Senior Living billing
SNF/ALF/IL physician services, consolidated billing exclusions, and complex care plan oversight — different rules than office-based primary care.
Senior living billing has the highest 'I didn't know I could bill that' delta of any specialty we work with — practices routinely add 8–12% to collections just by capturing CPO and TCM.
Where revenue leaks
The senior living traps we see most
Patterns we run into across SNF practices in Texas. None are obvious from a 30,000-foot view of the practice — they show up only when someone's actually looking at every claim.
Consolidated billing landmines
Medicare SNF Part A consolidated billing means most services for SNF Part A residents get paid to the SNF, not the physician. Billing the physician part directly to Medicare gets denied. Knowing what's bundled vs. carved out (physician E/M, certain therapies) is critical.
Wrong place-of-service code
POS 31 (SNF), 32 (Nursing Facility), 13 (ALF), 14 (Group Home), 12 (Home). Wrong POS code triggers denials and incorrect reimbursement.
Care plan oversight (G0181/G0182) ignored
Care plan oversight for home health and hospice patients pays $100–$120 for cumulative supervision time exceeding 30 minutes per month. Most practices never bill this even when documenting the work.
Transitional Care Management around facility transitions
99495/99496 applies when a patient is discharged from a facility and the physician follows up. Often missed in senior living because the physician sees the patient anyway during their regular rounds.
Coding focus
Where our coders specialize
- Nursing facility services (99304–99318)
- Domiciliary/rest home (99324–99340 — replaced by 99341–99350 home services in 2023)
- Home services (99341–99350)
- Care plan oversight (G0181 home health, G0182 hospice)
- Transitional Care Management (99495, 99496)
- Advance care planning (99497, 99498)
- Place of service codes 31, 32, 13, 14, 12
Texas payer notes
Local rules we navigate every day
- Medicare SNF Part A consolidated billing rules are complex and frequently misunderstood
- Texas Medicaid Long-Term Services and Supports (STAR+PLUS) has specific managed care rules per MCO
- Medicare Advantage plans (especially Humana SNP, Wellcare DSNP) have additional auth requirements for facility-based visits
SNF KPIs we track
Specialty-specific benchmarks
We tailor reporting per specialty — these are the metrics that matter most for senior living.
100%
POS code accuracy
<2%
Consolidated billing denial rate
tracked monthly
CPO/TCM capture (when applicable)
What's your senior living practice leaking?
Get a free Revenue Leakage Analysis customized to SNF billing patterns. Three specific leaks at your practice, dollar amounts, and exactly how to fix them. 3 business days. No sales pitch.
Other specialties we serve