Our Comprehensive Geriatrics Billing Services
Managing billing for geriatric care can be complex, but it doesn’t have to be stressful. Our geriatrics billing services simplify the process, ensuring that senior care practices get paid accurately and on time.
From handling insurance claims and Medicaid billing to managing denials and audits, we take care of all the financial details so providers can focus on what matters most—their patients. With our expertise, every claim is submitted correctly, errors are minimized, and payments are tracked efficiently.
Our team works closely with your practice to streamline revenue cycle management, improve cash flow, and maintain compliance with healthcare regulations. Let us handle the billing so your geriatric practice can thrive while delivering exceptional care to older adults.
Geriatrics Payer Rules We Manage
Older patients move between the office, home, nursing facilities and hospice, and many have both Medicare and Medicaid. These are the payer rules we manage beyond the codes, and that our billing audits check most often:
Dual-eligible and QMB patients
What it means: Patients in the Qualified Medicare Beneficiary program can’t be billed for Medicare deductibles or coinsurance. The balance goes to Medicaid as the secondary payer.
How we handle it: We flag QMB status at eligibility checks, send crossover claims to Medicaid, and keep these balances off patient statements.
Medicare Advantage plans
What it means: Medicare Advantage plans set their own networks, authorization rules and filing limits, which differ from Original Medicare.
How we handle it: We confirm whether each patient has Original Medicare or an Advantage plan before every visit, and follow that plan’s rules.
Skilled nursing facility stays
What it means: During a Medicare Part A stay in a skilled nursing facility, most services such as labs, imaging and supplies are billed by the facility under consolidated billing. Physician professional services are still billed to Medicare by the physician.
How we handle it: We check whether the patient is in a covered stay, bill only the professional services, and send the rest to the facility.
Home health certification
What it means: Physicians bill G0180 for certifying a home health plan of care and G0179 for recertification, after a face-to-face visit. Care plan oversight (G0181) needs at least 30 minutes in a month.
How we handle it: We confirm the face-to-face visit and signed plan of care are on file, and track oversight time each month.
Hospice patients
What it means: When a patient is in hospice, care related to the terminal illness is paid through the hospice. The attending physician who isn’t employed by the hospice bills with modifier GV, and care for unrelated conditions is billed with GW.
How we handle it: We check hospice status before billing, and add GV or GW only when the note supports it.
Screening frequency limits
What it means: Medicare limits how often screenings are covered, such as bone density tests (77080) every 24 months for most patients.
How we handle it: We check the date of the last screening before the test, and use an ABN when the test may not be covered.
A Common Geriatrics Denial and How We Fix It
Example: an office visit denied for a hospice patient
The denial. A geriatrician sees a patient for a urinary tract infection, and the claim is denied with CARC B9 (patient is enrolled in a hospice).
How we fix it:
- Check the hospice diagnosis. We confirm the patient’s hospice election and the terminal diagnosis.
- Decide related or unrelated. If the visit was for a condition unrelated to the terminal illness, we add modifier GW. If the physician is the patient’s attending physician and not employed by the hospice, we add modifier GV.
- Correct and resubmit. We send a corrected claim with the right modifier and diagnosis, or bill the hospice when the care is related and the physician works under its agreement.
- Prevent the next one. We check hospice status for every patient before the visit is billed.
Example: an X-ray denied during a nursing facility stay
The denial. A portable X-ray for a resident is billed to Medicare during a covered Part A stay and denied as included in the facility’s payment under consolidated billing.
How we fix it: we confirm the stay dates. If the service was during a covered stay, the facility pays for it under its agreement, so we bill the facility instead of Medicare. If the stay had ended, our denial management team sends the discharge date with an appeal. Going forward, we get stay dates from each facility we bill for.
Why Healthcare Providers Choose Prospect Healthcare Solutions
Geriatric Billing Experience
Our company is a specialist in geriatric healthcare billing, where we are aware of the special needs of the elderly. We have a team to check the correct coding, timeliness of claim filing, and consideration of Medicare and insurance requirements, and make the most reimbursements possible and efficient/reliable geriatric practices.
Customized Solutions
All geriatric practices are unique, and so are their billing requirements. Our offerings are customized to meet your workflow, patient volume, and mix of insurance. Our customized philosophy means that we provide the correct billing, quicker claims handling, and end stability of your practice.
Technological Innovation
We also use the most current billing software and automation to optimize your revenue cycle. With our technology, you can have accurate coding and reporting, as well as manage patient data safely in real time, making your practice remain efficient, compliant, and a leader in geriatric billing processes.
Claim Denial Management
We actively monitor and fix claim rejections and find the common problems, and amend them before submission. Your geriatric practice loses less revenue, gets a better cash flow, and the reimbursements it rightfully deserves without undue delays, as our complete process of following up with your insurance companies.
Compliance and Accuracy
We are very compliant with HIPAA, Medicare, and insurance laws. Our billing department checks each and every claim twice, which minimizes the chances of being audited or fined. Our services will ensure that your practice complies and maximizes revenue.
Dedicated Support Team
In addition, we have a professional support team that is always ready to answer questions, offer assistance, and address billing issues promptly. We establish long-term relationships with practices, smooth communication, dependable service, and tranquility for your geriatric healthcare business.
Geriatrics Codes for Wellness Visits, Cognitive Assessment and Care Planning
Geriatric billing is mostly Medicare, with services built around prevention, chronic conditions and care in different settings.
| Service | Codes and rules | What we check |
|---|---|---|
| Annual wellness visits | G0438 initial and G0439 subsequent Medicare annual wellness visits | The 12-month frequency limit is checked |
| Cognitive assessment | 99483 cognitive assessment and care planning | All required elements, including a standardized tool and care plan, are documented |
| Chronic and transitional care | 99490 and 99439 chronic care management; 99495 and 99496 transitional care management | Consent, time and contact dates are documented |
| Advance care planning | 99497 and 99498, billed with or without the annual wellness visit | Time and the discussion are documented |
| Visits outside the office | 99341–99350 home or residence visits; 99304–99310 nursing facility care | Place of service matches where the patient was seen |
| Medicare secondary payer | Medicare may pay second to employer coverage, Medigap or other plans | Coordination of benefits is checked before claims go out |
Geriatrics Billing FAQs
What is the difference between G0438 and G0439?
G0438 is the first Medicare annual wellness visit and G0439 is each one after that. Both are allowed once every 12 months.
Can advance care planning be billed with an annual wellness visit?
Yes. When provided at the annual wellness visit, Medicare waives the patient's cost share for advance care planning (99497).
How are visits to assisted living residents billed?
With the home or residence visit codes 99341–99350 and the place of service for where the patient lives.
Get Started with Expert Geriatric Billing Services
Do you have questions regarding our Geriatrics Billing Services, or would you like to know how we can help your practice to maximize revenue? Contact us today! We have a team of skilled experts who are willing to take you through all the billing process, including checking of insurance and claim filing, handling of denials, and audit.
Our team is accessible to every single need of your practice, whereby we deliver customized services where billing is accurate and payment is faster, thereby lessening the administrative workload. You can be a small clinic or a big geriatric care facility; either way, we are going to streamline your billing process without any stress. Contact us today and receive professional help and embark on the journey to a more effective and profitable practice.
Prefer to talk? Call +1 (469) 935-4617 or visit our contact page.