Assisted Living Billing Services
Private pay, HCBS waiver, and level-of-care charges. Our ALF billers separate room-and-board from Medicaid HCBS waiver payments, manage level-of-care charge tiers, bill ancillary services, and handle state-specific waiver portals. Trained inside PointClickCare ALF, MatrixCare AL, ECP, and Eldermark.
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0:48Private pay, HCBS waivers, and level-of-care tiers do not bill alike.
Assisted living revenue moves on three rails that almost never reconcile cleanly. The resident agreement, the state Medicaid HCBS waiver portal, and the level-of-care assessment each have a different cycle, payer, and rule set.
Room-and-board confusion
Medicaid HCBS waivers cover personal care services but not room-and-board. ALF operators must separate the room-and-board portion (resident or family pays) from the waiver-covered services. Misallocation triggers waiver clawbacks during state audits.
Level-of-care charges missed
Most ALFs use a tiered level-of-care charge model (base, plus, max, memory care) tied to a resident assessment. When the assessment updates and the charge tier does not, the operator absorbs the higher acuity at the lower rate, often for months before it surfaces.
State waiver portal variance
Every state Medicaid HCBS waiver uses a different portal, billing form, claim cycle, and audit policy. Florida, Texas, Pennsylvania, New York, and California each run separate programs. One ALF biller cannot keep up with multi-state operations without daily portal coverage.
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What is an assisted living billing service ?
An assisted living billing service is a remote billing team that works inside your ALF EMR, separates the resident agreement private-pay charges from the Medicaid HCBS waiver portion, builds level-of-care charge tiers against the resident assessment, bills the state waiver portal on its own cycle, posts ancillary services and pharmacy charges, and reconciles every resident ledger month-over-month. Not a generic medical biller. An ALF-trained specialist who understands HCBS waivers, the room-and-board split, and the resident agreement billing structure.
What your ALF billing pod handles, day to day
Pick the queues that hurt most. Your ALF pod absorbs them. Your in-house team focuses on resident care, sales tours, and resident agreement updates.
Monthly resident statements
Generates resident or responsible-party statements with room-and-board, level-of-care tier, and ancillary charges itemized for each cycle.
Level-of-care tier updates
Reads the resident assessment, applies the right charge tier (base, plus, max, memory care), and retroactively adjusts if the assessment was late.
Room-and-board separation
Splits the resident agreement into the room-and-board portion (private pay) and the waiver-covered portion (Medicaid HCBS). Reconciles monthly.
HCBS waiver claim submission
Submits claims to state Medicaid HCBS waiver portals: FL SMMC, TX STAR+PLUS, PA CHC, NY ALP, CA ALW, and other state-specific programs.
Ancillary charge posting
Posts med-tech, salon, meals, transportation, and incidentals. Splits between resident liability and waiver coverage where applicable.
Medicaid pending tracking
Tracks Medicaid HCBS waiver applications through state caseworker review. Posts patient liability against family pay during pending status.
Payment posting and reconciliation
Posts family pay (check, ACH, autopay), waiver EFT deposits, and Long-Term Care insurance payments. Reconciles to bank statement weekly.
RCM reports and KPIs
Daily resident occupancy with level-of-care mix, waiver percent of revenue, days outstanding on family-pay AR, and ancillary capture rate.
ALF trained billers, not generic medical coders
Most outsourcing companies offer general medical coders and call them ALF billers. We do not. Our ALF specialists are tested on HCBS waiver rules, the room-and-board split, level-of-care charge tiers, and at least one platform from PointClickCare ALF, MatrixCare AL, ECP, Eldermark, or ALIS before placement.
ALF trained, not generic
Every biller passes an assessment on HCBS waiver mechanics, room-and-board separation, level-of-care tier billing, multi-state waiver portals, and at least one ALF platform before placement.
Stacked compliance posture
HIPAA + SOC 2 Type II + ISO 27001 + HITRUST. Plus alignment with state assisted living licensure rules and 45 CFR 164.514 de-identification rules. Ask your current vendor for proof of all four.
2-Week Risk-Free Pilot
Industry offers no trial. We give you 14 days of live ALF billing 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 ALF biller role at a mid-size assisted living operator.
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 ALF pain is loudest. Family-pay AR? HCBS waiver denials? Level-of-care tier mismatches? Ancillary capture? We map it on a shared call.
BAA + platform access
Business associate agreement signed. Role-based access provisioned in PointClickCare ALF, MatrixCare AL, ECP, Eldermark, ALIS, or Yardi Senior.
Workflow shadow (2 to 3 days)
Your ALF pod shadows your business office and care leadership. Resident agreement structure captured. State waiver portals accessed. Escalation rules locked.
Parallel pilot starts
Week 2 to 3. Your ALF pod runs alongside your team. Daily 15-minute sync. You see every statement generated, every waiver claim filed, every assessment tier update.
Decision point (end of week 2)
Pilot results reviewed. Go or no-go. No penalty if you cancel. Most communities keep going.
Full handoff, cadence locked
Resident occupancy mix, waiver percent, family-pay days outstanding, and ancillary capture rate KPIs in your inbox. Weekly review with your account lead.
How Staffingly works, in practice
Inside the workA trained Staffingly specialist works inside your existing platform, with clear escalation back to your team.
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 is private-pay billing structured at an assisted living community?
Private-pay billing follows the resident agreement: a fixed monthly room-and-board charge, a tiered level-of-care charge based on the resident assessment, and ancillary services such as med-tech, salon, meals, and transportation. Residents or responsible parties pay monthly. Long-term care insurance often reimburses part of the level-of-care portion after the elimination period.
How does HCBS waiver billing work for assisted living?
Medicaid HCBS waivers cover personal care, supervision, and other services for Medicaid-eligible residents in assisted living. Each state runs its own waiver program (FL SMMC, TX STAR+PLUS, PA CHC, NY ALP, CA ALW) with its own portal, billing form, and claim cycle. HCBS waivers do not cover room-and-board, which must be paid by the resident, family, or SSI.
How do you handle state variations in waiver billing?
Every state Medicaid HCBS waiver runs on a different portal and claim cycle. Our ALF billers are trained on FL SMMC LTC, TX STAR+PLUS Waiver, PA Community HealthChoices, NY Assisted Living Program, CA Assisted Living Waiver, NJ MLTSS, IL Supportive Living Program, and OH MyCare Ohio. For multi-state operators we assign state-trained billers to each portal.
How are level-of-care rate steps calculated and updated?
Most ALFs use a tiered charge model (base, plus, max, memory care) tied to a resident assessment of ADLs, cognition, behaviors, and clinical needs. The assessment is done at move-in, every 90 days, and after significant change. When the assessment moves the resident to a higher tier, the charge moves on the next billing cycle and a retroactive adjustment may be posted.
How do you bill ancillary services at an ALF?
Ancillary services include med-tech, salon, meals beyond the base plan, transportation, special diets, and incontinence supplies. We post ancillary charges by resident and service date against the resident ledger. For HCBS waiver residents we split between waiver-covered services and resident-liability charges. Monthly statements itemize every ancillary charge.
How is HIPAA handled across remote ALF billers?
Full HIPAA-aware workflow with signed BAA, role-based platform access in PointClickCare ALF, MatrixCare AL, ECP, Eldermark, ALIS, or Yardi Senior, and audit logging under 45 CFR 164.514 de-identification rules where applicable. PHI never leaves the controlled environment.
How does pricing work for assisted living billing?
Per ALF specialist FTE, per week. Per-skill pricing for biller, coder, AR follow-up specialist, and waiver-portal 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.
What is included in the 2-Week Risk-Free Pilot for assisted living billing?
Two weeks of live ALF billing and RCM work running in parallel with your business office. Full reporting on resident occupancy and level-of-care mix, waiver percent of revenue, family-pay days outstanding, ancillary capture rate, and waiver claim acceptance rate. No setup fee. No penalty if you cancel before day 14.
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.
