Medical billing & coding for nursing home facilities seems complicated at first. Reimbursement for services received in a nursing home is subject to an increasing number of regulatory restrictions. In an effort to reduce potential fraud and abuse due to double billing by healthcare providers, nursing home s currently bill Medicare under a Prospective Payment System (PPS) similar to the way inpatient facilities are reimbursed for medically necessary care to patients.
Nursing home billing services include durable medical equipment, screenings, many tests, transportation to and from routine medical appointments, and services that are required by a physician’s care plan that are performed by nurse practitioners and physician assistants incident to the that plan. Speech therapy, occupational therapy, and physical therapy are required to be billed directly by a nursing home in a consolidate bill, rather than by individual therapists.
Understanding which Medicare agency to bill is the responsibility of professional medical billers like GoTelecare where we specialize in sending the right bills to the right payers with the medical code that accurately reflects the services provided.