Outsource Nursing Home Billing Services - RCM Matter

Nursing Home Billing Services

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Medicare Rules

While Medicare Part A does offer coverage for nursing homes, meeting the necessary conditions can be a complicated process that requires careful attention to detail. Patients must receive a skilled level of medical care that is directly related to a recent hospitalization, among other criteria. Because of these stringent requirements, medical billers must be meticulous in their coding efforts to avoid claim rejection.


Multiple Insurers

Medicare Part A provides coverage for a limited period of time for those requiring skilled nursing care during a nursing home stay related to a recent hospitalization. However, there are individuals who require long-term nursing home care without having been recently hospitalized. In such cases, private insurers may offer long-term care plans, while Medicaid can provide coverage for those who cannot afford nursing home care. It is worth noting that Medicaid coverage and the conditions under which it applies can differ between states.



The Centers for Medicare & Medicaid Services (CMS) establish a daily rate through consolidated billing that covers the majority of services and medications provided in nursing homes. However, there are specific categories of exceptions, such as oncology, that require separate claims processing through the nursing home. As such, it is crucial for medical billers to be familiar with these additional services and understand how to accurately code them to ensure proper reimbursement.


Our Proprietary

We have revolutionized nursing home billing by introducing a unique approach that simplifies the entire process while ensuring efficiency. Our proprietary nursing home billing software is designed to incorporate all the latest code changes seamlessly. In addition to this, we offer a comprehensive range of RCM services including annual payback, compliance reviews, bill collection, payer credentialing, and much more.