Per-diem reimbursement, MDS-driven case-mix, consolidated billing and three payers per resident make SNF billing unforgiving. Helix reconciles HIPPS to the MDS and keeps Part A, Part B and Medicaid claims clean.
Clean-claim rate
Avg. net revenue lift
Days in A/R
Denials overturned
Under PDPM, your reimbursement is only as accurate as your MDS. A mis-keyed assessment, a late HIPPS reconciliation, or a consolidated-billing slip quietly costs per-diem dollars across every covered day and every resident.
Helix reconciles billing to the MDS, applies consolidated-billing edits, and coordinates Medicare, Medicaid and managed-care so the facility collects the full, accurate per-diem it has earned.
HIPPS codes reconciled to the MDS for correct case-mix.
Bundled vs. excluded services billed to the right payer.
Part A, Part B therapy/ancillary and Medicaid room-and-board.
Accurate institutional claims and benefit-day tracking.
SNF revenue runs on HIPPS, revenue codes and condition codes on the UB-04, not office CPTs. We keep each element accurate and reconciled.
| 0022 | SNF PPS / HIPPS rate code (PDPM) | MDS-driven |
| 0120 | Room & board, semi-private | per-diem |
| 0420 | Physical therapy | Part B |
| 0250 | Pharmacy | consolidated |
| 0420 | Therapy (excluded service check) | CB edit |
| G0299 | Skilled nursing service (home health crossover) | as applicable |
Billed HIPPS code doesn't reconcile to the transmitted MDS, triggering RTP or recoupment.
Helix fix: HIPPS-to-MDS reconciliation check before each Part A claim drops.
A service that should be bundled into the SNF per-diem billed separately (or vice versa).
Helix fix: consolidated-billing edit routes each service to the correct claim.
Part A days billed past the 100-day benefit or without a qualifying hospital stay.
Helix fix: benefit-day tracker flags exhaustion and transitions to the next payer.
Medicaid or managed-care billed before Medicare, or crossover not applied correctly.
Helix fix: payer-sequence rules enforce correct primary/secondary order and crossover.
HIPPS validated against the transmitted MDS assessment.
UB-04 built with correct revenue, condition and occurrence codes.
Consolidated-billing and payer-sequence edits applied.
RTP correction, appeals and aged-A/R workdown.
"Our HIPPS codes and MDS were drifting apart and Medicaid crossovers were a mess. Helix reconciled everything and stabilized our cash flow."
A mid-size facility with HIPPS/MDS mismatches causing RTPs, consolidated-billing errors, and a backlog of aged Medicaid and managed-care claims after a billing-staff turnover.
Helix implemented HIPPS-to-MDS reconciliation, consolidated-billing edits, benefit-day and COB tracking, and ran a 90-day aged-A/R recovery across Medicare and Medicaid.
Clean-claim rate reached 98.2%, A/R days fell to 26, the facility recovered $430K in aged claims, and net revenue rose 20%.
Representative composite based on Helix engagement outcomes. Individual results vary.
"Return-to-provider claims were eating our staff alive. The MDS reconciliation stopped them at the source."
Result: $176K recovered in year one.
"COB sequencing was wrong on half our dual-eligible residents. Helix fixed the payer order and the money came in."
Result: +$21K average monthly Medicaid revenue.
Representative composites based on Helix engagement outcomes. Individual results vary.
Get a free audit of your PDPM reconciliation, consolidated billing and aged A/R, and a clear picture of the revenue you could be recovering.