Geriatrics Medical Billing Services
Specialized billing and RCM for geriatricians, senior care clinics, and multi-disciplinary eldercare practices protect revenue, reduce denials, and improve patient financial experience with AI-augmented billing tailored to older adults.
Caring for older adults is deeply rewarding and administratively complex. Geriatric practices manage multiple chronic conditions, care coordination, cognitive assessments, advanced care planning and preventive services all while navigating Medicare, Medicare Advantage, and often dual-eligibility Medicaid rules. At Sirius Solutions Global, we combine geriatric clinical knowledge, experienced coders, and AI-powered revenue cycle automation so you get paid accurately and on time and your team spends time with patients, not claim stacks.
What we deliver full-cycle geriatrics revenue cycle management
We treat your practice like a geriatrics clinic, not a generic medical office. Our model blends people, process, and AI.
1) Front-door: eligibility, benefits & consent capture
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Verify Medicare/Medicare Advantage/Medicaid eligibility at scheduling and daily check-ins.
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Capture patient consents for CCM, RPM, telehealth billing, and advanced care planning (digital or e-signature where allowed).
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Flag dual-eligible patients and co-pay/secondary payer rules.
2) Documentation templates & clinical mapping
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Deliver structured EHR templates for cognitive assessments, functional status, medication reconciliation, and ACP (advance care planning) that link directly to charge capture.
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Templates reduce ambiguity and ensure coding teams can confidently assign chronic care or prolonged/time-based codes.
3) Coding accuracy E/M, time/prolonged, and program codes
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Expert coders trained in geriatric workflows ensure accurate E/M level capture (or time-based coding where appropriate), apply prolonged services correctly, and capture CCM/RPM/TCM/ACP codes with compliant documentation.
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We also review bundling rules so you’re not missing separately payable services.
4) AI-Powered claim scrubbing & predictive denial scoring
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Pre-bill scrubs check for missing consents, insufficient time documentation, unlinked care-coordination encounters, and payer-specific edits.
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ML model predicts denial risk and assigns priority by estimated recoverable value your team works the highest impact items first.
5) A/R workflow & appeal management
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Prioritized follow-up by payer and by expected recovery value.
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Clinician-backed appeals with targeted documentation for high-value denials (e.g., prolonged service denials, CCM non-compliance denials).
6) Patient billing & financial counseling
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Create simplified patient statements (senior-friendly), set up payment plans for those on fixed incomes, and provide phone support to explain EOBs.
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We incorporate social worker or payer-assistance touchpoints for duals to reduce self-pay balances.
7) Reporting & continuous improvement
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Weekly KPI dashboards: clean claim rate, CCM enrollment/recapture rate, denial % by reason, days-in-A/R, net collection rate, and patient balance trends.
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Monthly review & action playbook we train your staff on recurring issues and workflow improvements.
Typical outcomes & KPIs you can expect
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Increase in recurring care revenue (CCM/RPM enrollment & capture) measurable uplift within 60–90 days.
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Reduction in prolonged/time denials through better documentation and AI-backed detection.
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Higher first-pass acceptance via payer-specific pre-bill scrubs.
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Shorter days-in-A/R by prioritizing high-value denials and automated follow-ups.
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Improved patient satisfaction with clearer statements and financial counseling.
Why geriatric billing is different
Geriatrics is not simply “primary care for older adults.” It’s layered care over time combining medical, functional, cognitive, social, and often home-based care elements. That raises specific billing requirements:
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Multiple overlapping revenue streams. Routine office E/M visits, care coordination programs, transitional care management, vaccine administration, chronic disease visits, and possibly home visits or telehealth must be properly captured and not double-billed.
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Longitudinal services matter. Chronic Care Management (CCM), remote physiologic monitoring (RPM), and behavioral health integration are recurring revenue lines that require specific patient consent, time/engagement documentation, and month-by-month tracking. Missing the consent or time stamps costs revenue.
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Complex documentation expectations. Cognitive assessments, depression screens, functional status exams (ADLs/IADLs), and advance care planning need structured documentation to link to billing codes and to justify medical necessity during reviews.
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Payer variability. Medicare fee-for-service vs Medicare Advantage vary on prior-auth needs, coverage of care coordination, and how they treat telehealth and home-based services. Practices need payer-specific rules baked into pre-bill scrubs.
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lOlder patients more frequently have multiple payers, secondary insurance, or dual eligibility verification and coordination are essential to avoid billed-to-wrong-payer errors.
Common geriatric billing scenarios & how we fix them
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Geriatrics = complexity + volume of touchpoints. Elder care involves frequent E/M visits, chronic care management (longitudinal care), transitional care, advanced care planning, home visits, medication management, and behavioral/cognitive evaluations. These lead to mixed professional and care-coordination revenue streams that must be captured precisely for proper reimbursement.
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Medicare / Medicare Advantage focus. Most payment complexity centers on Medicare rules, supplemental MA plan requirements, and state Medicaid carve-ins for dual-eligible patients accuracy in eligibility checks and benefit verification is vital.
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Top denial drivers: miscoded E/M levels (or missing prolonged/time-based documentation), missing care-coordination codes, incomplete advanced care planning documentation, bundled services not separated properly, and eligibility changes (duals switching plans). These are the recurring leaks many practices overlook.
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Competitive landscape: Competitors include general RCM firms and boutique practices-focused vendors. The winning edge: explicit geriatrics expertise (clinical coders who understand cognitive/functional assessments), demonstrated KPI improvements, and technology that automates repetitive work (AI for scrubbing, prioritization, and documentation extraction).
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Why AI matters: AI reduces routine manual work it pre-flags incomplete documentation, maps free-text clinical notes to billing-relevant items, predicts denials, and prioritizes high-value claims for human review. Practices that combine geriatric domain experience with AI see faster cash flow and lower cost-to-collect.
Market & competitor snapshot what matters right now
Scenario: missed Chronic Care Management (CCM) revenue
Problem: Eligible patients are not enrolled, or consent is missing or not documented recurring monthly revenue is lost.
Fix: We run an eligibility sweep, provide outreach scripts to enroll patients, capture electronic consent, and automate monthly documentation bundles to support CCM claims.
Scenario: prolonged service denial
Problem: Physician documents extended time but the payer denies due to unclear start/stop times or lack of clinical necessity.
Fix: AI extracts timestamps, cross-validates with nurse notes, and prepares a clinician-signed supplemental note tailored for the appeal.
Scenario: advanced care planning not captured
Problem: ACP conversations happen but are not captured in a billable way.
Fix: We provide ACP templates, patient consent capture, and coder review so the practice receives appropriate reimbursement when ACP rules apply.
Scenario: dual eligibility confusion
Problem: Patients switch between Medicare and Medicaid or have supplemental coverage, causing incorrect payer submissions.
Fix: Robust eligibility checks at scheduling and automated payer sequence logic ensure claims go to the correct payer first.
How our AI-Powered Billing specifically helps geriatric practices
You asked for concrete AI benefits here’s how we apply AI to increase revenue and reduce friction.
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Consent & documentation detection
NLP scans clinical notes to confirm required patient consents (CCM, RPM, ACP) and highlights missing elements before claims are created. This prevents whole-month rejections on care-coordination codes. -
Time-and-prolonged detection
For time-based E/M or prolonged services, AI reviews encounter timestamps, dictations, and nursing notes to assemble a time-based claim packet reducing denials from insufficient documentation. -
CCM / RPM patient identification & targeting
ML models identify eligible patients (multi-morbidity, frequent visits) who aren’t enrolled in CCM or RPM programs increasing enrollment and recurring revenue. -
Predictive denial prevention
Using historical denials, AI flags claims most likely to be denied (by payer, code, or documentation gap) so the human team fixes them pre-submission. -
Prioritization by recoverable value
The system scores denials by likely recoverable dollars and success probability. Staff focus on appeals that move the needle, improving cash collections. -
Policy surveillance & dynamic scrub updates
AI agents monitor payer bulletin changes and suggest updates to scrub rules reducing time between policy change and configurational updates.
Quick Helpful Answers
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Ready to stop chasing payments and start focusing on patients
Is billing paperwork stealing time from your patients? Reclaim that time. Contact us for a complimentary baseline audit and a clear action plan. Pinpoint your team's #1 billing frustration, and we'll deliver targeted 'quick wins' in your report