Geriatrics Billing Services

Geriatric billing is Medicare billing at its most complex. Older adults bring multiple chronic conditions, polypharmacy, cognitive change, and frequent transitions between home, hospital, and post-acute care, and nearly every encounter touches a Medicare rule with its own timing, consent, or documentation requirement. The work is rarely a single procedure, it is a year of coordinated care that must be captured visit by visit and month by month.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for geriatrics practices, built around Medicare’s senior care programs.

Geriatrics billing challenges

Medicare’s preventive and care management programs are the biggest opportunity and the biggest trap. The Annual Wellness Visit is available once every 12 months and is not a head-to-toe physical, it is a health risk assessment with a personalized prevention plan. Chronic care management covers monthly non-face-to-face coordination for patients with two or more chronic conditions, and it requires a qualifying initiating visit, documented consent, and a comprehensive care plan. Transitional care management covers the window after a hospital discharge, with an interactive contact within two business days and a face-to-face visit within 7 or 14 days. Each program pays only when its own rules are met, and each is routinely performed but never billed.
Cognitive and functional assessment adds another layer. Dementia staging, cognitive testing, advance care planning conversations, and caregiver communication all have their own coding and documentation requirements, and they are easily lost inside a general visit note that never names them as distinct services. Medication management for patients on many drugs also raises the medical decision-making level of a visit, but only when the note shows what was actually managed at that encounter.
Transitions of care are the third challenge. Hospital discharge, skilled nursing facility admission, home health certification, and hospice election each change who can bill what, and overlapping claims across settings are a common denial source. Coordination with facilities and home health agencies must be tracked, not assumed.

What MedPlus RCM handles for geriatrics practices

  • End-to-end medical billing. Charge entry, claim scrubbing, submission, payment posting, and patient billing, the full cycle.
  • Medical coding. Certified coders assign current ICD-10, CPT, and HCPCS codes matched to your documentation and specialty.
  • Provider credentialing and enrollment. End-to-end enrollment with Medicare, Medicare Advantage plans, and commercial payers, plus re-credentialing maintenance.
  • Denial management and recovery. Every denial investigated to root cause, corrected, and appealed with documentation.
  • A/R recovery. Aged and outstanding balances audited and pursued, including balances already written off where the appeal window is still open.
  • Financial reporting. Clean claim rates, collections, denial patterns, and A/R aging visible by payer and provider.
    We serve geriatrics practices of every size, from solo clinics to multi-provider groups, across all 50 states.

Results geriatrics practices can check

MedPlus RCM maintains a 99% clean claim rate and keeps client accounts receivable under 30 days. Pricing is a performance-based percentage of successfully collected revenue: if you don’t get paid, we don’t get paid. We are 100% HIPAA compliant, and onboarding takes 2 to 4 weeks depending on practice size, with no disruption to your daily cash flow.

Frequently asked questions

Is the Annual Wellness Visit the same as a physical exam?
No. The Annual Wellness Visit is a preventive planning visit built around a health risk assessment and a personalized prevention plan. Medicare does not cover a routine head-to-toe physical, and billing the wellness visit as one creates documentation problems.
What does chronic care management require in a geriatrics practice?
A qualifying initiating visit, documented patient consent, a comprehensive care plan accessible to the care team, and at least 20 minutes of qualifying coordination time in the calendar month. Only one practitioner may bill it for a patient in a given month.
How does transitional care management work after a discharge?
It requires an interactive contact within two business days of discharge and a face-to-face visit within 7 or 14 days, depending on complexity. Missing either window means the service cannot be billed.
Do you handle Medicare Advantage as well as traditional Medicare?
Yes. We bill traditional Medicare and Medicare Advantage plans, and we track the prior authorization and documentation rules that differ between them.
How long does it take to switch our billing to MedPlus RCM?
Onboarding takes between 2 and 4 weeks depending on practice size, including data migration and payer clearinghouse setup.
What does MedPlus RCM charge?
A performance-based percentage of successfully collected revenue. If you don’t get paid, we don’t get paid.

Get a free financial audit

Find out where your geriatrics practice is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
Request your free financial audit