Skilled need not documented
Medicare SNF coverage requires daily skilled services documented in the record.
How we prevent it: We review documentation for skilled need before claims are submitted.
NURSING HOME BILLING
Nursing Home Billing Services
Nursing home and skilled nursing billing involves facility claims, resident eligibility tracking and Medicare and Medicaid rules for long-term care.
No upfront feesHIPAA-compliantSpecialty-trained coders
$0
Upfront or setup fees
0
Revenue cycle steps managed end to end
0
Specialties and lab types we bill for
0
Of your data and systems stay yours
OVERVIEW
Nursing Home billing done right
Nursing home and skilled nursing billing involves facility claims under the SNF Prospective Payment System, where payment depends on the Patient Driven Payment Model (PDPM) and MDS assessments.
SNFs must follow consolidated billing, track benefit days and qualifying stays, coordinate with Medicare Advantage authorizations and bill Medicaid long-term care with patient liability. Physicians and NPPs who visit residents bill separately with nursing facility visit codes.
We bill SNF facility claims with HIPPS codes that match the MDS, track benefit periods and authorizations, and bill professional visits with the right place of service.
Also see our medical coding, denial management, eligibility verification and revenue cycle management services.
CODING
Common nursing home CPT & HCPCS codes we bill
SNF facility claims use revenue codes and HIPPS codes; visiting providers use nursing facility E/M codes.
| Code | Description | What we watch for |
|---|---|---|
| Rev 0022 | SNF PPS revenue code reported with the HIPPS code | Each line carries the HIPPS code from the matching MDS assessment. |
| HIPPS | Five-character PDPM payment code | Derived from the MDS assessment; must match the claim period. |
| 99304 | Initial nursing facility care, straightforward or low MDM | Used for admission visits by physicians. |
| 99306 | Initial nursing facility care, high MDM | Highest level for admission visits. |
| 99307 | Subsequent nursing facility care, straightforward MDM | Routine follow-up visits. |
| 99310 | Subsequent nursing facility care, high MDM | For unstable patients or significant new problems. |
| 99315 | Nursing facility discharge management, 30 minutes or less | Use 99316 for more than 30 minutes. |
| 99497 | Advance care planning, first 30 minutes | Common in long-term care settings. |
| 99483 | Cognitive assessment and care planning | For patients with cognitive impairment. |
| G0180 | Physician certification for home health | Billed when certifying home health after discharge. |
Code descriptions are summarized. CPT® is a registered trademark of the American Medical Association. Coverage and payment rules vary by payer and change every year; we code to the current code set and your payers’ policies.
Modifiers that matter in nursing home billing
POS 31
Skilled nursing facilityProfessional visits to patients in a covered Part A SNF stay.
POS 32
Nursing facilityProfessional visits to long-term care residents.
25
Significant, separate E/MFor a separate visit on the same day as a procedure.
95
Synchronous telehealthFor telehealth visits where allowed.
DENIALS
Why nursing home claims get denied
The denial reasons we see most often in nursing home billing, with the claim adjustment reason code (CARC) payers usually attach, and what we do so they don't happen again.
HIPPS code does not match the MDS
Claims are rejected when the HIPPS code or assessment dates do not match the MDS.
How we prevent it: We reconcile MDS submissions with claim periods each month.
Benefit days exhausted
Medicare covers up to 100 SNF days per benefit period.
How we prevent it: We track benefit days and notify you before coverage ends.
Consolidated billing
Services included in the SNF payment that are billed by outside suppliers are denied.
How we prevent it: We track consolidated billing exclusions and arrange services under the SNF.
Wrong place of service
Professional visits billed with POS 31 versus 32 incorrectly are denied or paid wrong.
How we prevent it: We confirm the resident’s stay status before coding visits.
HOW WE WORK
How we run your nursing home revenue cycle
From the first eligibility check to the final patient payment, one dedicated team handles every step and reports back to you.
01
Eligibility and authorization
We verify coverage, benefits, copays and deductibles before the visit. For SNFs, that includes qualifying stay checks, benefit days and Medicare Advantage authorizations.
02
Charge capture and coding
Our coders review documentation and assign CPT, HCPCS and ICD-10-CM codes to the highest supported specificity. Facility claims are built from MDS assessments, and visits are coded with the correct place of service.
03
Claim scrubbing and submission
Every claim is checked against NCCI edits, payer policies and modifier rules before it goes out electronically, so it is paid on the first pass.
04
Payment posting and reconciliation
We post ERAs and EOBs, compare payments to your contracted rates and flag underpayments for appeal.
05
Denial management and A/R follow-up
Every denial is worked: corrected, appealed or escalated, with root causes fed back to the front end. Documentation and consolidated billing denials are appealed with records and assessments.
06
Reporting and patient billing
You get clear monthly reports on collections, denials and A/R aging, and patients get easy-to-read statements and answers to billing questions.
COMPLIANCE
Nursing Home payer rules we track for you
Rules that change how nursing home claims must be coded, documented and submitted.
PDPM: payment is based on patient characteristics from the MDS, not therapy minutes.
Qualifying stay: traditional Medicare requires a 3-day inpatient stay before SNF coverage, with some waivers.
Consolidated billing: the SNF is responsible for most services during a Part A stay.
Benefit periods: Medicare covers up to 100 days per benefit period, with daily coinsurance after day 20.
FAQ
Nursing Home billing questions
Do you bill SNF facility claims?
Yes. We bill UB-04 facility claims with HIPPS codes for Medicare, Medicare Advantage, Medicaid and commercial plans.
Do you bill physician visits in nursing homes?
Yes. We bill nursing facility visits for physicians and NPPs with the right place of service.
Can you help with Medicaid long-term care?
Yes. We bill Medicaid long-term care, track patient liability and follow up on eligibility.
How much do your nursing home billing services cost?
We charge a percentage of what we actually collect for you, with no upfront or setup fees. Your rate depends on claim volume and the services you need, so we quote it after a free review of your current billing.
Do we have to change our EHR or practice management system?
No. We work inside the systems you already use, and your data stays yours. We set up secure access, learn your workflows and start working claims without disrupting your front desk.
Related specialties
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