Healthcare practice guide
Billing, Books, and Payroll for Skilled Nursing and Long-Term Care Facilities
Census-driven revenue, payer conversions, and a close that survives a cost report.
In skilled nursing, revenue is census times payer mix, and both move daily. A resident converting from Medicare to Medicaid pending, a therapy minute that was not captured, or an ancillary charge that never reached the claim all show up as a quiet reduction rather than a denial you can see.
Your practice
Set once — every healthcare tool below pre-fills from it and it stays with you for this visit.
- Days in A/R target
- Under 50
- Medicaid pending
- Under 60 days
- Bad debt
- Under 2%
Medicaid pending drives the tail
Average time from application to approval
Of annual net revenue
Where the money leaks
Payer conversion timing
Medicare-to-Medicaid conversions billed against the wrong payer for the overlap days.
Medicaid pending applications
Residents sitting pending for months with no one working the application to approval.
Uncaptured ancillaries
Therapy, pharmacy, and supply charges that never reached the claim before it dropped.
How we run it
- 1
Daily census reconciliation
Admissions, discharges, and payer changes captured the day they happen.
- 2
Triple-check before billing
Census, clinical, and charges verified together before the month drops.
- 3
Medicaid pending pipeline
Every pending application tracked to approval with a named owner and a date.
- 4
Ancillary capture
Therapy and pharmacy charges reconciled to the claim, not to the invoice.
- 5
Cost report ready close
Ledger mapped to cost report categories every month, not once a year.
Payers we bill every month
- Medicare Part A
- Medicare Advantage plans
- State Medicaid
- Managed long-term care plans
- Private pay residents
- Long-term care insurance
State rules we work under
Medicaid programs, payer portals, and payroll rules change at the state line. Pick your state for the specifics.
AHCCCS (Arizona Health Care Cost Containment System) · Phoenix, Scottsdale, Mesa
State billing detailMaineCare · Portland, Bangor, Lewiston-Auburn
State billing detailNJ FamilyCare · Newark, Jersey City, Princeton
State billing detailNorth Dakota Medicaid · Fargo, Bismarck, Grand Forks
State billing detailOregon Health Plan (OHP) · Portland, Salem, Eugene
State billing detailApple Health · Seattle, Bellevue, Tacoma
State billing detailTexas Medicaid · Houston, Dallas–Fort Worth, Austin
State billing detail