SoftbeckMedicare provides all the services you could need from a nursing home medical billing company. In addition to our billing system, which has proven to increase revenue for our clients, we also offer a full suite of medical revenue cycle management (RCM) services.
Nursing Home is one of the more demanding fields of medicine to bill for, with its own documentation standards, payer rules, and coding conventions. These factors combine to make nursing home medical billing among the most complex of all the different specialties.
The codes for medical billing are updated annually, but there are also changes to regulations, government program rules, and insurer requirements that may happen all through the year. Failing to incorporate each payer's demands and the latest codes into every nursing home claim will result in non-payment — and in this economy, no one can afford to not get paid for the services they provide.
On the other hand, trying to stay on top of all the changes can take so much time and attention that it becomes impossible to focus on patients and the care they need. Outsourcing nursing home revenue cycle management has become a popular solution that increases revenue while allowing medical professionals to get back to focusing on patient care.
Nursing Home care continues to evolve, and with it, the complexity billers must manage has increased. Outsourcing to experienced nursing home billing experts has proven to increase revenue and reduce the administrative strain these claims create.
96%
Collection Ratio
98.5%
First Pass Clean Claims Rate
Up to 35%
Revenue Increase
35%
Reduction in A/R
Different CPT and ICD-10 codes apply depending on how a nursing home service is documented. Any confusion in the medical record can eventually lead coders to pick the wrong code. In order to achieve accuracy, our nursing home coders examine the documentation and ask the provider questions rather than making assumptions.
Prior authorization and payer-specific utilization review add their own demands: state and plan-specific rules, authorization workflows, and medical necessity documentation. We manage nursing home authorizations across all 50 states and handle the longer billing cycles these claims can involve, so your practice doesn't have to carry this burden in-house.
Our services for nursing home billing span the entire revenue cycle, starting from coding to the A/R follow-up. Our expertise stops errors that general billers would miss, automation catches things that mass processing may overlook, and we combine both aspects to uncover potential problems before they cause trouble at the denial stage.
Accurate procedure coding for nursing home services and encounters, matched to the operative or clinical note.
Diagnosis codes for nursing home conditions assigned with the correct specificity, laterality, and severity.
Layered review of modifiers against NCCI edits and each payer's own policy to prevent bundling denials.
Charts reviewed against payer requirements before submission to catch gaps that would otherwise trigger a denial.
Nursing Home claims go through several processes between documentation and payment. Our four-layer AI-driven approach helps patch the gaps where nursing home revenue often leaks, and four connected products run on top of it. Take the whole AI Ecosystem or wire a single piece into the EHR you already run.
Nursing Home records are managed from the point of documenting the encounter through to its charges.
Captures the clinical detail coders need to justify nursing home procedure and modifier selection, from the point of care.
Assists with CPT, ICD-10, and HCPCS assignment for nursing home encounters, reviewed by our expert coders.
Runs scheduling, eligibility, and claims from one platform, with dashboards on collections by provider and payer.
Four connected layers sit under every product, and it is this stack that turns a complex nursing home claim into a clean one before a payer ever sees it.
Transfers claim, eligibility, and payment data from your system without manually entering any information.
Monitors claim status and payer activity to identify nursing home denial patterns before the end of the month.
Uses nursing home-specific edits and payer bundling logic to process the claim.
Carries out coding assistance, denial procedures, and follow-up in connection with claim volume.
Talk to our nursing home billing specialists and see how much revenue you could be recovering.