● Nursing Home & SNF Billing Specialists

Nursing Home Billing Services for Long Term Care Claims

Claim Click Solutions manages Medicare, Medicaid, and private payer billing for nursing homes, keeping reimbursement steady for long term residents.

Trusted by urgent care centers and multi-site groups.

96.8%

Clean claim rate

● The Real Cost of Generic Billing

Nursing home billing breaks in ways general billers never catch

Every one of these is a claim your facility has probably already lost money on this month.

Consolidated billing exceptions missed

Oncology, ambulance, and certain DME services carved out of the daily CMS rate get billed incorrectly — or never billed at all.

PDPM case-mix misalignment

Billers unfamiliar with PDPM fail to align MDS assessment data with the correct case-mix groups, leaving reimbursement on the table every stay.

Benefit period tracking errors

Medicare Part A's 100-day benefit periods and required 60-day wellness breaks get miscounted, triggering avoidable denials.

Multi-payer confusion

Medicare, Medicaid, managed long-term care, and private LTC insurers each carry different rules — and state-by-state Medicaid variance makes it worse.

Missed recertifications

Late physician orders and recertifications create documentation gaps that payers use to justify denials weeks after the stay.

Staffing that can't flex with census

High resident turnover and staffing shortages overwhelm in-house billers, creating backlogs that turn into unworked, aging AR.

● How We Fix It

A billing team built around long-term care, from admission to payment

We don't hand your claims to generalists. Every coder on your account is trained specifically on PDPM case-mix groups, consolidated billing exceptions, and multi-payer nursing home rules.

✓

SNF-certified coders

Specialists who know PDPM case-mix groups, MDS alignment, and consolidated billing exceptions cold.

✓

Benefit period monitoring

Every Medicare Part A benefit period and required break tracked automatically, so coverage surprises don't happen mid-stay.

✓

Active denial rework

Denied claims are corrected and resubmitted — repeatedly, until paid — not filed away.

✓

Volume-flexible staffing

Our billing bench scales with your resident census, so admissions spikes never become a claims backlog.

● Full-Service RCM

Every stage of nursing home revenue cycle management

From eligibility checks to appealed denials, we run the parts of your revenue cycle that pull attention away from resident care.

Insurance Verification

Eligibility checks across Medicare, Medicaid, and managed LTC plans confirmed at admission — before care begins.

Medical Coding & PDPM Alignment

MDS assessments accurately translated into PDPM case-mix groups, HCPCS, and ICD-10 by long-term care specialists.

Claim Submission

Clean claims scrubbed against consolidated billing edits before they ever leave the building — fewer rejections, faster payment.

Payment Posting

ERA/EOB reconciliation posted daily so your AR reports always reflect what's actually been collected.

Denial Management

Every denial is diagnosed, corrected, and appealed with the documentation nursing home payers require.

AR Management & Patient Billing

Aging claims worked back to payment, plus clear, timely private-pay and family-responsible-party statements.

● Built For Nursing Homes Specifically

We speak fluent PDPM for every stay type you admit

No learning curve, no generic templates — just billers who already know the rules your facility works under every single day.

MEDICARE PART A

Skilled Stays & Benefit Periods

Accurate PDPM case-mix coding and benefit-period tracking so every skilled stay is billed and monitored correctly from day one.

MEDICAID & MANAGED LTC

Multi-Payer & State Variance

Custodial-care Medicaid, managed long-term care plans, and private LTC insurance billed correctly, state rules and all.

CONSOLIDATED BILLING

Part B Exceptions

Oncology, ambulance, and other carve-out services billed correctly outside the daily consolidated rate — no missed revenue.

PDPM & MDS

Case-Mix Coding Alignment

MDS assessment data translated into the correct PDPM components — nursing, therapy, NTA — every reimbursement cycle.

● Why Facilities Switch to Us

What actually changes when Claim Click Solutions takes over

01

Specialty-trained coders

Not general billers learning PDPM on your dime.

02

Same-week onboarding

Live claim tracking active within days, not months.

03

Volume-flexible bench

Staffing that scales with resident census, not against it.

04

No long-term lock-in

Month-to-month terms — we earn your business every cycle.

● The Bottom Line

What specialized nursing home billing does for your facility

No learning curve, no generic templates — just billers who already know the codes your center uses every single shift.

+ 0 %

Average revenue lift

Recovered through corrected PDPM coding and worked denials in the first 6 months.

- 0 %

Fewer claim denials

Achieved through pre-submission scrubbing built for consolidated billing edits.

0 Days

Faster reimbursement

Average time from claim submission to posted payment across our client base.

● Case Study

How a 3-facility nursing home group recovered $612K in stalled AR

A regional nursing home group came to us with a 27% denial rate driven by PDPM misalignment and consolidated billing errors, plus over six months of unworked accounts receivable. We rebuilt their coding process, cleared the AR backlog, and stood up real-time claim tracking across all three facilities.

AR recovered

$ 0 k

Denial rate

%→9%

New avg. payment time

0 Days

● Common Questions

Nursing home billing FAQ

What makes nursing home billing different from general medical billing?

Nursing home claims combine PDPM case-mix coding, MDS assessment cycles, consolidated billing exceptions (services carved out of the daily CMS rate), and Medicare benefit-period tracking that generalist billers routinely miss. Getting it right requires coders trained specifically on skilled nursing and long-term care billing.

Do you handle PDPM coding and MDS alignment correctly?

Yes. Every claim is coded with PDPM case-mix groups aligned to the resident's MDS assessment data, so you're never underpaid or denied for a misalignment between clinical documentation and billing.

Can you bill Medicaid and managed long-term care plans across multiple states?

Yes. We manage Medicaid custodial-care billing, managed long-term care plans, and private LTC insurance claims, adapting to the specific rules and documentation each state and payer requires.

How do you handle consolidated billing exceptions?

We identify and correctly bill the services CMS carves out of the daily consolidated rate — such as certain oncology treatments, ambulance transport, and specific DME — so those claims don't get lost in the daily-rate bundle.

Are you compliant with CMS and HIPAA requirements?

Yes. Our billing workflows are built around current CMS, HIPAA, and PDPM requirements, and we track regulatory changes that affect nursing home and skilled nursing facility billing specifically.

● Free Billing Audit

See exactly what your current billing process is missing

We'll review a sample of your recent nursing home claims and show you where revenue is being left on the table — no cost, no obligation.