Medicare Part A & B Billing
Expert Medicare billing for Illinois skilled nursing facilities from admission through final claim, every dollar verified, tracked, and collected.
Our Services
Additional Details
Tell us about your facility’s Medicare billing needs or specific concerns.
Comprehensive Medicare Billing for Illinois SNFs
Our Medicare Part A and Part B billing program is designed to protect your facility’s reimbursement at every stage — from admission through final claim submission. We combine deep PDPM expertise with a rigorous three-step verification process, ensuring every claim is clean, compliant, and submitted with the documentation payers require.
Illinois skilled nursing facilities face one of the most complex Medicare billing environments in the country. Between PDPM case mix management, consolidated billing requirements, benefit period monitoring, and the growing complexity of Medicare Advantage adjudication — every detail matters. LTC Billing handles the entire Medicare revenue cycle so your team can stay focused on resident care, not claim status calls.
What’s Included
Admission & Eligibility Verification
We confirm Medicare Part A eligibility, benefit period status, and SNF level-of-care requirements before the first claim is ever submitted preventing denials at the source
PDPM Case Mix & MDS Coordination
We work directly with your MDS coordinator to review assessment timing, capture all relevant clinical conditions, and ensure your PDPM payment rate accurately reflects each resident's acuity.
Consolidated Billing Compliance
All Part B services included in the consolidated billing bundle are managed and tracked eliminating the risk of duplicate billing, unbundling errors, and costly Medicare overpayment recoupments.
Benefit Period & Medicare Day Tracking
We monitor benefit period utilization, coinsurance day thresholds, and Medicare Advantage coordination so your team is never caught off guard by coverage gaps or unexpected coverage endings.
Denial Management & Medicare Appeals
Every Medicare denial is reviewed, corrected, and resubmitted or appealed within 24 hours — with full documentation, ALJ appeal experience, and persistent follow-through on every balance.
Our Process
01
Admission Review & Eligibility Confirmation
We verify Medicare Part A eligibility, benefit period status, and SNF level-of-care requirements before the first claim is submitted.
02
PDPM Assessment & MDS Claim Mapping
We map each resident’s PDPM classification to the MDS schedule and flag undercoded conditions before the claim is finalized.
03
Triple-Verified Claim Submission
Every claim is verified for eligibility, coding accuracy, and payer requirements before electronic submission.
04
Payment Posting & Denial Follow-Through
ERA remittances are posted daily and every denial is reviewed, corrected, and resubmitted within 24 hours.
Why Specialized Medicare Billing Matters for Illinois SNFs
Medicare Part A is typically the highest-revenue payer in a skilled nursing facility — and the most complex to bill correctly. PDPM reimbursement is driven entirely by MDS documentation, meaning a single missed diagnosis code or an incorrectly timed assessment can reduce your payment rate by hundreds of dollars per resident per day. For a facility with 100 residents, even a 5% coding gap translates to tens of thousands of dollars in lost monthly revenue that is nearly impossible to recover after the fact.
For Illinois SNFs, Medicare billing complexity is compounded by consolidated billing rules, the growing volume of Medicare Advantage plans with non-standard policies, and IDPH survey findings that can trigger additional payer scrutiny. LTC Billing’s Medicare specialists understand these dynamics at the operational level — because our team has worked directly inside Illinois SNF billing departments. We do not just submit claims. We protect your entire Medicare reimbursement stream from admission through final payment.