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:

CPT code Description
Evaluation & Management
99324Domiciliary or rest home visit for E/M, new patient, low complexity
99327Domiciliary or rest home visit for E/M, new patient, moderate complexity
99334Domiciliary or rest home visit for E/M, established patient, low complexity
99337Domiciliary or rest home visit for E/M, established patient, high complexity
CPT code Description
Chronic care & Care Coordination 
99490Chronic care management, at least 20 minutes per month
99491Chronic care management, at least 30 minutes per month by a physician or other qualified healthcare professional
99487Complex chronic care management, at least 60 minutes per month
99489Additional 30 minutes of complex chronic care management
CPT code Description
Medication management & Diabetes self-management training
99605Medication therapy management, initial 15 minutes, new patient
99606Medication therapy management, initial 15 minutes, established patient
G0108Diabetes self-management training, individual session
G0109Diabetes self-management training, group session
CPT code Description
Physical Medicine & Rehabilitation services
97110Therapeutic exercises, per 15 minutes
97530Therapeutic activities to improve functional performance, per 15 minutes
97112Neuromuscular re-education, per 15 minutes
97535Self-care/home management training, per 15 minutes
CPT code Description
Advance care & Medicare annual wellness services
99497Advance care planning, first 30 minutes
99498Additional 30 minutes of advance care planning
G0438Annual wellness visit, initial visit
G0439Annual wellness visit, subsequent visit
CPT code Description
Nursing care at home
T1019Personal care services, per 15 minutes
T1020Personal care services, per diem
S9123Nursing care in the home, RN, per hour
S9124Nursing 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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