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Exploring Medical Billing in Long-Term Care Facilities

Effectively managing processes of medical billing in long-term care facilities are one of the essential parts of running a successful LTC (long-term care) practice. Medical billing services for the long-term care entails understanding of intricacies of long-term care, starting from the initial patient registration to the final reimbursements. With that many processes in LTC cycles, it is quite difficult for practitioners to maintain and stay on top of all crucial details.

Medical Billing in Long-Term Care Facilities

Knowing exactly how every step fits together and how to look for red flags in addition to looking for places to improve – can ensure that your LTC practice runs smoothly. Efficient running of LTC facilities leads to higher profits/reimbursements and also to better quality of care for patients.

Below, we have discussed the strategies for successful medical billing in long-term care facilities.

Effective Strategies for Successful Long-Term Revenue Cycle Management (LTRCM)

Long-term care facilities in the US face multiple challenges for revenue cycle management optimization. Still, there are many employable strategies that can help in making medical billing in long-term care facilities successful, and these include the following:

1. Timely and Precise Healthcare Billing Processes

It is important to ensure that all billing processes remain timely yet accurate to avoid delays in payment collections. To do so, the LTC facilities must stay updated with the latest coding and billing requirements for every service they offer and monitor any patient eligibility changes.

2. Using Technology

LTC facilities face numerous and unique challenges in revenue cycle management, including payment sources and authorization requirements. Leveraging technology solutions such as EHRs can help simplify billing by automating medical billing procedures. Effective and automated medical billing in long-term care facilities can help reduce mistakes and make operations smoother.

3. Regular Follow-Ups for LTRCM

Medical billing in long-term care facilities calls for regular follow-ups on unpaid claims and other problems. Doing so is vital to keep the revenue cycle running smoothly. Furthermore, regular follow-ups also assist in reducing payment delays and even incorrect payments.

4. Staff Trainings

Furthermore, it is extremely important for long-term care facilities to educate and train their staff on the correct procedures and ways to bill correctly. Additionally, staff at LTC facilities must know how to code and follow compliance regulations properly. Doing so will ensure that all processes are taken care of and thus, revenue cycle management for LTC facilities works as well as possible.

5. Compliance Monitoring

Continuous monitoring of compliance regulations and industry standards is important for successful medical billing in long-term care facilities. The process includes regular and ongoing continuous audits of billing processes. All of that in addition to ensuring that the staff is well-aware of and trained over the compliance requirements.

6. Cash Flow

Efficient cash flow management is vital for LTC facilities to ensure financial health and stability. The overall cash flow management involves effective monitoring of accounts receivable, management of expenses, collection of payments, and even maintaining satisfactory reserves.

For effectively managing the cash flow, the long-term facilities must have a workable and efficient revenue cycle process that considers the sources of revenues, including government-funded programs.

6. Hands-on Managing of Denied Claims

The denied claims add up and can easily become one of the major sources of lost revenue for the LTC facilities. Practical management of denied claims by identification of the reasons for denials and then effectively addressing those can help cut down on the losses, thus improving revenue.

The process can involve implementing procedures that ensure all claims are coded and submitted correctly by providing accurate information. All of this, in addition to the effective filing of appeals, whenever and wherever necessary.

Final Word

Coders and medical billers at Physicians Revenue Group, Inc., have years of experience offering proactive RCM services and support for medical billing in long-term care facilities. Our experts understand that long-term care patients call for around-the-clock attention and care. Thus, we offer 24/7 technical and customer support channels for our partner practices. Work alongside us to streamline your RCM, billing, and credentialing management – so you can focus more on offering excellent patient care.

Frequently Asked Questions

The credentialing process entails the validation of a physician to determine whether or not they meet the set standards for providing clinical care. Here payers verify the following:

  • Physician’s Education
  • License
  • Physicians’ experience
  • Certifications
  • Affiliations
  • Adverse clinical occurrences
  • Training
  • Malpractice, and more.

A modifier offers additional medical procedures, services, or supply information. All of this information is communicated through the modifiers without changing the medical codes’ meaning.

  • CPT Code 99214 can be used for office visits
  • 99397 is for preventive exams for patients over 65, and so on.



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