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What is going on with our Medicaid & Medicare money?  Are we getting paid everything that we should this month?

We hope you find this second part of our 3 part series on How To Ensure A Wildly Successful Business Office to be interesting and informative. Part 1 of our series, which deals with the Month End Process should interest you too.

Medicaid Billing

Depending on your facility, the billing for all your residents may occur on either a weekly or monthly basis.  For a facility billing monthly, the goal is typically to have the bills out on the first business day of the month.  For weekly billers, it is typically being done on the same day each week. The first task is to verify the accuracy of your census by payer. For many facilities, the Medicaid Billing makes up a large portion of the cash receipts for the month.  This means that it can make a big difference in cash collections if these bills don’t go out when they should.  You may now be billing your Medicaid residents to a Managed Care company, making the timeliness and accuracy of the claims even more critical.

You may also receive new Medicaid approvals throughout the month.  It’s great to get the approval, but the first question should be:

* “Has it been billed yet?”

Billing newly approved Medicaid residents right away will help lower the amount of time it takes to collect your money for that resident. It can also help, and lead to lowering your Days Outstanding (DSO).  Another opportunity for accelerating the collection cycle is to bill for your discharges right away.  When a resident has discharged, again the first question to the BOM should be:

“Has it been billed?”


Medicare Billing

The bulk billing of the Medicare claims typically occurs once a month.  Depending on your facility, this may be a huge part of your monthly cash collections.  Medicare takes about two weeks to process and pay on a clean claim.  So to get your money in the same month as it is billed, it is vital that these claims are billed in a timely and accurate manner.  A good goal for completing the Medicare billing is about the fifth business day of the month.


Getting the claims out this quickly means that your Business Office, Therapy and MDS departments must work together closely and smoothly.  In order to get the bills out, the Business Office needs to enter all of the charges for the month and needs to receive the therapy logs.  Also, all MDS assessments need to be completed for the month being billed.  Some claims may be held for late assessments, but most of the claims should be ready to be billed by the fifth business day of the month.


Before the claims can be sent, there should be an interdisciplinary review of the claims for accuracy and completeness.  This is often referred to as the “Triple Check” meeting.  At a minimum, this meeting should include the Business Office Manager, Director of Rehab and MDS Manager.  The Administrator should attend as well to ensure the meeting is accomplishing the objective of verifying the accuracy of the claims, and to make sure it progresses quickly.  If team members do not come to the meeting prepared, the meeting can drag on for an excruciatingly long period of time.   If everyone is prepared, you should be able to get through it spending approximately just a minute or so on each claim. We consider the Triple Check Meeting to be the first step in assuring you will have clean Medicare audits.

  •   Click here to see our blog about Triple Check Meetings

Once the Medicare claims are submitted, it will take a day or two for the claims to be visible in the Medicare DDE billing system.  This gives the Business Office Manager (BOM) the opportunity to fix any errors that may prevent payment for particular claims.  There are many different reasons for why a claim may error out or not pay.  Beware that initial,quick fixes may easily lead to the necessity of further corrections before getting paid.  It is very important for the BOM to monitor the DDE system for claim errors regularly.  Daily is ideal, but looking in DDE and following up at least 3 times a week should be adequate.  It is not unusual for BOMs and billers who are not able to get a claim fix to go through, and are reluctant to call Medicare to find out how to fix the problem.  It is important for them to show initiative in order to get paid. Ask your BOM,

* “Are you having trouble getting paid for any of this month’s claims?”

By about the second week of the month, they should be able to give the administrator a detailed status report for all of the month’s Medicare claims.  Anything without a payment date is fair game to ask,

*  “What is being done about it?”

If the answer is hazy, suggest they call Medicare or other available support.


We hope you enjoyed this installment of How To Ensure A Wildly Successful Business Office (part 2), please come back for part3.

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