Nursing Home Billing Services
Neurosurgery is high-stakes medicine: complex procedures, device implants, time-sensitive interventions, and extensive documentation. Your team’s priority is patient care and clinical outcomes not wrestling with claim edits, denials, or payer policy gymnastics. At Sirius Solutions Global we specialize in neurosurgery billing and revenue cycle management (RCM) for spine and brain practices, surgical centers, and hospital departments. We take on the complexity, navigate payer rules, and recover revenue with surgical precision so your team can do what it does best: deliver excellent care.
Our Nursing Home Billing Services
1) Front-end eligibility & pre-certification
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Admission-time benefit checks, Medicare Part A status validation, and prior authorization support for outpatient procedures or excluded services.
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Early identification if a resident has concurrent hospice, Medicare Secondary Payer issues, or unique Medicaid eligibility requirements.
2) Accurate charge capture & coding
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Facility-level PPS/HIPPS mapping and professional coder review for 99304–99318, wound care, and procedure CPTs.
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Correct therapy minute capture and unit mapping (PT/OT/ST), and HCPCS/DME coding for supplies and devices.
3) Consolidated billing governance
· Pre-submission checks that compare the service against consolidated billing rules and exclusions, preventing improper professional claims during Part A stays.
4) Clean claim submission and payer follow-up
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Payer-specific claim templates, EDI submission best practices, and daily monitoring of claim rejections and denials.
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Fast rework and resubmission workflows to reduce days-in-A/R.
5) Denial prevention & appeals
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Root cause analysis of denials (documentation, units, consolidated billing), targeted remediation, and clinically-supported appeals.
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Trend dashboards that reveal recurring deniers or code clusters and help update staff training.
6) Patient statements & resident billing
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Clear, empathetic resident statements and support for family inquiries. Payment plan setup and self-pay aging management.
7) KPI reporting & continuous improvement
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Weekly KPI dashboards: clean claim rate, denial % by payer, A/R aging 30/60/90, average days-to-pay, and net collection rate.
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Monthly review calls with action items and process audits.
Why Choose Sirius Solutions Global?
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5+ years of experience in healthcare RCM.
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Dedicated team specializing in nursing home and long-term care billing.
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AI-driven billing solutions with proven results.
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Customized workflows for small, mid-sized, and large facilities.
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U.S.-based compliance
Why Nursing Home Billing Is Different
Nursing home billing is a layered puzzle: facility rates, professional services, therapy units, behavioral health, durable medical equipment, pharmacy billing, and sometimes end-of-life or hospice overlays. A key difference is consolidated billing under Medicare Part A, the SNF is responsible for billing many services that residents receive during a covered stay. If you don’t know which services are included (and which are excluded), you’ll either leave money on the table or trigger denials and recoupments.
Other unique complexities:
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Daily and per-encounter codes: Nursing facility E/M (99304–99318) require precise documentation and correct initial vs subsequent visit selection.
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Therapy and rehab billing: Speech, physical, and occupational therapy often operate on unit counts and therapy minutes; time-tracking errors are a top denial source.
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Facility vs professional splits: Making sure facility charges (room, medical supplies) are captured under the SNF PPS and physicians/NPPs bill professional services to Part B correctly is essential.
Frequent nursing home billing challenges & how we solve them
Consolidated billing mistakes (the silent revenue killer)
Problem: During a Medicare Part A SNF stay, billers inadvertently submit claims for services that should be included in the SNF’s consolidated bill leading to denials and potential recoupments.
Our solution: pre-claim consolidated-billing checks, a rules library aligned to CMS guidance, and training so staff know which services are separately payable. This step alone cuts a large slice of denials for many clients.
Therapy minute capture & billing
Problem: Therapy minutes are tracked poorly or rounded incorrectly, causing underbilling or audits.
Our solution: build point-of-care capture templates, automated minute-to-unit converters, and coder review that ensures therapy billing lines match clinical documentation.
Facility PPS/HIPPS coding
Problem: Wrong RUG/PDPM assignment (or wrong HIPPS code) causes underpayment of facility payments.
Our solution: daily reconciliation of clinical inputs against PDPM grouper outputs and a verification layer before facility claims transmit.
Wound care, IV therapy, and complex procedures
Problem: These services often have special reporting rules and separate payer edits. Missing modifiers or wrong revenue codes lead to denials.
Our solution: clinical-coder pairing a coder with clinical understanding reviews service notes and pairs the right CPT/HCPCS and revenue codes.
Long-stay and transition billing (hospital → SNF)
Problem: Admission timing errors and overlap between hospital billing and SNF Part A cause billing gaps.
Our solution: admission coordination, timeline reconciliation, and proactive claim sequencing rules to ensure correct payer responsibility and maximize allowable reimbursement.
Challenges We Solve for Nursing Homes
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Denied Medicare Claims owing to inadequate documentation.
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Low Medicaid Reimbursement from Miss Preauthorization
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Cash Flow Gaps caused by late or denied claims.
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Audit dangers resulting from incorrect or incomplete encoding.
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Staffer overload arises when billing departments are overburdened.
We not only recognize these problems; we also rectify them and keep them fixed
AI in Nursing Home Billing – Smarter, Faster, Better
To turn nursing home billing into a proactive, revenue-increasing system, we use AI-driven tools:
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Automated Denial Prediction helps artificial intelligence identify claims likely to be refused before submission.
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Real-time eligibility checks help to avoid upfront coverage mistakes.
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Predictive analysis projects payer performance and income trends.
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Compliance Monitoring enhances with Artificial intelligence constantly checks for correctness in coding and documentation.
For nursing homes, this mix of human knowledge and artificial intelligence lowers financial risk and streamlines billing.
Outcomes we typically deliver
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Increased clean-claim rate within 60–90 days through targeted fixes to consolidated billing and therapy capture.
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Reduced A/R days via prioritized appeals and daily follow-up.
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Fewer audit recoupments because documentation and billing align with payer and CMS rules.
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