The nursing home often sends its residents a monthly charge for the services it has performed and the medical attention it has given. A contract is
signed by the resident (or their legal representative) and the nursing home. The contract provides information about the frequency of billing.
This bill primarily covers the cost of all essential services rendered. However, occasionally it also includes the cost of additional related services.
The billing frequency should be specified in the terms of your contract because most nursing homes bill residents (or the resident’s legal representative)
on a monthly basis for care. The cost of basic charges will be on the nursing home bill, but it also can contain the cost of auxiliary services. It's critical to understand the distinction. The intricacy of the care, the extent of the services, the style of room (private or semi-private), and other facilities will all affect the nursing home billing rate. The first billing statement should include a prorated cost for the month of admission, assuming the resident did not attend the healthcare facility on the first day of the billing cycle (the number of days spent in the facility x the rate for room and board). A "pre-bill" for the expense of the following month is another common feature of nursing care invoices; once more, some states will charge a tax on the entire bill amount. The sum remaining after deductions for Medicare/Medicaid, health insurance, and/or long-term care insurance will represent the amount payable by the resident.
Contact the county’s Department of Social Services (or another applicable department, depending on the state/county) if a resident’s available funds
are so low that they can only afford to pay for three more months of private nursing care. They ought to be able to offer a packet of details on what is necessary to apply for Medicaid. Be careful to inform the facility's social work department and/or billing office when you start the Medicaid procedure and keep them informed of any status updates you receive. This application process is complicated and can take three months or longer to complete.
Make sure to inform the nursing home whether your loved one has long-term care (LTC) insurance when they are first hospitalized. While some
LTC carriers will pay the nursing home directly, the majority of these policies will make payments on the policy directly to the resident (policy holder). Ask the billing office if they will monthly submit the invoices for nursing care services straight to the policy carrier if this is the case with your loved one's coverage to save you time and hassle. The resident is now liable for any costs that are not covered by the insurance. Keep in mind that the majority of long-term care insurance plans do not cover state taxes imposed on the entire month's balance.
It is crucial to know how such leaves of absence will be handled because residents occasionally need to leave the healthcare facility briefly for
either personal or medical reasons.
A bed hold waiver is typically signed by the person being admitted to the nursing facility (or their representative) and states that the nursing home will reserve the resident's room during any absences. But be aware that this agreement also provides the provider permission to privately bill the resident for room and board, as well as any state tax assessments, on a per-day basis while the person is not present at the facility. The resident will be discharged and their room in the care facility won't be held if a bed hold agreement isn't completed and they take a leave of absence from the center.
Assigning the appropriate codes to medical diagnoses, treatments, and procedures is the primary duty of a nursing home medical coder.
They will typically need to examine the medical records and charts of the patients in order to achieve this. Then, for the purpose of invoicing and insurance, they will choose and assign the most precise medical codes.
Nursing home medical coders use a few standard categories of medical codes, just like other types of medical coders. These include codes that serve as diagnoses, such as ICD and DRG codes from the International Classification of Diseases. It is also possible to use Current Procedural Terminology (CPT) codes, which are used to describe specific medical operations and treatments.
The employer will often decide how much experience is required to work as a nursing home medical coder. A few nursing homes might take into consideration hiring medical
coders with little to no experience, but the majority favor candidates with at least a year or more of experience. So, MD CAVE has a dedicated team of experts along with mentors to minimize billing and coding errors and pull out maximum reimbursement.