Medicare & Medi-Cal Billing for Skilled Nursing
Every denied claim is money your facility already earned but cannot collect. AssistedCare connects clinical documentation directly to billing so claims go out clean, on time, and at the correct reimbursement level.
Challenges in Skilled Nursing
High Claim Denial Rates
Disconnected charting and billing systems create documentation gaps that payers exploit to deny or down-code claims. Each denial costs time and money to appeal.
Slow Reimbursement Cycles
Manual claim preparation, paper-based verification, and batch submission delays push cash collection out weeks beyond what is necessary, straining working capital.
Medi-Cal Authorization Complexity
California Medi-Cal requires treatment authorization requests, level-of-care certifications, and specific documentation that differs from Medicare. Managing both payer requirements manually doubles the work.
How AssistedCare Solves It
Clinical-to-Billing Data Flow
Diagnoses, procedures, and therapy minutes documented at the point of care flow directly into claim records. Billing staff validate rather than re-enter, eliminating transcription errors.
See Billing Platform→Pre-Submission Claim Scrubbing
Every claim runs through payer-specific edit checks before submission. Common rejection reasons — missing modifiers, invalid diagnosis pairings, authorization gaps — are caught and corrected upfront.
Medi-Cal Authorization Management
Track TARs, level-of-care certifications, and reauthorization deadlines in one place. The system alerts your team before authorizations expire so coverage gaps never cause denials.
Revenue Cycle Dashboards
See days in accounts receivable, denial rates by payer and reason code, and collection trends at a glance. Identify revenue leaks before they become cash flow problems.
PDPM Reimbursement Optimization
The system maps clinical documentation to PDPM components in real time and highlights where accurate coding could improve case-mix classification without upcoding.
Frequently Asked Questions
Yes. The system handles skilled nursing Part A consolidated billing, Part B ancillary services, and the transition between benefit periods. Claims are generated in the appropriate format for each payer type.
AssistedCare supports California Medi-Cal fee-for-service and managed care plans. Each plan's specific authorization requirements and billing rules are built into the claim generation workflow.
Yes. Denied claims are flagged with the reason code and suggested corrective actions. Your billing team can prepare and track appeals from the same interface, with all supporting clinical documentation attached.
Both form types are supported. The system populates the correct form based on payer type and service setting, and generates electronic submissions in the required X12 837I and 837P formats.
We offer transparent per-bed pricing with no hidden fees, no long-term contracts, and no charges for updates or support. Contact our team for a customized quote based on your facility size and needs.
Ready to See It in Action?
Try AssistedCare free and see how it transforms your facility operations.