• Revenue Cycle is the heart behind the Financial health of your Practice, never compromise on the people working on it

Streamlining the Billing Operations of Nursing Homes with a Focus on Efficiency, Accuracy, & Compliance

In the ever-evolving landscape of healthcare, nursing home billing codes play a vital role in providing care for the elderly and individuals with complex medical needs. Running a nursing facility, however, requires medical staff to stay focused on the core aspects of patient care, making it difficult for the management to deal with their coding and billing processes. Outsourcing your administrative side of your long-term care facility with skilled nursing collections experts is the perfect way to simplify your medical billing and optimize your workflow.

Speak to us Today For Free Billing Analysis

Nursing Home Billing Codes

We at Wise Medical Billing understand that nursing facilities require more than standard billing services. That’s why we offer specialized solutions to help them maximize their reimbursement and streamline their workflow.

With years of hands-on industry experience, we have the expertise and knowledge to tactically navigate the complexities of nursing home billing codes, regulations, and payer requirements.

Irrespective of the size and scope of services of your facility, we offer flexible solutions to help you improve your performance, enhance patient care, and ensure regulatory compliance.

From coding accuracy to payment posting and denial management to final payment reconciliation, we optimize every stage of the revenue cycle to ensure maximum compliance.

Get Full Reimbursement for the Compassionate Care You Provide

We code accurately to ensure that you get paid promptly for the services you provide and create a healthy cash flow for your business. By delegating the financial side of your business to us, you can breathe easy knowing that your finances are always on the right track.

medical-management-services-in-the-US

Claim Submission

We utilize state-of-the-art EHR systems and billing software to streamline the billing processes of nursing facilities. Our expert coders ensure timely and accurate submission of claims to Medicare, Medicaid, and private insurance providers to maximize cash flow and expedite reimbursement.

We precisely code each claim and then track it until it is successfully reimbursed to the facility.

Coding and Documentation Review

We meticulously review clinical documentation to ensure accurate coding and compliance with regulatory guidelines. Our extensive industry expertise helps us minimize the risk of errors and denials and optimize revenue capture for nursing facilities.
We leverage our expertise in long-term care billing codes to minimize the likelihood of errors and claim denials and optimize revenue capture for nursing home billing codes.

Compliance Audits & Consulting

The intricacies involved in staying fully compliant with the rules and regulations and the lack of knowledge can lead to claims denials which may cause payment delays.
We conduct regular audits to compliance audits and provide consulting services to help nursing home billing codes ensure that they are always fully compliant with regulatory requirements.

Dedicated Account Management

We assign a dedicated account manager to each of the nursing facilities we serve. The manager acts as a primary point of contact, working closely with you to understand your unique needs and provide the support you need to optimize your billing processes.

Choose WMB as Your Billing Partner and See Revenues That You Haven’t Achieved in Years!

Trust us to handle your nursing home billing, and experience the difference that our qualified professionals can make for your facility.
Transparency
We believe in upholding the highest degree of transparency in everything we do. Our experts work on the software provided by our clients to ensure that they are always able to access to the information they need. It helps them achieve reliable cash flow and efficiency throughout their revenue cycle.
Communication
Our experts provide clear and open communication to nursing home billing codes, keeping them informed of their billing status and revenue performance. Our detailed reporting and analytics enable facilities to make informed decisions and track progress toward their financial goals.
Specialized Expertise
Our qualified billing professionals possess extensive experience and knowledge in the long- term healthcare care industry. This enables us to deliver accurate and efficient billing services tailored specifically to their unique needs.

Accessibility

We understand that nursing home billing codes should be able to reach out to us for assistance when they need it most. That’s why our representatives are standing by 24/7 through email and phone call. There is no need to open a support ticket and spend days waiting for someone to get back. We address the queries of our clients in record time.

Achieve the Financial Health Your Deserve with WMB

While you concentrate on the core aspects of patient care, let us handle the complexities of your billing professionally and efficiently.  
Reach out to us today to discover more about what we can do to streamline your financial operations and maximize your profitability.
wmb-medical-management-services-necessary-preauthorization-icon
What Can Happen if You Don't Get Necessary Preauthorization?

When services are provided without expected preauthorization, what happens next depends on the insurer and the specific policy under which the patient is covered. Some insurance plans state that if a patient seeks services requiring preauthorization, but doesn’t obtain preauthorization, the patient is liable for covering the payment. If a provider neglects to obtain preauthorization and payment is denied by the insurer, it may come down to absorbing the cost of the treatment or trying to collect it directly from the patient, neither of which are good options.

The burden of obtaining pre-authorizations is on the provider because patients don’t know CPT codes and may not know when preauthorization is (or might be) required. Double-checking up front whether preauthorization is required may take some extra time on the front end, but with WMB teams of experts, it can save significant time trying to chase down claims and payments and prevent having to absorb costs for procedures that weren’t preauthorized.

wmb-medical-management-services-benefits-of-using-it
Benefits of using WMB Prior-Authorization Services:

Pre-approval processing can typically take several days, but a proactive team like WMB can help reduce the time it takes to obtain and process pre-approval.

With WMB (Wise Medical Billing) Team,

  • Lower staffing burnout
  • Maximize profit
  • Fast claims processing
  • Reduced denials and rejections
  • Timely payments
  • Patient Satisfaction

Please do not hesitate to contact us today for a quick call consultation or a demonstration of our services with nursing home billing services.

1-(888) 816-6676

Ask any question

Injection & Pain Management

We provide compliant billing for foot injections, nerve blocks, and pain management procedures with accurate documentation and proper modifier usage.

Advanced Treatments

We handle advanced podiatric treatments with proper prior authorization management and comprehensive clinical documentation for high-value services.

Nail & Skin Procedures

We ensure accurate coding for nail debridement, callus removal, and skin lesion treatments with proper medical necessity justification and frequency compliance.

Surgical Procedures

We manage complex podiatric surgeries with accurate modifier usage, justified gaps between claims, and transparent timeframe documentation for all procedures.

Diabetic Care Management

We coordinate diabetic foot care services with proper medical necessity documentation and systematic condition correlation for comprehensive treatment.

Orthotic Services

We provide specialized billing for custom orthotics and devices, ensuring proper HCPCS and ICD-10 code pairing to justify fitting and delivery documentation.

Routine Care & Diagnostics

We handle routine foot care according to strict medical necessity criteria, ensuring precise paperwork and accurate coding for debridement and mycotic nail care, with proper frequency documentation.

Wound Care Partnerships

We provide accurate code coordination to prevent overlapping, ensure transparent tracking for pre- and post-surgical services, and deliver complete operative notes with reduced errors.

Graft & Skin Substitute Procedures

We select accurate application and graft codes based on location and wound size, audit surgical documents to ensure correct Q-code pairing for procedures and supplies, and assist in navigating state-specific Medicaid nuances through proactive prior authorization.

DME Billing

Robust compliance for orthotics, diabetic shoes, walking boots, and offloading devices. We ensure that certified coders are used for accurate coding and a perfect match for every claim. We evaluate the signature requirements of every payer and employ proactive strategies for expedited prior authorization.

Injection Therapies

We handle foot injection procedures with accurate MCO compliance, ensuring proper documentation and modifier usage for maximum reimbursement in the NY market.

Nail & Skin Care

We provide compliant billing for nail debridement and skin lesion procedures, meeting eMedNY-specific documentation requirements and ensuring proper medical necessity justification.

Advanced Treatments

We manage advanced podiatric treatments with NY-specific requirements, ensuring proper Q-code usage, comprehensive clinical packets, and expedited prior authorization processes.

Diabetic Care Management

We coordinate diabetic foot care services with wound care partnerships, ensuring proper documentation and transparent billing coordination for all involved providers.

Surgical Procedures

We handle complex podiatric surgeries with MCO coordination, ensuring accurate service sequencing and proper documentation to prevent overlapping claims and denials.

Orthotic Services

We provide specialized eMedNY-compliant orthotic billing with precise HCPCS coding, accurate ICD-10 pairing, and comprehensive modifier knowledge for maximum reimbursement.

Routine Care & Diagnostics

We ensure eMedNY compliance for routine foot care services with systematic condition documentation, proper modifier alignment, and comprehensive medical necessity justification for all procedures.

Graft & Skin Substitute Procedures

We prepare comprehensive clinical packages for fast approval, ensure thorough compensation for graft products and application, and prevent claims denials through accurate coding and correct submission.

Wound Care Partnerships

We provide accurate code coordination to prevent overlapping, ensure transparent tracking for pre- and post-surgical services, and deliver complete operative notes with reduced errors.

DME Billing

NY Medicaid’s top coverages include diabetic shoes and inserts, ankle-foot orthoses, braces, and custom-molded orthotics. We ensure eMedNY compliance through precise documentation, proper ICD-10 coding, and in-depth knowledge of modifiers to prevent denials.

Robotic Procedures

We deal with complex billing for radical prostatectomy, partial nephrectomy, and cystectomy by elaborative documents for the used devices. Our accurate codes and modifiers ensure successful approvals.

Telehealth

Our coders ensure accuracy for pre-op consultations, follow-ups, and LUTS/OAB management. Our optimized POS and use of modifiers have lower denial rates, as we demonstrate their necessity with clinical documents.

Urodynamics & Diagnostics:

We handle multi-channel involvement and billing complications with detailed CPT/ICD pairing. Our proactive prior authorization handling and expert claim structuring ensure error-free approvals.

Cystoscopy & Endoscopy:

We capture every detail and require evidence to ensure a smooth claim approval for office-based and hospital-based endoscopic procedures. We offer robust billing claims for biopsies and stone removals.

Lithotripsy (ESWL) & Stone Management:

We understand the complex bundling of ESWL, URS, and stone procedures, including device charges, anesthesia, and supplies for ongoing care. This in-depth knowledge ensures coding accuracy for each component.

Prostate Procedures & Biopsy:

We offer meticulous billing for targeted biopsies and imaging-guided prostate procedures, ensuring proper coordination of involved pathology and detailed capture of all allowable charges.

Implants & Prosthetics

We strictly follow the payer’s rules for high-value penile prostheses and testicular implants, ensuring proper coverage for device charges. Our coders ensure proper coding pairs, transparent vendor contracts, and logs for implants.

Pathology & Imaging

Our team possesses in-depth knowledge of the working principles of pathology and imaging centers. We collaborate with service providers to obtain accurate clinical information, ensuring that we capture all allowable charges.

Botox & Neuromodulation

For these complex services, we provide thorough coverage by handling prior authorization approvals and ensuring coding accuracy for both trial and permanent procedures. Our modifier’s accuracy provides high compliance with diverse payer requirements.

DME & Catheter Supplies:

We provide streamlined billing claims for catheter and drainage bag supplies, ensuring smooth and timely payment collections. Our proof-of-delivery and proactive SOPs save practices from financial loss.

DME & Catheters

We handle catheter supplies, ongoing maintenance claims, and billing for incontinence aids. We complete clinical documents with proof of need, supply evidence, and other supporting elements according to Medicaid requirements.

Pathology & Advanced Imaging

Outpatient labs and imaging services face facility-based billing cuts due to poor classification. We manage all complexities with professional splits and ensure compliant claims for radiology reads and pathology services.

Botox & Neuromodulation

We perfectly align the trial with a permanent implant and explain all stages with accurate codes. Our precise and error-free claim submission ensures maximum reimbursement for all elements.

Implants & Prosthetics

We offer support for commercial or Medicaid billing claims through transparent device tracking, fair vendor contracts, and compliant pre-auths, resulting in the successful implantation of penile prostheses, urinary sphincters, or slings.

Prostate Procedures & Biopsies

Pairing of biopsies with MRI-guided prostate means additional care for billing documents. These coordinated services required accurate pathology linking, ensuring that our robust component captures the necessary information.

Lithotripsy & Stone Procedures

We offer coding accuracy from ESWL to ureteroscopy by managing compliant documents for anesthesia, professional components, and prior authorization for such high-value services.

Cystoscopy & Endoscopic Interventions

Our technical expertise ensures billing accuracy for stent removals, cystoscopy, and facility-based endoscopy procedures. We separate each component of treatment to bring payment for all.

Urodynamics & Pelvic Testing

We justify the clinical necessity for urodynamic services. We offer hands-on support for authorization, ensure claims accuracy with diagnosis justifications, and document compliance for revisits.

Telehealth Evaluation Services

We have current information about eMedNY and MCO policies, ensuring coding accuracy with proper place-of-service designations, relevant modifiers, patient consent forms, and explanations of rendered services.

Robotic Procedures

We cover high-value procedures such as prostatectomy and nephrectomy, among others, by accurately documenting device costs in clinical documents and justifying their necessity under APG and facility-based insurance rules.

Pathology & Imaging Coordination

We resolve coding conflicts for these pairing services and ensure a justified coordination in documents to prepare a clean claim with reduced denial risks.

DME & Catheter Supply Managemen

The Medi-Cal and commercial payers have strict compliance requirements for DME. We streamline your claims with transparent usage tracking to ensure quality care and justified reimbursement.

Botox, Neuromodulation & OAB Treatments

We simplify the staged billing process for trials by managing prior authorization, the device’s paperwork, and submitting claims to accurate insurers to make it more manageable.

Implants & Prosthetics

We expedite your operation by handling authorization and vendor contracts, managing paperwork for pre-approvals, ensuring coordination, and maintaining inventory logs for stents and penile implants.

Prostate Procedures & Biopsies

Our experts accurately sequence the complex billing claims for MRI-fusion biopsies, prostate services, and imaging pairings across various payers to ensure maximum reimbursement for practices.

Lithotripsy & Stone Procedures

We navigate the complex process through accurate coding, transparent anesthesia reports, and the use of durable equipment, resulting in maximum coverage for every service.

Cystoscopy & Endoscopic Interventions

We capture each detail about scope procedures, stent placements, and biopsies performed in facility or ASC settings to prepare compliant claim documents.

Urodynamics & Pelvic Testing

We understand the unique compliance requirements, from bladder studies to pelvic floor testing, which prove the clinical necessity to ensure robust prior authorization and successful billing claims.

Telehealth Evaluation Services

California has broader telehealth services, with high Medi-Cal reimbursement for these services. We cover modality, consent, and explain facility settings so that you can get maximum advantage from every allowed charge.

Robotic Procedures

We precisely document robotic-assisted surgeries, negotiate with insurers, reflect the procedure’s complexity, and complete all paperwork in accordance with payer requirements to ensure a justified payment.

AB 72 – Surprise Billing Law

For podiatrists providing surgical services in out-of-network facilities, California’s AB 72 limits balance billing. Navigating this requires precise billing strategies.

Prior Authorization Hurdles


Increasingly, California payers require prior authorizations for DME, orthotics, skin grafts, and advanced wound care procedures. Failure leads to non-payment.

Workers’ Compensation Complications

California’s Workers’ Compensation system demands strict adherence to the Official Medical Fee Schedule (OMFS) and highly detailed documentation—especially for podiatric injury care, fracture management, and surgical interventions

Complex Wound Care & Skin Graft Billing

Podiatrists collaborating with wound care centers for diabetic ulcers, pressure sores, or limb salvage procedures face frequent denials related to skin substitute grafts (e.g., Apligraf®, Dermagraft®) and advanced wound treatments like NPWT (vacuum therapy).

Medi-Cal Restrictions

Medi-Cal limits podiatry services unless directly related to chronic disease management. Denials are common without proper coding and documentation.

Routine Foot Care Scrutiny

California insurers, including Medi-Cal and major HMOs (Kaiser, Blue Shield CA), often classify foot care (like nail debridement and callus removal) as non-covered unless medically justified by conditions like diabetes or peripheral vascular disease.