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Nursing Home Billing Guide

Nursing Home Billing Guidelines

Nursing homes are as important as hospitals and other centers of medical care nowadays. They are an equally important factor for ensuring the good health and wellness of citizens of modern American society. This applies more to the infirm and the elderly.

There are different types of nursing homes like skilled nursing facilities (SNFs), Independent Living Facilities, Assisted Living Centers, to name a few. These institutions bill their patient or the patient’s legal appointee for their services. The State has put some guidelines in place for such billing.

Let’s see what these nursing home billing guidelines are and which factors affect the billing process.

Period of Coverage of Bill

The nursing home usually issues a monthly bill for its residents for services it has rendered and medical care it has provided. The resident (or their legal appointee) enters into a contract with the nursing home. This contract offers details about billing frequency.

Mainly, this bill includes the charge of all essential services provided. However, sometimes, it also includes the charge of other associated services.

The billing cycle is the time period (calculated as the number of days – a month, for example) for which each billing takes place. Then, the nursing home may also charge a prorated amount for the month of admission. This means that in case the resident did not start his stay on the first day of the billing cycle, the billing amount equates to the per-day charge of room and board multiplied by the number of days. Sometimes, the care facilities also issue a pre-bill for the cost of the upcoming month.

Level of Care Provided

Assisted Living Centers like nursing homes and SNFs provide different, multiple levels of care based on the requirement of their inpatients. This level of care affects the amount they bill their patients to a significant extent. Further, these levels can broadly be classified into primary, secondary, tertiary, and quaternary levels of care.

A primary level of care provides the very essentials or the basic level of medical care. So, routine testing of a patient’s vitals falls under primary care. Additionally, if you require other specialized doctors to treat you, the primary level of care undertakes this required coordination.

Then there is the secondary level of care. Medical specialists usually provide this level of service. As an example, the primary care physician might treat a resident for common indigestion. But when the physician refers them to a gastroenterologist for further gastro investigation, it becomes the secondary level of care.

Tertiary care is very high, requiring complex equipment and a high degree of medical expertise. Some examples are complex microsurgeries and neurosurgeries. Tertiary care, being complex in nature, is not provided at small, regular hospitals or nursing homes. The nursing home usually refers its patients to specialized tertiary care centers.

Lastly, there is quaternary care which is nothing but an extension of tertiary care. It is a highly specialized level. Experimental cancer trials are an example of this.

Nursing Home Billing Guidelines

Type of Insurance Coverage

There are some Medicare Part A criteria for SNFs. If the medical needs of the patient in question meet these criteria, Medicare as an insurance carrier will pay for up to 20 days of stay in the nursing facility. Some insurance policies cover long-term care in nursing facilities.

Leaves of Absence

This is a factor that also affects the nursing home bill. A resident might need to leave the nursing home for a while. Mostly, they or their proxy will sign the bed hold waiver to reserve their room for them in their absence.

But this implies that the care facility will continue to bill the patient in his absence too. Alternatively, the inpatient could forfeit the bed hold, meaning fewer charges but nonavailability of room as a possibility when the resident returns.

The US Government has also specifically created and issued nursing home billing guidelines for nursing home billing. There are also CPT codes for nursing homes that simplify the billing process. For more information, you can visit Medical Healthcare Solutions, Inc.

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medical billing company services

Medical Billing Company Services to Help You Stay in Business

Are you thinking of taking help from medical billing company services? But, are you not sure how it can work for your business? Let us look at a few points to understand how medical billing company services can help you stay in business.

Assists concentrating on patient care:

Being a qualified doctor and an institutional manager simultaneously is always a problem. Hospitals can spare staff time and secure higher returns by shifting resources away from difficult billing problems toward helping patients. These high-value activities assist the clinic in earning more cash and building a more successful practice with dedicated patient care. 

As a result, medical practitioners can focus on their job the most. They can do so by practicing medicine and treating patients rather than juggling between payers and regulations.

Lessens Billing Errors:

Competent and well-trained medical billers are well-versed in the complexities of claim submission. Taking Medical billing company services will work best here. It’s because those companies make sure that they provide proper training of the processes. Therefore, it helps in driving and assessing the understanding of the domain with the desired excellence. 

Further, these medical billers assure filings and precision while at work. Before sending the claims to the payer, they assess and modify the claims accordingly, which further reduces the number of denied claims for problems.

Saves Money:

One of the key motivations for outsourcing has always been to save money. Hospitals can save money on wages, training, and benefits by delegating medical billing. They can also save money on office supplies, furniture, and technology purchases or upgrades. 

Many customers prefer specialist suppliers because they may get high-quality service at a reduced price. Clients can choose the solution that best matches their needs due to the variable pricing models.

Improves Cash Flow:

Medical billing firms allow companies to maintain a regular cash flow and faster settlement irrespective of their workforce. Allowing a specialized agency to handle medical billing swiftly allows hospitals to gain better economies of scale.

Increases Patient Satisfaction:

Managing a medical practice or an organization necessitates a certain level of expertise to streamline the entire work cycle. It is extremely difficult for small or early-stage medical businesses to separate their active staff into medical billing or other roles. This somehow diverts their attention away from their assigned tasks. 

You can easily outsource hospital billing operations to remedy the problem. Consequently, the clinic staff’s efficiency will be boosted, which will eventually lead to higher patient satisfaction.

Provides real-time data access and strong authentication:

medical billing company services

Another advantage of medical billing company services is that you can receive data and reports promptly. On the other hand, real-time data analytics allows healthcare service providers to acquire in-depth insights into the firm’s performance and what can be handled more or less. 

Furthermore, once all the data has been gathered, the firm will find it easier to make judgments in keeping with the growth techniques. Billing is the process of storing very sensitive and crucial patient information. However, a single data leak or misplacement might result in widespread discontent within the company. This has a lot of negative ramifications as well. As a result, the professionals in the sector to whom you will outsource can readily address these obligations.

Seeking new ways to cut operating costs and improve billing control is the method to go in the ever-changing healthcare industry. Getting competent medical billing company services will only benefit your company. Get in touch with Medical Healthcare Solutions today.

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8 medical billing tips

Collect More from Patients: 8 Medical Billing Tips

Unsurprisingly, medical billing is among the most challenging tasks that healthcare organizations come across. Though physicians are well-trained in handling their patients’ health, there are a number of things to consider to keep up with the revenue cycle

While medical billing is complicated, here are the eight medical billing tips which can help you to sustain the costly work of offering healthcare services.

Tip #1: Develop a clear collection procedure

This is the first and most significant medical billing tip. 

  • Notify patients about the requirements of debt repayment. Provide information concerning their payment responsibilities in their new-patient papers, and nudge them off their duties frequently, particularly when things alter. 
  • Collect complete details of the patient. Such details comprise their address, contact number, email-id, etc.
  • Help the patients recall their co-pay and its importance. Make sure your team knows how to respond to any inquiries a patient may have.
  • To avert claim rejections, bring the proof of insurance with you to each appointment and double-check the person’s eligibility. Much better, to save money on staffing, employ an electronic verification method.
  • Determine what funding methods are accessible to the patient at the moment. Clarify what comes under their payments. For instance, help them to know if credit cards, cheques, or money are accepted and whether installment plans are possible.

Tip #2: Engage in staff training

After establishing a structured and verifiable billing procedure, you must put effort into proper staff training. It’s never a good idea to skip this medical billing tip or think that only the person who files the claims requires training. In addition, ensure that every team member has exact knowledge of their responsibilities and expectations.

Tip #3: Handle claims correctly

8 medical billing tips

  • Never procrastinate in filing claims. Yet, exercise extreme caution to confirm that the claims are accurate and comprehensive. Make it a practice to file all the claims at the end of the day. 
  • Submission of the claim does not refer to the end of the process. Make very sure that all claims are updated until the patients fully settle them. It’s all too easy to get caught up in the daily grind and overlook minor claims.
  • It’s essential to deliver the claim to the correct payer — the one who is accountable for that specific payment. Claims addressed to the wrong recipient will cause delays. They will reject the claim, and then you have to resend it to the correct recipient. Delayed payments have almost the same impact on the revenue cycle as rejected refunds.

Tip #4: Verify Patient’s Insurance

You can check the patient’s insurance upon every visit. In addition, double checking that it is up to date from when they were last seen would help to avoid any further renewal issues. Also, it is important to check eligibility to be sure the patient’s visit is covered by their insurance. This will not only increase cash collection but will also eliminate any bad debt. 

Tip #5: Stay informed

Medical billing standards are continually updating, and catching up with them can necessitate ongoing staff training and technology updates. Keep up with any changes that may affect medical billing processes, and obtain required training. It’ll save you money in the long run if you don’t have to redo claims as often.

Tip #6: Determine problem accounts

By setting clear protocols for dealing with patient finances, you can have the data for identifying possible problems. Adopt methods for identifying problematic behaviors such as delayed payment, consistently denied payments, or variations in contact details. 

Tip #7: Manage denied and rejected claims on time

Screening a claim for mistakes can help to reduce the number of rejections and cancellations. However, if they do happen, make sure to deal with them as soon as possible. 

Maintain contact with a payer agent. They can assist in resolving issues with the initial claim and supply updates on subsequent claims. This can all assist in speeding up the claim modification cycle and reduce the time it takes to reject and resubmit claims.

Tip #8: Hire a trustworthy billing company

8 medical billing tips

This is the must-follow medical billing tip if you are unable to follow the above ones. If you’re having trouble keeping up with current invoicing laws, getting rejections in payments,  have problems delegating responsibilities, etc., then a medical billing company can help you.


All these tips can help you collect more from your patients and on time. For your best medical billing system and to have some more information, Medical Healthcare Solutions Inc. can help you.

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Physician Credentialing Services

The Advantages of Using Physician Credentialing Services

When it comes to the medical world, medical credentialing has opened doors that were earlier not so helpful for medical providers. More and more patients opt for insurance and try to benefit themselves with reimbursement from the insurance companies. Thus, the medical practitioners can deliver their services to a number larger than ever.

Let us look at how physician credentialing can benefit the physicians searching for credentialing services and offer them privileges through an insurance company.

Assuring quality

Medical credentialing offers quality assurance in the healthcare industry. It’s a means of review for the medical field. In other words, it makes sure that the medical sector regularly provides quality standards to the patients.

To keep the prices down, insurance companies are attracted only towards well-off medical physicians. Also, they look at those who have shown the ability to showcase their specialties.

Physician Credentialing Services

Keep up patient’s safety

Credentialing helps to keep patients safe as it ensures continuous practices. It makes sure the physician has the skill, capability, and experience needed to perform procedures on their patients. This process helps reduce the chances of medical errors, usually caused due to incompetent providers.

When all this background is available, physician credentialing helps rebuild the lost trust between medical practices and the patients. Patients who are aware of their physicians’ merit and qualifications to be the chosen providers place their faith in their capabilities. 

Save losing revenues

Proper credentialing helps medical practitioners save thousands of dollars in revenue in the form of reimbursement. This is either denied or delayed. If there are errors in the process or receive improper attention to receive proper credentialing, it may lead to insurance companies failing to reimburse the medical bills for the treatment.

In scenarios where medical practice lets a physician give services before or between the credentialing process, the insurance company can advise the patient for the complete reimbursement to cover the expenses of the treatment.

Enhances your patient base

Physician credentialing gives medical practices access to those patient bases that were not earlier available to them. With this, they can accept patients covered under health insurance. Most Americans use health insurance plans.

As per 2019 data, 90.8% of people were covered under health insurance. This helps medical practices to raise their clients and significantly boosts their revenue.

Increase practice reputation

The number of patients researching healthcare practices and the physicians before choosing them has seen unprecedented growth. These include knowing their background or going through a patient’s review online.

One of the best ways to improve your online reputation is to undergo medical credentialing. While potential patients research your medical practice, looking at your credentials conveys that your practice is reputable, merited, and trusted.

Improves the hiring process

Physician Credentialing Services

If a physician is credentialing, they need to go through a full examination process that studies their educational background, residential history, work experience, and any other merit.

If your medical practice wants to hire a medical practitioner, who should be credentialed, this process helps verify whether they are capable enough to perform the given job tasks.


Though it is important to access the new patients, the medical credentialing process can be time-consuming and lengthy. To speed it up, learning how medical credentialing works will help you simplify all credentialing requirements. For more information, you can visit Medical Healthcare Solutions Inc.

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MHS Featured in CIO

Medical Healthcare Solutions Featured in CIO Review Magazine

We are proud to share that Medical Healthcare Solutions has been selected as one of the 50 Most Promising Healthcare Solution Providers in the CIO Review magazine. The CIO Review is a leading print magazine and online portal that bridges the gap between enterprise IT vendors & buyers. As a knowledge network, CIOReview offers a range of in-depth CIO/CXO articles, white papers, latest Enterprise Technology News to help CIOs & IT leaders make the right decisions.

It is a great honor to be listed among 49 other top healthcare solution providers in this series.

Our very own Stephen Brighton took part in an interview feature for CIO Review and was quoted saying, “MHS’ service-oriented approach and utilization of cutting edge technology allows us to provide healthcare professionals with medical billing, electronic health records, and practice management solutions.”

The article provides an in-depth overview of the services MHS offers such as medical billing, healthcare informatics, and practice management consulting services to name a few. Additionally, the article highlights the effectiveness of third-party billing and how it can ‘take precedence in determining the sustainability of a practice.’  A streamlined medical billing service only scratches the surface of what MHS has to offer and why MHS is listed in CIO Review as one of the 50 most promising healthcare solution providers. Brighton is also quoted in the article saying, “MHS’ services allow enhanced insights into medical practice performance with an outcome that achieves higher profitability and provides more time for staff to focus on patient care and increases referrals, especially in small practices.” Most importantly MHS can help practices, hospitals, and universities ‘experience immediate improvement in day-to-day collections, boosted cash flow, and reduced costs.’

We thank CIO Review for featuring MHS in their TOP 50 Most Promising Medical Healthcare Solution Providers of 2018 series. We invite you to check out the article. Click here to go to the article and turn to page 63.

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