Nursing Home Billing Services

Skilled nursing facilities bill on a very different model from physician offices. Medicare Part A stays are tied to resident assessments, and the facility claim carries payment codes that come from those assessments. A late or incorrect assessment can delay a claim for an entire stay.

Nursing home billing also involves consolidated billing, Medicaid, managed care plans, and private pay residents. Many services for a resident in a covered stay must go through the facility, not through outside suppliers. Westmont Revenue Partners connects nursing homes and skilled nursing facilities with vetted billing experts who understand these rules and can support the revenue cycle.

Who this is for

• Skilled nursing facilities and nursing homes
• Facility groups and long-term care operators
• Business office managers and administrators
• Rehabilitation providers working inside nursing facilities
• Physician and practitioner groups that visit nursing facility residents

What gets billed

• Medicare Part A covered stays
• Medicare Advantage and managed care stays
• Medicaid room and board
• Private pay and long-term care insurance
• Therapy services during covered stays
• Part B therapy and services in non-covered stays
• Ancillary supplies and drugs
• Leave of absence days
• Physician and practitioner nursing facility visits
• Resident balances and patient liability

Commonly billed codes

Code	Type	What it covers
99304-99310	CPT	Nursing facility visits by physicians and other practitioners
21X	Type of bill	Skilled nursing facility inpatient Part A claims
22X	Type of bill	Skilled nursing facility Part B claims, such as therapy in non-covered stays
0022	Revenue code	Identifies a claim paid under the SNF prospective payment system
0420	Revenue code	General physical therapy charges
0430	Revenue code	General occupational therapy charges
0440	Revenue code	General speech therapy charges
0450	Revenue code	General emergency room charges, often outside consolidated billing
31	Place of service	Skilled nursing facility
32	Place of service	Nursing facility

Note

Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.

Billing challenges in nursing home billing

• Assessment timing. The payment code on a Part A claim must match an accepted resident assessment. A biller tracks assessment dates so claims are not held.
• Consolidated billing. Most services in a covered stay must be billed by the facility, with some exclusions. A biller checks what outside providers may bill separately.
• Qualifying stay. Medicare Part A generally requires a prior inpatient hospital stay of at least three days. A biller verifies this at admission.
• Therapy reporting. Therapy revenue lines must be reported correctly. A biller works with the therapy team so units and dates agree.
• Medicaid and patient liability. Residents may owe part of their cost of care. A biller tracks liability amounts and coordinates with the state program.
• Managed care authorizations. Medicare Advantage plans often require authorization and set their own rules. A biller tracks approvals and covered days.
• Practitioner billing. Visits in nursing facilities use specific visit codes and place-of-service codes. Billers confirm the right ones for each setting.

How Westmont can help

• Matching you with vetted billing experts experienced in skilled nursing and long-term care
• End-to-end revenue cycle support for facility and practitioner claims
• Denial management and appeal follow-up
• Support with payer enrollment and credentialing
• Help tracking Medicaid, managed care, and private pay accounts

Frequently asked questions

What is PDPM in nursing home billing?

PDPM, the Patient Driven Payment Model, is the Medicare payment system for skilled nursing facilities and has been in place since October 2019. Payment is based on resident characteristics from the assessment. The claim carries a payment code tied to that assessment. Review current-year updates each October.

What is consolidated billing for a nursing home?

Consolidated billing means the facility bills Medicare for most services a resident receives during a covered Part A stay, even if outside providers deliver them. Some services, such as physician professional services, are excluded and billed separately. A biller checks each service against current Medicare rules.

What is the three-day rule?

Medicare Part A skilled nursing coverage generally requires a prior inpatient hospital stay of at least three consecutive days, and admission to the facility generally within a set window after discharge. Rules and waivers can change, so verify current Medicare policy and the resident's plan.

Why do nursing home claims get delayed?

Frequent causes include assessments not yet accepted, mismatched dates, missing therapy lines, eligibility errors, and missing authorization for managed care plans. A biller tracks these items before the claim is due and corrects them before submission.

Do physicians visiting nursing homes use different billing?

Yes. Practitioners billing for visits to nursing facility residents use nursing facility visit codes and place-of-service codes for the setting. Those claims are separate from the facility's claim. A biller confirms the right codes for each resident status.

Related billing services

• Assisted Living and Long-Term Care
• Home Health
• Hospice
• Geriatrics
• Physical Therapy
• Speech-Language Pathology