Specialities
Assisted Living Facility
Assisted Living Facilities (ALFs) provide essential care services, including personal care assistance, medication management, and specialized support for residents with chronic conditions or disabilities. The billing process for ALFs is complex, as it involves multiple payer sources, including private pay, Medicaid, long-term care insurance, and managed care organizations. Unlike traditional medical billing, ALF billing often requires detailed documentation of services provided, eligibility verification, and compliance with state-specific Medicaid requirements.
The nuances of ALF billing include variations in reimbursement for daily living assistance, medication administration, therapy services, and skilled nursing care. Additionally, facilities must navigate the challenges of Medicaid waiver programs, level-of-care assessments, and evolving payer regulations. Ensuring accurate and timely billing is critical to maintaining the financial health of an assisted living facility.
At OceanStack, we understand the unique complexities of ALF billing and offer customized solutions to help facilities maximize revenue while staying compliant. Our expert team manages everything from verifying resident eligibility and submitting clean claims to handling Medicaid billing, appeals, and reimbursements. We stay updated on regulatory changes, ensuring that your facility is always in compliance with payer requirements.
Our comprehensive Revenue Cycle Management (RCM) services provide ALF administrators with real-time financial insights, detailed reporting, and proactive claim management. With OceanStack handling your billing operations, your facility can focus on delivering quality care to residents while ensuring a steady and optimized revenue flow.
Below are some of the commonly used CPT codes that our customers in the field of Assisted Living Facility use:
| 99324 | Domiciliary or rest home visit for E/M, new patient, low complexity |
| 99327 | Domiciliary or rest home visit for E/M, new patient, moderate complexity |
| 99334 | Domiciliary or rest home visit for E/M, established patient, low complexity |
| 99337 | Domiciliary or rest home visit for E/M, established patient, high complexity |
| 99490 | Chronic care management, at least 20 minutes per month |
| 99491 | Chronic care management, at least 30 minutes per month by a physician or other qualified healthcare professional |
| 99487 | Complex chronic care management, at least 60 minutes per month |
| 99489 | Additional 30 minutes of complex chronic care management |
| 99605 | Medication therapy management, initial 15 minutes, new patient |
| 99606 | Medication therapy management, initial 15 minutes, established patient |
| G0108 | Diabetes self-management training, individual session |
| G0109 | Diabetes self-management training, group session |
| 97110 | Therapeutic exercises, per 15 minutes |
| 97530 | Therapeutic activities to improve functional performance, per 15 minutes |
| 97112 | Neuromuscular re-education, per 15 minutes |
| 97535 | Self-care/home management training, per 15 minutes |
| 99497 | Advance care planning, first 30 minutes |
| 99498 | Additional 30 minutes of advance care planning |
| G0438 | Annual wellness visit, initial visit |
| G0439 | Annual wellness visit, subsequent visit |
| T1019 | Personal care services, per 15 minutes |
| T1020 | Personal care services, per diem |
| S9123 | Nursing care in the home, RN, per hour |
| S9124 | Nursing care in the home, LPN, per hour |
Our Services
CREDENTIALING
& LICENSING
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MEDICAL BILLING
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FRONT OFFICE SUPPORT
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CODING
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ANALYTICS & REPORTING
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REVENUE CYCLE MANAGEMENT
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DENTAL BILLING
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