SpecialtiesCare settings & programs
How we see nursing home & assisted living billing.
Reviewed by the VisMed care settings & programs billing team
Visits in nursing facilities, assisted living and other residential settings use their own code families, with rules about initial and subsequent visits, the regulatory visits required by federal rules, and who may perform which. Coding an office visit by mistake, or the wrong facility family for the setting, is a denial on every encounter.
Consolidated billing adds a second layer. During a Medicare Part A stay, many services are bundled into the facility’s payment and must be billed to the facility, not to Medicare. Physician professional services are mostly excluded from consolidation, but therapies, some diagnostics and supplies are not. Billing the wrong party wastes months.
VisMed codes each visit by setting, checks consolidated billing per service against the patient’s stay status, reconciles a daily census across every facility you round at, and captures the care-management and advance care planning services this population supports.
Where nursing home & assisted living practices lose money
The patterns we find in the aging and denial history before anything else changes.
Wrong code family or place of service
Nursing facility, domiciliary and home visits each have their own codes and place-of-service values. Errors deny or misprice every visit.Consolidated billing misrouted
Services subject to consolidation billed to Medicare during a Part A stay are denied; services excluded from it billed to the facility are never paid.Census gaps
Rounding across several facilities without a reconciled census loses visits.Regulatory visit rules
Required visits and their timing, and which practitioners may alternate them, have documentation and coding implications that are often missed.Advance care planning and care management unbilled
Goals-of-care conversations, chronic care management and cognitive assessments are billable and rarely captured in facility practice.
What we do differently for nursing home & assisted living
Specialty-matched coders and a denials specialist, working inside your own system.
We code by setting
Visit code family and place of service set by where the patient was seen and the type of visit, from the note.We check consolidated billing per service
Each service checked against the patient’s stay status and the consolidation lists before it is routed to the payer or the facility.We reconcile the census
Daily census from each facility matched to claims.We capture the programs this population supports
Advance care planning prompts, care management and cognitive assessment codes captured where documented.
What we bill
The procedure and code families your account team already works in.
Nursing home & assisted living billing, asked and answered.
What a physician-owner in this specialty asks on the first call.
How does VisMed know when to bill the facility instead of Medicare?
By checking the patient’s Part A stay status and the service against the consolidated-billing lists before routing. Physician professional services generally go to Medicare; therapies, many diagnostics and supplies during a covered stay go to the facility under your arrangement with it.
Can nurse practitioners bill facility visits?
Yes, within the rules on which visits may be performed by non-physician practitioners and how required visits may alternate. VisMed applies those rules per visit type and setting.
How does VisMed avoid missing visits across several facilities?
With a daily census from each facility reconciled to claims. Every patient-day on a census becomes a claim or a documented reason.
Is care management billable for nursing home residents?
For residents in assisted living and other non-skilled settings, often yes. For patients in a Part A stay, consolidated billing and overlap rules restrict it. VisMed applies the rule per patient status.
How does VisMed keep medical director work separate from clinical billing?
Medical director and administrative duties are paid by the facility under a written agreement and are never billed to a payer. VisMed keeps those arrangements documented and off the claim stream, and bills only the face-to-face patient care the physician provides, which is the separation auditors look for.
Also in care settings & programs
Federally qualified health centers
PPS rates, wrap-around and sliding-fee reporting.
Durable medical equipment
Orders, proof of delivery and competitive-bid rules.
Wound care
Debridement levels, skin substitutes and frequency edits.
Hospice
Election periods, levels of care and NOE timing.
Home health
OASIS-linked episodes and PDGM grouping.
Behavioral health
Parity rules, telehealth and group-session codes.
Substance-use treatment
Bundled programs, MAT and authorization units.
All specialties
The full list, in six groups
See where your nursing home & assisted living practice is losing money. Free.
Six months of aging and denials, read by people who bill your specialty every day — quantified as monthly leakage with a recovery estimate. Yours to keep.
or write directly hello@vis.med