Nursing home billing is a complex process that demands careful attention to detail. Unfortunately, it’s also an area where small oversights can lead to big financial problems for both providers and families. From denied insurance claims to unexpected charges, billing mistakes can quickly snowball if they’re not caught early. In this article, we’ll walk through the most common errors made in long-term care billing - and more importantly, how to avoid them. For a full breakdown of the process, check out our comprehensive billing guide.
Failing to Verify Insurance Coverage
One of the most common and costly mistakes is neglecting to verify insurance coverage before services begin. Whether a resident is covered under Medicare, Medicaid, or private insurance, providers must confirm eligibility, benefits, and any pre-authorization requirements.
Failing to do so can result in denied claims, delayed payments, or unexpected out-of-pocket costs for families. In some cases, a patient may be assumed to have active coverage that has lapsed or changed. This is especially risky in long-term care, where policies may shift over time due to age or changing medical needs.
To prevent this mistake:
Always verify coverage at admission and on a recurring basis
Confirm authorization requirements and limits on services
Keep up-to-date contact info for insurance providers
Train staff to flag discrepancies before billing begins
Insurance verification should be standard practice - not a one-time task. Getting this right saves time, money, and unnecessary stress for everyone involved.
Overlooking Detailed Bill Reviews
It’s easy to assume that if a bill comes from a trusted healthcare provider, it must be correct. But in reality, nursing home billing errors are more common than you might think. These can include duplicate charges, unlisted services, or incorrect rates.
Unfortunately, many families only notice these issues after paying - or not at all. A simple error, like entering the wrong billing code or forgetting to apply insurance adjustments, can result in hundreds or even thousands of dollars in overcharges.
To avoid this, make it a habit to:
Request an itemized bill every month
Compare the services provided with the services billed
Question vague descriptions or bundled charges
Look out for duplicate entries or unexplained fees
Creating a checklist for bill review can help ensure nothing gets missed. When possible, involve more than one person in the review process - two sets of eyes are better than one.
Ignoring Documentation Requirements
Every charge submitted on a nursing home bill must be supported by accurate documentation. That means detailed records of the care provided, medications administered, therapy sessions delivered, and any other billed service.
When documentation is missing or incomplete, it can lead to claim denials and compliance issues. Worse, it can raise legal concerns if services are billed but not properly recorded. Regulatory bodies like Medicare and Medicaid require clear documentation as proof that services were medically necessary and actually delivered.
To ensure compliance:
Make documentation part of every caregiver’s routine
Use standardized forms and digital recordkeeping
Review documentation for completeness before submission
Educate staff on what’s required for billable services
Providers should also do periodic audits to catch gaps in documentation before they become billing problems.
Not Seeking Professional Help When Needed
Trying to manage the entire billing process in-house can be overwhelming, especially for smaller facilities or organizations that lack dedicated billing staff. Yet many providers hesitate to seek outside help until serious issues arise.
Professional billing experts, advocates, or consultants can step in to provide clarity, speed up claims processing, reduce denials, and ensure compliance with current regulations. They also stay updated on the ever-changing world of healthcare billing, so you don’t have to.
Consider outside help when:
Your denial rate is increasing
Payments are consistently delayed
Your team is overwhelmed with administrative tasks
You’re expanding services or navigating new payer systems
Outsourcing doesn’t mean losing control - it means gaining expertise. Companies like Pharmbills specialize in helping healthcare providers manage billing, reduce errors, and improve financial performance. Their services can make a huge difference in accuracy, efficiency, and peace of mind.
Conclusion
Mistakes in nursing home billing are more than just paperwork problems - they can result in lost revenue, regulatory headaches, and significant stress for families. By staying proactive and informed, providers and patients alike can avoid the most common billing pitfalls.
Remember to:
Verify insurance coverage thoroughly
Review every bill with a critical eye
Keep meticulous documentation
Don’t hesitate to bring in expert help