PointClickCare billing services for skilled nursing and post-acute providers
We work inside your PointClickCare account through named, two-step accounts you control, after a signed BAA. For Medicare skilled nursing stays we check the UB-04 claim, the PDPM HIPPS code against the accepted MDS, and consolidated billing, then work remittances, denials and A/R.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026
In short: we work in your PointClickCare account with our own named logins, in the queues you assign. We claim no partnership with the vendor, and every skilled nursing billing rule on this page comes from the CMS Medicare Claims Processing Manual, chapter 6.
What is PointClickCare and who bills out of it?
PointClickCare is a health technology company whose electronic health record is built for senior care. Its site lists products for skilled nursing, senior living, hospitals and health systems, health plans, ACOs, pharmacy and practice groups. This page covers skilled nursing billing.
The vendor calls its EHR for Skilled Nursing Facilities a cloud-based post-acute EHR. The same page names a Revenue Cycle Management function for creating, submitting, tracking and appealing claims.
Its skilled nursing add-ons include Billing Advisor, PDPM Coach and Advanced Insights.
The claim rules below come from CMS, not the vendor. See our hospital and facility billing service and the other systems we work in.
How does an outside billing team get into your PointClickCare account?
We work inside accounts you create and control.
What does a Medicare skilled nursing claim look like?
Medicare Part A skilled nursing stays are billed on the institutional claim: the ASC X12 837 institutional format or Form CMS-1450, also called the UB-04.
| Claim element | What chapter 6 requires |
|---|---|
| Bill type | Type of Bill 21X for SNF inpatient services. Bill type 210 is the no-payment bill, used when a resident dropped to non-skilled care and the SNF needs a Medicare denial for another insurer. |
| Revenue code 0022 | Shows the claim is paid under the SNF PPS. It can repeat on one claim to show different HIPPS rate codes and assessment periods. |
| HIPPS code | A 5-digit code in the HCPCS/Rates field on the revenue code 0022 line. |
| Occurrence span code 70 | Reports the dates of the qualifying hospital stay of at least three consecutive days. |
| Occurrence code 50 | The assessment reference date for each assessment period on a revenue code 0022 line. Not required with default HIPPS code ZZZZZ. |
An admission that spans October 1 needs separate bills for each federal fiscal year.
How does the PDPM HIPPS code on a PointClickCare claim get set?
The Patient Driven Payment Model (PDPM) is the case-mix system CMS uses to pay Part A skilled nursing stays.
Under chapter 6, a SNF can bill only after the assessment is submitted to the State RAI database, a Final Validation Report shows it was accepted, and the covered day has been used. Claims that skip this are not paid.
Per section 120.1, the PDPM code has five positions: physical and occupational therapy group, speech-language pathology group, nursing group, non-therapy ancillary group, and the assessment indicator.
When an MDS is late, the SNF can bill the default code, ZZZZZ, the lowest possible per diem rate.
PointClickCare describes PDPM Coach as guidance that helps staff complete the 5-day Admission Minimum Data Set (MDS). Our check is the same with or without it: HIPPS code, assessment reference date and accepted assessment must agree.
What is consolidated billing and why does it cause denials?
Under SNF consolidated billing, the facility bills Medicare for nearly everything a resident receives in a covered Part A stay. Chapter 6, section 10.1 says the SNF submits all claims for all Part A services except certain excluded ones, plus all Part B physical, occupational and speech-language pathology.
The chapter states that SNFs can no longer unbundle services to an outside supplier that then bills the MAC separately.
These rules apply to Medicare fee-for-service residents. For Medicare Advantage residents, chapter 6 section 90.2 says to appeal denials to the plan, and to still send a claim to the A/B MAC (A) so benefit days are subtracted, because plans do not send SNF claims to the Common Working File.
How often do SNF claims go out, and what breaks the sequence?
Chapter 6 section 40 says SNFs bill on discharge, benefit exhaustion, a drop below skilled level of care, or monthly.
Bills for a continuous stay must go in sequence. If the prior bill has not been processed, the MAC returns the later one, and the SNF holds it until it receives the remittance advice for the earlier bill.
After a resident uses all 100 covered days, benefits exhaust bills are still submitted monthly, even when another payer will pay.
Interrupted stays are another trap. If a resident leaves Part A coverage and returns by 11:59 pm on the third consecutive calendar day, it is the same stay, with no new assessment. Return later, or to a different SNF, and it is a new stay.
What do we do inside PointClickCare?
- Review charges against the revenue codes and units on the 21x claim.
- Check the HIPPS code, occurrence codes 50 and 70 and the bill type before release.
- Edit claims and send them through your clearinghouse, within 24 hours of charge entry.
- Post ERA 835 remittances and match each payment to the stay and month it belongs to.
- Work denials in the queues you assign, with denials worked within 48 hours.
- Follow up on A/R by payer, including Medicare Advantage and Medicaid, and send patient statements.
- Flag consolidated billing conflicts and out-of-sequence returns.
Scope is agreed at setup. Clinical documentation and the MDS stay with your clinical team. See revenue cycle management for the full cycle.
Which PointClickCare reports matter for denial and A/R tracking?
We name only the reports the vendor documents in Advanced Insights and Billing Advisor. PointClickCare's pages name no A/R aging or denial report, so we describe those views by purpose and map each at setup.
| Purpose | Where it comes from |
|---|---|
| Payer mix and census trend | Advanced Insights Day Start shows current census and payer mix. The Census report shows admissions and changes by hospital and payer. |
| Length of stay by payer | Advanced Insights Length of Stay, by payer and admitting hospital. |
| PDPM documentation completeness | Advanced Insights PD3 Cross-check lists PDPM residents and which supporting documentation is complete or outstanding. |
| Admission financial screening | Advanced Insights Preadmission Estimator screens financial and care effects of accepting a patient under PDPM. |
| Missed charges before billing | Billing Advisor, if licensed, queues billing opportunities such as high-cost medications and level-of-care mismatches. |
| A/R aging by payer, denial trends, payment variance, charge lag | Built from your claim and remittance data. Which export you use is agreed at setup. |
How do claims and remittances move from PointClickCare to the payer?
For Medicare, CMS says the SNF sends an 837 institutional claim or Form CMS-1450 to its A/B MAC (A). The vendor's pages do not name a clearinghouse or describe 835 posting, so we confirm both at setup.
At setup we confirm your clearinghouse, your payer portals, and how the ERA reaches the posting screen.
Medicare Advantage and Medicaid plans follow their own manuals.
How we handle billing in PointClickCare
We work in your account in named logins and hold each skilled nursing claim to the chapter 6 elements above before it leaves.
Security details are on our security page, and our guide to choosing a billing partner lists what to ask. To talk through your facility, book a call.
- PointClickCare home page · PointClickCare
- EHR for Skilled Nursing Facilities · PointClickCare
- Billing Advisor for Skilled Nursing · PointClickCare
- PDPM Coach · PointClickCare
- Advanced Insights · PointClickCare
- Billing for Senior Living · PointClickCare
- Medicare Claims Processing Manual, chapter 6 · CMS
- Skilled Nursing Facility PPS · CMS
We check every rule, code and deadline against the official source. See our editorial policy.
Common questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01Can an outside billing company work inside PointClickCare?
Yes, if your facility gives it access. Your administrator creates a named user for each person on our team after a BAA is signed, with role-based access and two-step login. We never use shared logins. We claim no partnership with PointClickCare.
02What access does a billing partner need in PointClickCare?
Role-based access to the resident financial and billing screens, plus the reports you choose to share. Each person gets a named user and two-step login, the BAA is signed first, no logins are shared, and scope is written down at setup.
03Which PointClickCare reports matter for denial and A/R tracking?
The vendor documents Advanced Insights reports for census, payer mix, length of stay and PDPM documentation, but its pages name no A/R or denial report, so we map each view to its purpose at setup. We build A/R by payer and denial trends from your claim and remittance data.
04How do claims move from PointClickCare to the clearinghouse and payer?
CMS says SNFs send an 837 institutional claim or Form CMS-1450 to their A/B MAC (A). The vendor's pages do not name a clearinghouse, so we confirm yours at setup. We confirm your clearinghouse and payer portals at setup, then send claims through your channel.
05How does PointClickCare post ERA and 835 remittances?
The vendor's pages do not document 835 posting, so we confirm at setup how your account posts. At setup we confirm how the ERA reaches your account, then match each payment to the resident, stay and billing month.
06What billing mistakes are common in PointClickCare (charge capture, modifiers, demographics)?
On skilled nursing claims we check the CMS chapter 6 elements: 21x bill type, revenue code 0022, a HIPPS code matching the accepted assessment, occurrence codes 50 and 70, and the October 1 split. We attribute no defects to the vendor.
07What is SNF consolidated billing?
It is the Medicare rule that the SNF bills for nearly all services a resident receives in a covered Part A stay, plus Part B therapy. Outside suppliers cannot bill the MAC separately for bundled services, except for categories CMS excludes in chapter 6.
08Does PointClickCare also handle senior living billing?
The vendor sells Billing for Senior Living, which it describes as integrated with its senior living EHR, with move-ins, move-outs and level-of-care changes reflected on the resident account. Its FAQ says Medicaid waivers and other government programs can be managed as supplemental payers.
09Is there a billing company that works in PointClickCare for skilled nursing facilities?
Yes. Nucleus Align supports post-acute providers that run PointClickCare. We work inside your system with named logins you grant, covering SNF claims on bill type 21x, PDPM checks, consolidated billing, monthly bills, remittance posting and denial work. Scope and reporting are agreed with you at setup.
10Medical billing service for SNFs on PointClickCare
Nucleus Align provides SNF billing in PointClickCare: claim review, submission within 24 hours of charge entry, ERA posting, and denials worked within 48 hours. You keep ownership of the system and choose the roles our team receives. You can book a call on our contact page to walk through your setup.
11Can an outsourced team use our PointClickCare logins?
No shared logins. Your PointClickCare administrator creates a named user for each Nucleus Align team member with billing roles after a BAA is signed. We use two-step login and HIPAA-trained staff, and you can end access whenever you wish. Nothing changes in how your team documents care.
Running PointClickCare? Talk to us.
A 20-minute call about your payers, volume and setup. Monday to Friday, 9am to 5pm Eastern.