Nursing Home Medical Billing Services
Med Bridge handles nursing home billing for skilled nursing facilities, long-term care centers, and rehab facilities, with accurate Medicare and Medicaid coding, consolidated billing, and denial recovery. Get a free billing analysis.
Nursing home billing runs on rules that don't exist anywhere else in healthcare. Medicare Part A stays get paid by RUG or PDPM categories. Consolidated billing means the facility bills for almost everything including services your own staff never touched. Medicaid case-mix rates change by state. And the five-day assessment window decides whether you get paid for the whole stay. Med Bridge takes the whole nursing home revenue cycle off your plate, from admission through denial appeals, so your facility gets paid for the care it provides.
15+ years in medical billing
90+ nursing homes and long-term care facilities served
HIPAA Compliant
Nursing Home Medical Billing Services
Nursing Home Billing Service Specifications
Complete field-by-field overview for nursing home practices
| Service Type | Nursing Home Medical Billing & Revenue Cycle Management |
|---|---|
| Facilities Served | Skilled nursing facilities (SNFs), long-term care centers, rehabilitation facilities, assisted living facilities with skilled units, memory care centers, ventilator and respiratory care units, multi-facility chains |
| Services Covered | Medicare Part A skilled stays, Medicare Part B therapy and physician services, Medicaid long-term care, managed care and Medicare Advantage stays, consolidated billing for ancillary services, therapy services (PT, OT, speech), wound care, respiratory therapy, pharmacy and lab coordination |
| Coding Systems | ICD-10, CPT, HCPCS, MDS/PDPM categories — with expertise in consolidated billing, RUG and PDPM grouping, 5-day assessment windows, MDS accuracy, and UB-04 claim form requirements |
| Pricing | Percentage of collections no hidden fees, no setup charges |
| EHR/PMS Compatibilit | PointClickCare, MatrixCare, American HealthTech, AHT, SigmaCare, Epic, Cerner |
| Compliance | HIPAA-compliant, SOC 2 Type II certified, Medicare and Medicaid compliance monitoring |
What Is Nursing Home Billing?
Nursing home billing services cover the full revenue cycle for skilled nursing and long-term care facilities: admission verification, MDS coordination, consolidated billing, UB-04 claim submission, payment posting, and denial management. But nursing home billing isn't hospital billing with longer stays. The consolidated billing and assessment rules are their own world.
Key Benefits of Nursing Home Billing Services
Our experienced billing team handles the complexities of nursing home coding and claims so you can focus on delivering quality patient care.
Consolidated Billing Rules
Under Medicare consolidated billing, the facility bills for nearly all services a resident receives during a Part A stay, including therapy, lab, radiology, and supplies provided by outside vendors. Bill an outside service separately when it should be on the facility claim, and you get a denial. Leave it off, and the facility eats the cost.
The 5-Day Assessment Window
The MDS assessment has to be completed within a specific window after admission, and the assessment date determines the payment category for the entire stay. Miss the window and the facility loses payment for the whole episode.
PDPM and RUG Grouping
Medicare Part A stays are paid by PDPM (Patient-Driven Payment Model) categories now, with different payment tiers based on nursing, therapy, and non-therapy ancillary needs. The MDS has to support the category billed, and grouping errors mean underpayment or takebacks.
Medicaid Case-Mix Rates
Medicaid long-term care rates are set by state and often depend on case-mix categories. Each state has its own assessment tool, rate structure, and billing rules. A billing team that doesn't know your state's Medicaid rules will miss payments.
Medicare Part B and Therapy Billing
When a resident isn't in a covered Part A stay, therapy and physician services bill under Part B. The distinction between Part A and Part B billing changes by day, by coverage status, and by service type.
Medicare Advantage and Managed Care Stays
Medicare Advantage plans have their own authorization requirements, length-of-stay rules, and billing formats. A stay that's covered under traditional Medicare may need prior auth under a Medicare Advantage plan and the rules differ by plan.
UB-04 Claim Form Requirements
Nursing home claims go out on the UB-04 form, not the CMS-1500. Revenue codes, occurrence codes, and condition codes all carry specific meaning, and errors on the form cause denials that look like coding problems but aren't.
Payer Rules Change Every Year
MDS coding updates annually, PDPM categories shift, and state Medicaid rules change constantly.
Our Nursing Home Revenue Cycle Management Process
Every claim goes through a six-step process built to stop denials before they happen, not chase them after.
Admission & Eligibility Verification
We verify Medicare, Medicaid, Medicare Advantage, and managed care coverage at admission. Part A eligibility, benefit days remaining, and prior auth requirements get checked before the stay begins. Real-time checks flag coverage gaps the same day.
MDS Coordination & Assessment Tracking
We track assessment windows, flag upcoming deadlines, and coordinate with your MDS team so assessments are completed on time and support the payment category billed.
Nursing Home-Specific Coding
Certified coders apply ICD-10, CPT, HCPCS, and PDPM categories carefully: diagnosis codes matched to the MDS, therapy minutes documented and grouped correctly, and revenue codes applied on the UB-04 based on service type.
Claim Scrubbing & Submission
Before anything leaves the system, we catch consolidated billing gaps, assessment window problems, PDPM grouping errors, UB-04 coding mistakes, and eligibility issues. Clean claims go out within 48 hours.
Payment Posting & Remittance Reconciliation
ERA/EOB posting gets matched against what we expected. Underpayments on Part A stay, and Medicaid claims get appealed, not written off.
Denial Management & Appeals
Denials get worked within 24–48 hours. Appeals go out with MDS documentation, therapy notes, and regulatory citations. We track why denials happen so we can fix the root cause upstream.
Nursing Home Billing & Specialty Depth
General billing companies treat nursing homes like hospitals with longer stays. We treat each payer and stay type as its own workflow with its own rules.
Medicare Part A Skilled Stay Billing
Part A stays pay by PDPM category, and the MDS has to support the category billed. We track assessment windows and make sure grouping matches documentation.
Medicaid Long-Term Care Billing
Medicaid rates are set by state and depend on case-mix categories. We handle your state's Medicaid rules, assessment tools, and rate structure.
Consolidated Billing Coordination
Under consolidated billing, the facility bills for most services a resident receives. We make sure outside services get captured on the facility claim instead of billed separately.
UB-04 Claim Form Coding
Revenue codes, occurrence codes, and condition codes all carry specific meaning on the UB-04. We make sure claims are coded correctly for each payer type.
Medicare Part B Billing
When a resident isn't in a covered Part A stay, therapy and physician services bill under Part B. We handle the Part A versus Part B distinction for every service.
Medicare Advantage & Managed Care Billing
Medicare Advantage and managed care plans have their own auth requirements and billing formats. We track plan-specific rules so stays get authorized and paid.
Therapy Services Billing
PT, OT, and speech therapy minutes have to be documented and grouped correctly for PDPM. We make sure therapy claims match the documentation.
Ancillary Services Billing
Wound care, respiratory therapy, pharmacy, and lab services each have their own billing rules under consolidated billing. We make sure ancillary services get captured and billed correctly.
Prior Authorization & Compliance
Prior authorization and compliance monitoring matter for Medicare Advantage stays, managed care, and Medicaid. We treat them as a core part of the job, not a side task.
Services that commonly require prior auth:
Medicare Advantage skilled stays
Managed care long-term care admissions
Ventilator and respiratory care units
Some therapy services
Out-of-network placements
How we handle it:
Real-time eligibility and authorization tracking we know which plans require auth, which don't, and which have their own clinical criteria
Prior auth requests submitted with documentation that meets plan criteria the first time
Length-of-stay tracking and re-authorization requests before approval expires
Follow-up on pending authorizations so admissions don't get delayed
Compliance with the CMS Interoperability and Prior Authorization final rule for turnaround times
Compliance monitoring:
HIPAA-compliant workflows and data security
Documentation audits to keep MDS coding, PDPM grouping, and therapy minutes defensible
Medicare and Medicaid compliance monitoring
Payer-specific rule tracking for consolidated billing, assessment windows, and state Medicaid requirements
Annual coder training on MDS updates and nursing home billing changes
Precision Medical Billing and Coding for Modern Healthcare Practices
Real Numbers From Nursing Home Practices
These figures are presented in the supplied source as results from active nursing home clients.
Average Days in A/R
Claim Turnaround Time
Clean Claims Rate
Average Collections Increase
Denial Rates
Prior Authorization Approval
Payment posting accuracy
First-pass acceptance rate
Why Med Bridge
Nursing Home-Specific Certified Coders
Our coders are certified (CPC, CCS) and work in nursing home billing, not hospital billing. They know consolidated billing rules, PDPM grouping, MDS assessment windows, and UB-04 coding.
Faster Reimbursement
97.6% clean claim rate. 28-day average A/R. 48-hour claim turnaround. These aren't marketing numbers they're our actual performance metrics across 90+ nursing home facilities.
Data Security & Compliance
SOC 2 Type II certified. HIPAA-compliant. We keep rigorous audit trails, monitor Medicare and Medicaid compliance, and send regular reports so you always know where your money stands.
Scales With Your Facility
Single facility? Multi-facility chain? Ventilator unit? Our workflows scale without changing your EHR or adding staff, while keeping billing, coding, claims, and payment processes.
In-House vs. Outsourced Nursing Home Billing
| Cost Category | In-House Billing | Med Bridge Outsourced |
|---|---|---|
| Biller salary + benefits | $45,000–$65,000 / year | — |
| Billing software + clearinghouse | $10,000–$25,000 / year | Included |
| MDS and billing Training | $3,000–$7,000/year | Included |
| Denial write-offs | 7–12% of revenue | 4.6% denial rate |
| Total annual cost | $65,000–$100,000+ | Percentage of collections no hidden fees |
| Net annual savings | — | $30,000–$60,000+ |
Frequently Asked Questions
Nursing home billing involves Medicare consolidated billing, PDPM grouping, the 5-day MDS assessment window, Medicaid case-mix rates that vary by state, Medicare Advantage authorization rules, and UB-04 claim form requirements. General billers miss these, and denials follow.
Yes. We work with skilled nursing facilities, long-term care centers, rehabilitation facilities, assisted living facilities with skilled units, and multi-facility chains. Our workflows cover Medicare Part A, Part B, Medicaid, Medicare Advantage, and managed care billing.
You get monthly dashboards: clean claim rate, A/R days, denial rate by payer, claim turnaround time, assessment window compliance, and collections by payer type. We also run ad-hoc reports for specific payers or stay types.
Denials get worked within 24–48 hours. Appeals include MDS documentation, therapy notes, and regulatory citations. We track denial reasons so we can fix root causes upstream, especially consolidated billing gaps and assessment window issues that recur in nursing homes.
PointClickCare, MatrixCare, American HealthTech, SigmaCare, Epic, and Cerner. If you use something else, we can work with your existing workflow or suggest an integration.
Pricing is a percentage of collections. No setup fees. No software fees. No hidden charges. You pay when you get paid.
We track plan-specific authorization requirements, submit requests with documentation that meets criteria, and monitor length-of-stay approvals so stays don't get cut off. We follow the CMS Interoperability and Prior Authorization final rule for turnaround times.
Most facilities are fully onboarded within 30–60 days. We handle the transition from your current billing company or in-house team, including EHR access, payer enrollment, MDS coordination setup, and nursing home billing configuration.