Geriatric medicine, also known as elder care, focuses on the comprehensive treatment and care of patients aged 65 and older. These patients often suffer from multiple chronic conditions, require frequent monitoring, and are eligible for Medicare and special care programs.

While the goal of geriatric care is to improve quality of life for seniors, the billing side is often complex due to the need for accurate E/M coding, chronic care management (CCM), care coordination, and compliance with Medicare guidelines.

At Progressive RCM, we offer end-to-end geriatrics billing services that help physicians, clinics, and long-term care facilities navigate complex coding, reduce claim denials, and optimize reimbursement.

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Challenges in Geriatric Medical Billing

1. Multiple Chronic Conditions

Most elderly patients have two or more chronic diseases such as diabetes, hypertension, arthritis, or heart disease. Billing must reflect this complexity through correct CPT and ICD-10 coding, proper documentation, and even time-based E/M coding.

2. Chronic Care Management (CCM)

Many geriatric practices are eligible to bill CCM codes (99490, 99491, etc.), which require:

• Patient consent

• Non-face-to-face care documentation

• Minimum time thresholds (20+ minutes/month)

Failure to document these requirements results in non-payment.

3. Medicare Regulations

Since most elderly patients are covered by Medicare, providers must follow strict billing rules around:

• Annual Wellness Visits (G0438, G0439)

• Preventive screenings

• Modifier use

• Medical necessity documentation

4. Frequent Care Transitions

Geriatric patients often move between hospital, rehab, nursing home, and home care. Billing requires accurate place of service (POS) coding and appropriate use of TCM (99495, 99496) and home visit codes.

5. Telehealth & Remote Monitoring

Seniors now receive care via telehealth and remote patient monitoring (RPM). These require separate codes, consents, and audit-ready documentation.

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Common Geriatrics Billing Codes

We help bill and manage key services and procedures in elder care:

✅ Evaluation & Management (E/M):

• 99213–99215 – Office/outpatient established visits

• 99202–99205 – Office new patient visits

• 99304–99310 – Nursing facility services

• 99341–99350 – Home visits

• 99483 – Cognitive assessment and care plan services

✅ Preventive & Wellness:

• G0438 – Initial Annual Wellness Visit

• G0439 – Subsequent AWV

• G0402 – Initial preventive physical exam (IPPE)

• 80050 – General health panel (labs)

✅ Chronic Care & TCM:

• 99490 – CCM 20+ minutes

• 99439 – CCM additional 20 minutes

• 99491 – CCM by physician

• 99495–99496 – Transitional Care Management

✅ Remote Monitoring:

• 99453–99458 – RPM setup, monitoring, and time-based management

✅ ICD-10 Codes (Examples):

• I10 – Hypertension

• E11.9 – Type 2 Diabetes

• F03.90 – Unspecified dementia

• M16.0 – Primary osteoarthritis of hip

• G30.9 – Alzheimer’s disease

• R41.81 – Age-related cognitive decline

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Our Geriatric Billing Services

At Progressive RCM, we understand the nuances of elder care billing. Our comprehensive services include:

✅ Insurance Verification & Eligibility Checks

• Confirm Medicare Advantage or traditional Medicare coverage

• Verify dual eligibility with Medicaid

• Identify prior authorization needs and co-pay responsibilities

✅ Accurate Medical Coding

• Certified coders assign accurate CPT, ICD-10, and HCPCS codes

• Track multiple diagnoses per visit

• Apply appropriate modifiers (e.g., 25, 59, 24)

✅ Claims Submission & Denial Management

• Submit clean claims within 48 hours

• Use claim scrubbing tools to eliminate coding errors

• Analyze and correct denials — resubmit or appeal promptly

✅ Chronic Care Program Billing

• Help practices enroll patients in CCM programs

• Track non-face-to-face time using compliant templates

• Submit claims monthly and reconcile reports with documentation

✅ Transitional Care Billing

• Assist in billing TCM after hospital discharges

• Ensure compliance with time frames and documentation rules

✅ Patient Billing & Support

• Generate easy-to-understand statements

• Offer online payments and senior-friendly assistance

• Work with family members and caregivers for billing explanations

✅ Monthly Reports & Compliance

• Reports on aging balances, denial trends, top procedures, and provider productivity

• Ensure documentation meets CMS guidelines

• Prepare for audits and chart reviews

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Why Choose Progressive RCM for Geriatrics Billing?

✅ Medicare Billing Expertise
We understand CMS rules for AWVs, TCM, CCM, RPM, and more — ensuring clean, approved claims.

✅ Care Coordination Support
We help you document time, manage care plans, and support non-face-to-face services that increase revenue.

✅ Coding for Complex Cases
Elderly patients often have multi-problem visits — we ensure all diagnoses and time elements are accurately billed.

✅ Support for Long-Term Care Providers
We bill for services provided in SNFs, ALFs, group homes, and home settings using correct place-of-service codes.

✅ Fully Transparent Process
You receive detailed monthly reports, access to dashboards, and a dedicated billing specialist.

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Key Metrics We Track

• First-pass claim acceptance rate

• Medicare denial rate

• Average reimbursement per visit

• CCM and TCM participation rate

• Claim turnaround time

• Aging accounts receivable

• Missed billing opportunities (e.g., missed AWVs)

These KPIs help us maximize your profitability and keep your practice audit-ready.

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Final Thoughts

Caring for older adults comes with immense responsibility — and billing for their care should reflect that complexity. With the right processes in place, geriatric practices can earn more through CCM, TCM, RPM, and Medicare preventive services, all while providing better care.

Progressive RCM helps you manage every detail of geriatric billing, from documentation to denial management, so you can focus on what matters most: your patients.