesting - while most of us are drowning in paperwork and appeals, some facilities have figured out how to beat the system without adding staff or working nights and weekends. These SNFs have completely rethought how they handle the revenue cycle:

1. They've automated the tedious stuff: Insurance verification that took 45 minutes now happens automatically - staff only handle actual issues.
2. They catch documentation problems before claims go out: Their systems identify when documentation doesn't match payer expectations for specific diagnoses, so clinical teams fix it while residents are still in-house.
3. They've got 24/7 coverage without the 24/7 staff: Automated systems work overnight preparing appeals and monitoring claims - business office starts each morning with a prioritized action list.
4. They have payer-specific playbooks: Instead of one-size-fits-all documentation, these SNFs have tailored processes for each major payer.

What's the result? These facilities have cut their denial rates by 30-40%, reduced their AR days by 15+, and most importantly - freed up their clinical teams to focus on care instead of paperwork.

The path forward for your facility

We all entered this industry to provide care, not fight insurance companies. But in 2025, your reimbursement strategy is as critical as your clinical approach.

The most successful SNFs have stopped treating the revenue cycle as a back-office function and recognized it as a core strategic priority. They've given their teams the modern tools needed to level the playing field against payers who are using algorithms and AI to deny legitimate claims.

This analysis draws from Medicare MAC data, the Senate Permanent Subcommittee on Investigations report on Medicare Advantage, and conversations with dozens of SNF operators across the country.

Nanonets Health has built AI agents specifically for SNFs that handle the tedious parts of your revenue cycle - from insurance verification to documentation matching to denial management - without requiring you to hire additional staff.

Want to see how your facility's denial rates compare to others in your state? Get a complimentary reimbursement analysis from our team. No sales pitch, no obligation.

Schedule your consultation today.