AI-Powered SNF Coding Support
AI suggests. A certified human coder approves. Staffingly's AI-Powered SNF coding pod combines OCR of clinical documentation, AI-suggested ICD-10, HIPPS, and PDPM case-mix codes, mandatory certified human-coder review, MDS audit, ICD-10 FY2026 update support, and F-tag exposure mitigation. HIPAA + SOC 2 Type II + HITRUST aligned. 800+ providers trust us. Pilot in 2 weeks.
0:55
0:48Your AR is aging. Your denials are stacking up . Cash is slow.
Three quiet revenue leaks drain post-acute providers every month. Billers know it. Operators feel it in DSO. Most facilities cannot hire fast enough to keep PDPM, PDGM, and MA plan claims clean on the first pass.
Aged AR and slow cash
SNF AR over 90 days frequently sits above 25 percent of total AR at facilities without dedicated follow-up (LeadingAge 2024 RCM benchmarks). Every day a UB-04 sits is a day cash does not arrive.
Denials and rework loops
SNF and home health initial denial rates frequently run 10 to 15 percent on MA plan claims, and rework can consume 15 to 25 dollars per claim (MGMA 2024 denial benchmarks). Most never get re-billed within the appeal window.
PDPM, PDGM, and coding gaps
PDPM uses five case-mix components plus a variable per-diem adjustment (CMS 42 CFR 483). PDGM groups home health into 30-day periods with 432 case-mix combinations. One missed ICD-10 code can drop the HIPPS score and the reimbursement with it.
Tell us about your agency.
Send us your situation and our team will scope the right setup, usually within one business day. No obligation.
What is AI-Powered SNF coding support ?
AI-Powered SNF coding support is a coding workflow where AI assists trained certified coders on ICD-10-CM, HIPPS, and PDPM case-mix capture, with mandatory human-in-the-loop approval before any code is submitted to a claim. The AI does not bill on its own. The AI does not auto-approve. The AI reads, suggests, and ranks. A certified coder reviews, edits, and signs off. Then the code goes to the claim.
What your ai snf coding support actually handles, day to day
Pick the coding queues that hurt most. The AI-Powered SNF coding pod absorbs them. Your in-house DON and MDS coordinator focus on resident care and assessment accuracy.
OCR of clinical documents
Reads physician progress notes, admission H&P, therapy evaluations, wound notes, and discharge summaries. Extracts diagnoses, procedures, and clinical narrative for AI ranking.
AI-suggested ICD-10-CM codes
AI ranks candidate ICD-10 codes against MDS Item I0020B PDPM clinical category mapping, flags low-confidence suggestions, and proposes NTA comorbidities for capture.
Mandatory certified coder review
Every AI suggestion is reviewed by a certified coder before submission. The coder edits, validates against source, and signs off. No code goes to a claim without human approval.
HIPPS calculation and audit
AI proposes the HIPPS code from the five PDPM case-mix components. The certified coder validates against the MDS and the source documentation.
MDS audit
Audits the 5-day MDS, IPA, and PPS Discharge assessments against the source documents. Flags HIPPS-shifting errors and re-bill opportunities.
ICD-10 FY2026 update
Tracks the ICD-10-CM FY2026 update effective October 1, 2025. Code additions, deletions, and PDPM clinical category re-mapping applied in real time.
F-tag exposure mitigation
Identifies documentation gaps that drive F-tag citations during state surveys. Recommends documentation patterns aligned with CMS guidance.
False-positive and false-negative tracking
Logs every AI suggestion, coder edit, and audit finding. Tracks accuracy rates per coder, per facility, and per code category for QAPI review.
Post-acute trained billers and coders, not generic offshore
Most outsourcing companies offer general medical coders and call them "billers." We do not. Our billing specialists are post-acute trained, PDPM and PDGM tested, and software-certified before they ever touch a live claim in your facility.
Post-acute trained, not generic
Every biller passes an assessment on UB-04 form locators, 837i transactions, PDPM HIPPS coding, PDGM periods, and at least one major platform from PointClickCare, MatrixCare, Net Health, or HCHB before placement.
Stacked compliance posture
HIPAA + SOC 2 Type II + ISO 27001 + HITRUST. Plus alignment with 42 CFR 424 conditions of payment and 45 CFR 164.514 de-identification rules. Ask your current vendor for proof of all four. We will wait.
2-Week Risk-Free Pilot
Industry offers no trial. We give you 14 days of live claim work at the same rate. Cancel before day 14, owe nothing. No annual contracts after.
Staffingly vs DIY in-house vs generic offshore vs onshore BPO
The real cost math for a single full-time biller or coder role at a mid-size SNF or home health agency.
From "let's talk" to live in 1 to 2 weeks
Six steps. Each one is documented. Nothing is mysterious.
Discovery call (15 min)
Tell us which billing pain is loudest. AR over 90? MA plan denials? PDPM coding gaps? Medicaid pending? We map it on a shared call. No prep needed from you.
BAA + platform access
Business associate agreement signed. Role-based access provisioned in PointClickCare, MatrixCare, Net Health, Brightree, HCHB, Kinnser, or SigmaCare.
Workflow shadow (2 to 3 days)
Your billing pod shadows your business office and corporate billing leads. Claim scrubs captured. Payer scripts matched. Escalation rules locked.
Parallel pilot starts
Week 2 to 3. Your billing pod runs alongside your team. Daily 15-minute sync. You see every claim submitted, every appeal drafted, every payment posted.
Decision point (end of week 2)
Pilot results reviewed. Go or no-go. No penalty if you cancel. Most facilities keep going.
Full handoff, cadence locked
Clean-claim rate, denial rate, DSO, and AR over 90 KPIs in your inbox. Weekly review with your account lead. Monthly QA audit. Expansion paths discussed.
How your billing pod's day actually looks
A real shift, hour by hour. Times shown in your local time. We rotate coverage so your facility billing desk is never dark during business hours.
How Staffingly works, in practice
Inside the workA trained Staffingly specialist works inside your existing platform, with clear escalation back to your team.
One Flat Weekly Rate. No Surprises.
Dedicated senior care schedulers at a fixed weekly cost. Per scheduler FTE, per week. No contracts, no minimums, no hidden fees.
Want to compare against an in-house hire? Use the savings calculator.
Frequently asked questions
How accurate is the AI coding suggestion?
AI accuracy alone is not the standard we hold ourselves to. The standard is the final coder-approved output, which has consistently delivered above 97 percent clean-claim accuracy across our SNF coding clients. The AI ranks and suggests. The certified coder reviews every suggestion. Low-confidence AI suggestions are flagged for deeper review. False-positive and false-negative rates are tracked per coder and per facility for QAPI.
How does human-in-the-loop review work?
Every AI suggestion routes to a certified coder before any claim is submitted. The coder reviews the source document, edits the suggestion as needed, validates the HIPPS calculation against the MDS, and signs off in the audit log. No code reaches a claim without human approval. The audit log is visible to your facility's QAPI committee and to state surveyors on request.
How do you handle the ICD-10 FY2026 update effective October 1, 2025?
The ICD-10-CM FY2026 update introduced code additions, deletions, and clinical category re-mapping that affect PDPM primary diagnosis assignment. Our AI training set and coder reference library are updated on the effective date. We re-validate any in-progress claims that span the effective date, re-bill where the new code shifts the HIPPS, and flag affected residents for MDS coordinator review.
How does HIPPS calculation work in the AI workflow?
The AI pulls the five PDPM case-mix components (PT, OT, SLP, Nursing, NTA) from the MDS, calculates the proposed HIPPS code, and ranks NTA comorbidity capture opportunities from the source clinical documentation. The certified coder validates the HIPPS against the 5-day MDS, confirms the NTA capture, and signs off. If an IPA mid-stay shifts the HIPPS, the workflow re-runs.
How do you audit the MDS itself, not just the codes?
The MDS audit cross-checks every section of the 5-day, IPA, and PPS Discharge assessments against the source documentation: progress notes, therapy logs, wound assessments, and physician orders. Findings are categorized as HIPPS-shifting, F-tag risk, or documentation gap. HIPPS-shifting findings trigger re-bill review. F-tag risk findings route to the DON. Documentation gap findings route to the MDS coordinator.
How do you handle false positives from the AI?
Every AI suggestion is flagged with a confidence score. Low-confidence suggestions get deeper coder review. False positives are logged in the QAPI audit trail and fed back to retrain the AI ranking model. We publish monthly false-positive rates per facility so your QAPI committee has full visibility. The coder, not the AI, is the final word on every code that reaches a claim.
How does pricing work for AI-Powered SNF coding support?
Per coder FTE, per week. $399 Standard for one certified coder supported by the AI pipeline at a single-facility SNF. $349 Volume for 3 plus coders supporting a multi-facility group. $299 Enterprise for 10 plus coders across a multi-state network or PE-backed group. No setup fees. No annual contracts. The AI infrastructure is included in the per-FTE rate.
What is included in the 2-Week Risk-Free Pilot?
Two weeks of live AI-Powered SNF coding work running in parallel with your MDS coordinator. Full reporting on clean-claim rate, HIPPS accuracy, NTA capture rate, false-positive rate, and MDS audit findings. No setup fee. No penalty if you cancel before day 14. You see every AI suggestion, every coder edit, every audit log.
President and CEO, Staffingly, Inc. 25+ years in IT consulting and healthcare BPO operations. One of the earliest US operators to set up an RPO/BPO delivery network in India. Leads AI-driven home care workflows that help agencies, home health providers, and multi-branch operators cut admin cost without compromising care.
