Revenue leak
Wrong PDPM group
Root cause in Rochester
Late or inaccurate 5-day MDS
How 247MBS closes it
Pre-bill triple-check on every Part A claim
Skilled Nursing billing · Rochester, NY
Skilled Nursing Billing Services in Rochester, New York
Skilled nursing billing services in Rochester serve a Finger Lakes market anchored by the University of Rochester Medical Center, where academic post-acute referrals, a large non-profit nursing-home sector, and New York's blend of fee-for-service and Managed Long-Term Care Medicaid all meet inside the revenue cycle — the institutional billing 247 Medical Billing Services (247MBS) has run since 2005. We manage Medicare Part A per-diem under PDPM, MDS case-mix, consolidated billing, Medicare Advantage authorization, and Medicaid long-term care for Monroe County facilities, each backed by a dedicated account manager, a free 360° dashboard, and full HIPAA plus SOC 2 Type II protection.
HIPAACompliant
SOC 2Type II
Serving Since2005
Specialty-FocusedRCM
We bill Skilled Nursing for Rochester practices
Part A Stays
Part B Therapy
PDPM
Consolidated Billing
Medicare Advantage
And More
The Rochester Ownership Landscape and What It Means for Billing
Rochester's skilled nursing sector is dominated by mission-driven, non-profit and hospital-affiliated ownership rather than large national chains, and that shapes the revenue cycle in specific ways. Non-profit homes tied to community and faith-based sponsors tend to carry deep long-stay Medicaid caseloads and run leaner business offices, so a single unworked denial category compounds fast against thin operating margins. At the same time, University of Rochester Medical Center and its Strong Memorial network drive a steady post-acute rehab referral stream on Medicare Part A, where an accurate 5-day MDS is the difference between a matched per-diem and a misgrouped stay. New York Medicaid long-term care increasingly runs through Managed Long-Term Care plans, layering care-management and net-available-monthly-income rules on top of the traditional fee-for-service backbone. For a mission-focused Rochester operator, a billing partner that already knows this ownership reality protects margin that a generalist vendor tends to leak.
How a Skilled Nursing Claim Gets Paid in Rochester
Medicare Part A pays a per-diem set by the Patient-Driven Payment Model, with five case-mix components fixed on the MDS and carried onto the institutional claim. The table follows a Rochester Part A stay from assessment to payment.
| Step | What fixes the rate | Claim detail |
|---|---|---|
| MDS assessment | 5-day PPS assessment sets PT, OT, SLP, Nursing, NTA | HIPPS on revenue code 0022 |
| Per-diem | Variable adjustment tapers PT/OT past day 20; NTA front-loads | Bill type 21X, 837I institutional |
| Benefit period | Qualifying 3-day stay; up to 100 covered days | Days 1-20 full, 21-100 coinsurance |
| Part B fallback | Off Part A or benefit days exhausted | Bill type 22X, therapy modifiers |
| Consolidated billing | Bundled ancillaries versus excluded services | Value and occurrence codes applied |
Where Rochester Nursing Homes Lose Skilled Nursing Revenue
Most preventable losses in Monroe County trace back to a short list of failures that hit non-profit margins hardest. A late or thin 5-day MDS misgroups a Part A stay, so the per-diem no longer matches delivered care. Broken dual-eligible coordination leaves Medicare-primary balances without the Medicaid secondary that should follow. An incorrect net-available-monthly-income calculation stalls Managed Long-Term Care revenue. And skilled-level-of-care documentation gaps invite denials even when the care was genuinely skilled.
Revenue leak
Stranded dual-eligible balance
Root cause in Rochester
Broken Medicare/Medicaid coordination
How 247MBS closes it
Crossover and secondary follow-up
Revenue leak
Aged MLTC balance
Root cause in Rochester
Net-available-income or level-of-care gap
How 247MBS closes it
Managed Long-Term Care reconciliation
Revenue leak
Skilled-level-of-care denial
Root cause in Rochester
Documentation short of daily need
How 247MBS closes it
Clinical-documentation review before billing
Revenue review
Put a dollar figure on what your SNF claims are leaving behind.
A certified SNF billing specialist reviews your coding, unit counts, authorizations and aged A/R against the payers you actually bill in Rochester, NY — and puts a number on what your current process is leaving on the table.
- MDS assessment schedule tied to the component rates actually billed
- Consolidated-billing exclusions separated before the claim goes out
- Benefit days and the qualifying stay verified for every admission
HIPAA & SOC 2
Back to you within one business day
No long-term lock-in
Request a Revenue Review
Tell us about your practice.
A SNF specialist will reach out within one business day.
Thanks — we’ve got it.
A SNF specialist will reach out within one business day.
Why Rochester Facilities Outsource Skilled Nursing Billing to 247MBS
For a mission-driven, lean-margin operator, the decision to outsource turns on whether an in-house office can keep every Part A claim tied to a clean MDS while also coordinating dual-eligibles and reconciling Managed Long-Term Care. For most Rochester homes it cannot, and the leak is costly. As a medical billing services company built specifically for institutional long-term care, 247MBS runs the entire revenue cycle — eligibility verification, MDS and PDPM billing support, denial management, credentialing, and A/R recovery — under one accountable team. Our numbers are built to plan around: a 99% first-pass clean-claim rate, up to 40% fewer denials, 90% of worked denials recovered, and days in A/R under 25. A 98% client retention rate reflects two decades of professional, consistent SNF work since 2005. As a billing services company focused on this one domain, we are not a generalist billing company learning PDPM on your dime. Review our reach on the New York billing overview, and lean on the national SNF billing hub for the full institutional model.
Who We Serve in Rochester
Our Rochester clients cover the Finger Lakes skilled nursing mix: non-profit and faith-based nursing homes serving long-stay dual-eligible residents, freestanding SNFs taking rehab referrals from the University of Rochester Medical Center, hospital-affiliated skilled units, and higher-acuity subacute buildings managing complex residents. We also support county nursing facilities and long-term custodial homes carrying deep Managed Long-Term Care caseloads, plus smaller operators that need senior-level MDS expertise without a full business office. We serve facilities across the region — Greece, Irondequoit, Brighton, and Henrietta — with the same dedicated model and reporting, so a single mission-driven home gets the rigor a larger operator would buy.
Medical Billing for Skilled Nursing in Rochester
Medical billing for skilled nursing in Rochester protects the margin a mission-driven, lean-office operator cannot afford to leak, and that is the work 247MBS has run for Monroe County homes since 2005. We tie every Medicare Part A per-diem to a clean 5-day assessment so the post-acute rehab stream from the University of Rochester Medical Center pays fully, secure Medicare Advantage authorizations before an admission is voided, and reconcile New York Managed Long-Term Care net-available-income, level of care, and room-and-board so long-stay Medicaid revenue keeps moving. For a non-profit home where one unworked denial category compounds fast, that discipline is decisive. Clients hold days in A/R under 25 and recover up to 90% of worked denials. Request a revenue review and see where your Finger Lakes revenue is slipping.
Choosing a Skilled Nursing Billing Services Provider in Rochester
Skilled Nursing billing across New York
Rochester practices are billed out of the same New York desk. Statewide payer detail lives on the New York page.
Statewide
New York Skilled Nursing Facility billing services — the payer programs, authorities and rules behind every Rochester claim.
Specialty hub
Skilled Nursing Facility Billing Services — the codes, unit rules and denials nationally, without the local layer.
Frequently Asked Questions
Yes. Those short-stay Medicare admissions run on PDPM, so we verify the qualifying 3-day stay and benefit period, tie the per-diem to an accurate 5-day MDS, and submit the Part A claim clean — protecting the highest-value stays a Rochester facility handles.
We confirm level of care, apply the net-available-monthly-income calculation, work each plan's authorizations, and reconcile balances monthly, so a mission-driven home's custodial revenue keeps moving instead of aging.
Before any Part A claim drops, we reconcile the MDS, therapy and nursing documentation, physician orders, and census and eligibility. This triple-check catches HIPPS and consolidated-billing errors while they are still fixable — the single biggest safeguard against SNF denials.
PDPM components·MDS schedule·consolidated billing·benefit days
Ready to get more Rochester claims paid on the first pass?
From solo practices to multi-provider groups, we bill Skilled Nursing for Rochester practices with a dedicated account manager, certified coders and a live dashboard — so the units, authorizations and appeals that decide your month stop being the thing nobody has time for.
Prefer email? sales@247medicalbillingservices.com