At Medical Business Advocates, we provide comprehensive billing services for nursing homes and assisted living facilities. We offer a range of services, including billing and claims submission, insurance verification, payment posting and reconciliation, denial management, and more.

What is Nursing Home Billing?

Nursing home medical billing refers to the process of submitting and processing insurance claims for healthcare services provided to residents of a nursing home or long-term care facility. This involves creating and submitting accurate invoices to insurance companies, Medicare, or Medicaid for reimbursement of healthcare services provided to residents. Nursing home medical billing is important for ensuring that nursing homes are able to receive payment for the services they provide to their residents, and that residents have access to the care they need. It requires knowledge of medical coding, insurance rules, and billing procedures that are specific to nursing homes and long-term care facilities.

Medical Business Advocates’s Nursing Home Billing

Outsourcing skilled billing and coding is a practical solution for nursing homes that want to ensure quality patient care and efficient operations. Instead of making medical staff deal with detailed paperwork, which can take time and take them away from their main jobs, nursing home medical billing services can do the job. The fact that medical billing for skilled nursing facilities is so complicated shows how important it is to leave this part of healthcare administration to professionals.


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 Medical Business Advocates services including annual payback, compliance reviews, bill collection, payer credentialing, and much more.

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