Residential Care
Our assisted living facilities' medical billing services cover room and board, personal care assistance, housekeeping, laundry, and meal services.
Assisted Living Facilities Medical Billing Services Personalized to Your Needs
Managing elder care is complex enough. Adding assisted living facilities’ medical billing services The equation makes it a full-time challenge in its own right. Between state regulations, Medicaid waivers, Medicare guidelines, and private pay arrangements, billing can feel like an unsolvable puzzle. Choose our assisted living billing company to manage your RCM and secure the payments you deserve.
AAPC-qualified billing professionalsHIPAA-compliant billing processesState-specific Medicaid waiver expertiseLong-term care & assisted living billing specialization
From Daily Care to Specialized Services
We master the latest 2026 CPT, HCPCS, ICD-10, and revenue codes to ensure your assisted living billing is fully compliant, accurate, and optimized for maximum reimbursement.
We provide assisted living facility billing for:
Medication Management
We manage bills for Medication administration, monitoring, and pharmacy coordination with compliance standards.
Personal Care Services
You get outsourced assisted living billing for bathing, dressing, grooming, toileting, and mobility support.
Memory Care Services
Assisted living claim management for dementia and Alzheimer’s care, including enhanced supervision and structured therapeutic programs.
Health Monitoring
Vital sign monitoring, care coordination, physician oversight, and wellness services were captured correctly for reimbursement.
Respite Care
Short-term and temporary stays are billed to the appropriate payer sources without revenue leakage.
Need Exclusive Assisted Living RCM Services?
Dastify Solutions provides outsourced assisted living billing with a touch of modern technology and human expertise. We strategise your chaotic billing workflows into a consistent revenue stream, without hitting bottlenecks.
Medical Billing & Coding Services
We have hired the best skilled coders who provide compliant assisted living medical billing and coding services. We manage medication management, ancillary services, and more using appropriate HCPCS and ICD-10 codes.
Prior Authorization & Eligibility Verification
Need assisted living insurance verification support in real-time? We confirm coverage, handle Medicaid waiver eligibility, verify Medicare Part A/B, and confirm private insurance benefits.
Claim Submission Services
No experienced staff to handle your complex claims? Our 72-hour error-free assisted living claims management ensures each claim is thoroughly reviewed before submission, maximizing your first-pass clean claim rate and getting you paid faster.
Denial Management Services
We maintain assisted living claims follow-ups with payers on denied claims. Our denial experts follow an aggressive appeal strategy, review documentation, and resubmit claims. We find and fix your denial patterns.
AR Management Services
At Dastify Solution, we resolve unpaid and underpaid assisted living claims to prevent aging A/R. Our team follows up on pending claims, identifies denial trends, and works with payer-specific rules to accelerate collections.
Payment Posting & Reconciliation
We identify underpayments, missed reimbursements, and payer discrepancies in your RCM. Our payment posting experts reconcile every payment to keep your assisted living facility's revenue optimized.
What Makes Dastify Solutions Different?
We’re not a general medical billing company that happens to work with assisted living facilities. We specialize in the unique challenges of long-term care billing.
State Medicaid Expertise Deep knowledge of waiver programs, per diem rates, and state-specific billing requirements across all 50 states.
Multi-Payer Management Seamless handling of Medicaid, Medicare, private insurance, long-term care policies, VA benefits, and private pay.
Compliance Focused Proactive monitoring of regulatory changes and audit support to keep your facility protected. We ensure your compliance with State-specific assisted living billing regulations, including Medicare, Medicaid, Medicare Advantage Plans, Blue Cross Blue Shield, Aetna, UnitedHealthcare, Cigna, Humana, Tricare, and CMS (Centers for Medicare & Medicaid Services) and State Medicaid Programs.
Dedicated Support Team You'll have a dedicated account manager who knows your facility and is available when you need them.
Assisted Living Care Coordination Seamless coordination between caregivers, physicians, and external providers to reduce care gaps, missed services, and billing delays.
Medication Administration Records (MAR) Accurate MAR alignment to support compliant billing, reduce medication-related denials, and strengthen audit readiness.
HCBS Audit Shield We verify that your billing documentation aligns with the latest Home and Community-Based Services (HCBS) Settings Rule. We help you document the 'autonomy and integration' requirements needed to protect your Medicaid Waiver eligibility.
Pre-emptive TPE Auditing We run internal 'Five-Claim Probes' on your facility's high-volume per-diem codes (T2031) to identify documentation weaknesses before CMS auditors arrive.
2026 Billing Penalties Are Hefty Don’t Risk Your Revenue!
Wrong CPT/HCPCS codes, incorrect Medicaid waiver modifiers, or misapplied telehealth charge triggers can result in thousands of dollars in penalties, denied claims, and clawbacks.
We help you with:
Correct CPT/HCPCS & ICD-10 coding
Accurate Medicaid waiver billing
Telehealth services are billed to CMS and private payers correctly
Audit-ready documentation to prevent penalties
Choose Us for ALF RCM compliance 2026
At Dastify Solutions, we keep our medical billers and coders updated on regulatory changes. Stay ahead of changes to Medicaid, Medicare, and private payers this year with us.
Assisted living; waiver, per diem
T2031
Assisted living; waiver, per month
T2030
Residential care, waiver; per month
T2032
Home or residence visit – new patient
99341, 99342, 99344, 99345
Home or residence visit – established patient
99347, 99348, 99349, 99350
Place of Service – Assisted Living Facility
POS 13 (still paid as non-facility for 2026)
Revenue Code – Room & board / inclusive
0100–0109
Revenue Code – Specific ancillary charges
0110–0199
Revenue Code – Ancillary/residential services
0240–0249
ICD‑10: Home care/assistance
Z74.01
ICD‑10: Other reduced mobility
Z74.09
ICD‑10: Age‑related physical debility
R54
Add-On Code for Care Complexity
G2211 (HCPCS add-on code billed with office/outpatient E/M visits)
Assisted living claim management Modifiers:
U1–U8, UA, UB
Waiver/tier level modifiers (state Medicaid)
25
Significant, separately identifiable E/M
-59
Distinct procedural service
-95
Telehealth service
How we manage the complex U‑modifiers for 2026 (State Specific)
| Tier Level | HCPCS Code | Modifier | 2026 Reimbursement Focus |
|---|---|---|---|
| Tier 1 (Base) | T2031 | U1 | Basic ADL support documentation. |
| Tier 3 (High) | T2031 | U3 | Enhanced supervision & MAR alignment. |
| Tier 5 (Memory) | T2031 | U5 | Specialized dementia care & safety logs. |
Frequently Asked Questions
Does Medicare cover assisted living costs?
Medicare generally does not cover room and board in assisted living facilities. It only covers medically necessary services such as skilled nursing, therapy, or certain home health visits while a resident lives in the facility.
How does Medicaid work for assisted living billing?
Medicaid coverage varies by state. Many states offer waiver programs that help pay for personal care, medication management, or therapy services in assisted living facilities. Residents typically must meet financial and clinical eligibility requirements to qualify.
What costs are covered in assisted living billing?
Standard costs include room and board, personal care assistance, housekeeping, meals, and laundry services. Additional services such as medication management, therapy, and memory care programs may be billed separately, depending on payer requirements.