Home Care & SNF Billing and Revenue Cycle Management
We bill for every post-acute setting, every payer. From UB-04 and 837i claims to PDPM and PDGM coding, MA plan billing, AR follow-up, and denial appeals, Staffingly billers and coders work inside PointClickCare, MatrixCare, Net Health, Brightree, and HCHB. 800+ providers trust us. Pilot in 2 weeks.
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0:48Your AR is aging. Your denials are stacking up . Cash is slow.
Three quiet revenue leaks drain post-acute providers every month. Billers know it. Operators feel it in DSO. Most facilities cannot hire fast enough to keep PDPM, PDGM, and MA plan claims clean on the first pass.
Aged AR and slow cash
SNF AR over 90 days frequently sits above 25 percent of total AR at facilities without dedicated follow-up (LeadingAge 2024 RCM benchmarks). Every day a UB-04 sits is a day cash does not arrive.
Denials and rework loops
SNF and home health initial denial rates frequently run 10 to 15 percent on MA plan claims, and rework can consume 15 to 25 dollars per claim (MGMA 2024 denial benchmarks). Most never get re-billed within the appeal window.
PDPM, PDGM, and coding gaps
PDPM uses five case-mix components plus a variable per-diem adjustment (CMS 42 CFR 483). PDGM groups home health into 30-day periods with 432 case-mix combinations. One missed ICD-10 code can drop the HIPPS score and the reimbursement with it.
Tell us about your agency.
Send us your situation and our team will scope the right setup, usually within one business day. No obligation.
What is a home care and SNF billing and RCM service ?
A home care and SNF billing and RCM service is a remote billing team that works inside your software platform, follows your fiscal calendar, and treats your Medicare, Medicaid, and MA plan claims the way your in-house billing manager does. Not a generic offshore vendor. Not a coding-only outfit. A trained post-acute biller, coder, or AR follow-up specialist who happens to work from one of our secured facilities.
What your billing and RCM team actually handles, day to day
Pick the queues that hurt most. Your billing pod absorbs them. Your in-house business office focuses on resident admissions, payer relationships, and facility-level audits.
UB-04 and 837i claim submission
Builds, scrubs, and submits institutional claims for Part A, Medicaid, and MA plans. Tracks form locators, HIPPS codes, and revenue codes.
PDPM and PDGM coding
Five-component PDPM HIPPS coding for SNF Part A. PDGM 30-day period grouping for home health with LUPA threshold checks.
AR aging and follow-up
Works 0 to 30, 31 to 60, 61 to 90, and 90 plus AR buckets. Calls payers. Documents responses. Re-bills, escalates, or writes off with sign-off.
Denial management and appeals
Reads remits, identifies CARC and RARC codes, drafts appeal letters, and resubmits within the payer window. Tracks appeal-stage status.
Payment posting and ERA reconciliation
Posts ERA 835 files, reconciles to bank deposits, splits MSP and secondary balances, and flags underpayments against fee schedules.
Eligibility and Medicaid pending
Runs daily 270 and 271 eligibility checks. Tracks Medicaid pending applications with weekly state-portal updates and patient-due conversion.
RAC and TPE audit support
Responds to ADRs, packages medical records, tracks five-level appeal escalation, and logs audit findings for facility QAPI review.
RCM reports and KPIs
Daily clean-claim rate, denial rate by payer, DSO, AR over 90, cash collected, and net collection percentage. Owner-level summaries weekly.
Post-acute trained billers and coders, not generic offshore
Most outsourcing companies offer general medical coders and call them "billers." We do not. Our billing specialists are post-acute trained, PDPM and PDGM tested, and software-certified before they ever touch a live claim in your facility.
Post-acute trained, not generic
Every biller passes an assessment on UB-04 form locators, 837i transactions, PDPM HIPPS coding, PDGM periods, and at least one major platform from PointClickCare, MatrixCare, Net Health, or HCHB before placement.
Stacked compliance posture
HIPAA + SOC 2 Type II + ISO 27001 + HITRUST. Plus alignment with 42 CFR 424 conditions of payment and 45 CFR 164.514 de-identification rules. Ask your current vendor for proof of all four. We will wait.
2-Week Risk-Free Pilot
Industry offers no trial. We give you 14 days of live claim work at the same rate. Cancel before day 14, owe nothing. No annual contracts after.
Staffingly vs DIY in-house vs generic offshore vs onshore BPO
The real cost math for a single full-time biller or coder role at a mid-size SNF or home health agency.
From "let's talk" to live in 1 to 2 weeks
Six steps. Each one is documented. Nothing is mysterious.
Discovery call (15 min)
Tell us which billing pain is loudest. AR over 90? MA plan denials? PDPM coding gaps? Medicaid pending? We map it on a shared call. No prep needed from you.
BAA + platform access
Business associate agreement signed. Role-based access provisioned in PointClickCare, MatrixCare, Net Health, Brightree, HCHB, Kinnser, or SigmaCare.
Workflow shadow (2 to 3 days)
Your billing pod shadows your business office and corporate billing leads. Claim scrubs captured. Payer scripts matched. Escalation rules locked.
Parallel pilot starts
Week 2 to 3. Your billing pod runs alongside your team. Daily 15-minute sync. You see every claim submitted, every appeal drafted, every payment posted.
Decision point (end of week 2)
Pilot results reviewed. Go or no-go. No penalty if you cancel. Most facilities keep going.
Full handoff, cadence locked
Clean-claim rate, denial rate, DSO, and AR over 90 KPIs in your inbox. Weekly review with your account lead. Monthly QA audit. Expansion paths discussed.
How your billing pod's day actually looks
A real shift, hour by hour. Times shown in your local time. We rotate coverage so your facility billing desk is never dark during business hours.
Explore all home care & snf billing and revenue cycle management services
One Flat Weekly Rate. No Surprises.
Dedicated senior care schedulers at a fixed weekly cost. Per scheduler FTE, per week. No contracts, no minimums, no hidden fees.
Want to compare against an in-house hire? Use the savings calculator.
Frequently asked questions
How do you handle PDPM billing for SNF Part A?
PDPM (Patient-Driven Payment Model) replaced RUG-IV in October 2019 under 42 CFR 483. Our coders capture all five case-mix components (PT, OT, SLP, Nursing, NTA) plus the variable per-diem adjustment that ramps PT and OT down after day 20. We tie the HIPPS code to the 5-day MDS, monitor IPA triggers, and re-bill if a code change shifts the rate. NTA comorbidity capture alone often recovers 8 to 15 dollars per resident day when previously missed.
How is PHI and HIPAA handled across remote billers and coders?
Full HIPAA-aware workflow with signed BAA, role-based platform access, and audit logging under 45 CFR 164.514 de-identification rules where applicable. PHI never leaves the controlled environment. Billers work from biometric-secured facilities.
How do you handle UB-04 and 837i claims, and the CMS-1500 / 837P split?
The UB-04 and 837i are used for Part A inpatient SNF stays, home health 30-day periods, and hospice claims. The CMS-1500 and 837P are used for Part B therapy and physician services that fall outside SNF consolidated billing exclusions under 42 CFR 411.15. Our billers handle both transaction sets and reconcile the split where ancillary services must be billed separately from the Part A stay.
How does SNF consolidated billing work for outside providers?
SNF consolidated billing under 42 CFR 411.15 means most services for a Part A resident must be billed by the SNF, not by the outside provider. There is a published exclusion list (chemotherapy, certain radiology, ESRD services) that outside providers may bill directly. Our team maintains the current CMS exclusion list, reconciles outside-provider claims against the resident's Part A stay, and handles SNF-to-vendor pass-through billing where required.
What is included in the 2-Week Risk-Free Pilot?
Two weeks of live billing and RCM work running in parallel with your business office. Full reporting on clean-claim rate, denial rate, DSO movement, and AR over 90 reduction. No setup fee. No penalty if you cancel before day 14.
How do you appeal MA plan denials, and handle RAC and TPE audits?
For Medicare Advantage denials, we read the CARC and RARC codes on the 835 remit, identify the root cause (auth missing, medical necessity, level-of-care downgrade), draft the appeal letter with supporting MDS sections and physician orders, and submit within the payer's appeal window. For RAC and TPE audits, we respond to ADR letters, package the medical record, and track the five-level CMS appeal escalation from redetermination through Federal District Court if needed.
How does pricing work across multiple billers, coders, and facilities?
Per RCM specialist FTE, per week. Per-skill pricing for biller, coder, AR follow-up specialist, and denial analyst roles. No setup fees. $399 Standard, $349 Volume (3 or more), $299 Enterprise (10 or more). Add or remove specialists by the week. No annual contracts. Multi-state SNF and home health groups can pool specialists across facilities.
Can you work directly inside PointClickCare and MatrixCare, or do you require a separate system?
We work directly inside your EMR and billing platform. PointClickCare Financial Management, MatrixCare SNF and home health billing modules, Net Health Therapy and Wound, Brightree home health and hospice, HCHB, Kinnser, and SigmaCare are all native to our team. No data exports. No middleware. Your business office sees every claim, every note, every status change in real time inside the system you already use.
President and CEO, Staffingly, Inc. 25+ years in IT consulting and healthcare BPO operations. One of the earliest US operators to set up an RPO/BPO delivery network in India. Leads AI-driven home care workflows that help agencies, home health providers, and multi-branch operators cut admin cost without compromising care.
