What makes geriatric billing services different
Geriatric billing services are Medicare billing at its most demanding. Older adults bring multiple chronic conditions, frequent transitions between home, office, hospital and skilled nursing, and a payer mix dominated by Medicare with Medicaid crossover for dual-eligible patients. Fastora provides geriatric medical billing for geriatricians, senior-care practices and house-call programs, built around chronic care management, transitional care management, advance care planning, annual wellness visits and the strict balance-billing rules that protect dual-eligible patients. A geriatric billing company has to know Medicare's rules cold — because almost every claim runs through them.
The work is less about exotic procedures and more about getting the care-coordination codes right: consent, care plans, documented minutes and transition dates. Our medical billing services for geriatric practices are built around those elements.
Medicare wellness visits and advance care planning
The Welcome to Medicare visit and the annual wellness visits are reported with HCPCS codes G0438 and G0439 — not with standard E/M codes — and they have their own required elements: health risk assessment, personal prevention plan, cognitive screening as appropriate. Advance care planning is reported with 99497 for the first 30 minutes and 99498 for additional time, and it can be billed on the same day as a wellness visit with the right documentation.
We check that each wellness and advance-care-planning claim carries the elements the payer requires, because these are exactly the claims auditors sample first in geriatric practices.
Chronic care management for complex patients
Chronic care management is the financial backbone of many geriatric practices: 99490 for non-complex CCM per calendar month with at least 20 minutes of documented clinical staff time, 99491 for physician-directed CCM, and 99487/99489 for complex CCM with moderate-to-high decision-making. The practice needs patient consent, a comprehensive care plan shared with the patient and 24/7 access.
We confirm consent, care plans and monthly minutes before the first CCM claim is filed, and we reconcile the time logs each month so the reported tier matches the documented effort.
Transitional care management after discharge
Transitional care management — 99495 for moderate complexity, 99496 for high complexity — covers the 30 days after a hospital or SNF discharge, with required contact within two business days and a face-to-face visit within 7 or 14 days depending on complexity. Miss the contact window and the whole TCM episode is unbillable.
We track discharge dates, contact attempts and visit timing as a workflow, not as a hope, so TCM claims are filed only when every element is met — and the ones that qualify are never missed.
Home, office and facility visits
Home visits are reported with the 99341–99350 code families and SNF visits with 99304–99310, each with their own documentation and medical-necessity expectations. Cognitive assessment, behavioral health integration and fall-risk evaluation often ride along with these visits and need their own documented indications.
Our medical coding team reviews geriatric encounters for correct place-of-service coding and for the documentation each setting's codes require.
Dual-eligible patients and QMB balance-billing rules
Dual-eligible patients — Medicare primary, Medicaid secondary — are common in geriatric panels, and the Qualified Medicare Beneficiary (QMB) rules prohibit balance billing these patients for Medicare cost-sharing. The practice must accept the Medicare and Medicaid payments as payment in full and may not bill the patient for the difference.
We run eligibility and benefits checks that flag QMB status before the visit, so the billing workflow treats these patients correctly from the start. Crossover claims are filed to Medicaid for the cost-sharing, and patient statements never carry balances QMB rules prohibit.
Common geriatric billing denials and how we prevent them
| Denial | Typical cause | Prevention step |
|---|---|---|
| CCM denied | Missing consent or care plan in the record | Consent and care-plan check before first CCM claim |
| TCM denied | Contact or visit outside required windows | Discharge-date tracking workflow |
| Wellness visit denied | Billed with E/M instead of G0438/G0439 | Correct HCPCS selection at charge entry |
| Crossover balance denied | Medicaid timely filing missed after Medicare payment | Crossover claims filed on schedule |
| E/M downcoded | Insufficient documentation for the level | Note reviewed against level requirements |
Every claim passes our Advanced Pre-Submission Claim Review before submission. Denials that still occur are worked by our denial management team, corrected and resubmitted or appealed with the record.
Credentialing for geriatric practices
Geriatricians, nurse practitioners and physician assistants in senior-care practices each need enrollment with Medicare and the Medicaid plans they bill, linked to the group before their services pay in network.
Our credentialing and enrollment service tracks each file through a nine-stage process, from document collection and NPI and CAQH setup to payer applications, follow-ups and final approval.
How Fastora supports geriatric billing
Fastora works inside your existing EHR/PM system under the user access you grant, with no software to install and no hidden setup fees. You get a dedicated account contact, transparent dashboards, monthly performance reporting and a monthly review call.
Fees are quoted after a free assessment, and you can read how our pricing models work beforehand. To see how your current claims hold up, start with a free billing assessment.