# Jobs in Nursing Homes or Assisted Living



## George55 (Apr 16, 2010)

Can anyone share their experience about working as Coders in a Nursing Home or Assisted Living?  Do these facilities hire coders?   Also can you recommend any speciality certification for this type of coding.

I have never seen any jobs listed in my area for coding work in a Nursing Home or Assisted Living and am curious as to what type of employment might be out there.

Thank you!!

George
New Orleans


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## Pam Brooks (Apr 16, 2010)

Hi, George. Unless the nursing home or assisted living center employs physicians, you probably would not be doing any professional coding in those settings.  Nursing homes are considered inpatient facilities, and are reimbursed by Part A, not Part B.  They are reimbursed based on DRG assignment, so they may hire a CCS or RHIA (these are AHIMA certifications)  to code.  We (Certified Professional Coders) have different training, that is physician-based.    

Most physicians that see patients in the nursing home setting have their coding/billing done by the coders that they employ within their individual practices.

I'd be interested to hear if any of our posters are working in a nursing facility, and to learn how they got there!


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## mmorningstarcpc (Apr 16, 2010)

Several years ago I interview for a "billing" position at a nursing home/assisted living facility.  Very large place.  The billing consisted of billing for patients ancillary services, such as dining room, travel and off-site services.  It was unrelated to medical billing. It was however advertised in the heatlhcare section of the newspaper under medical billing?!?!?!?

Just FYI.


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## Rachel_Nelson (Apr 16, 2010)

*Nursing home*

My first job out of college was at a nursing home as the HIM Manager. I coded as well as everything else under the sun (except billing and I was only there 9 months). As I understand it, coding does not affect the reimbursement for nursing home patients because they are paid per diem. It helps to use correct code assignment however, because the doctor and staff needs to be aware of the patients problems and also because when meds are ordered, it is important to show medical necessity for the med. Insurance does not cover usually cover nursing home stays unless they have Medicaid or another private payer that offers LTC benefits. Not Part A

We also had skilled nursing facilties and they are paid based on RUG (Resource Utilization Groups) based on the MDS (Minimum Data Set) resident assessments. SNF's complete their MDS assessments according to schedule (5th, 14th, 30th, 60th, and 90th days). This is based on the patient as a whole but it is equally important to correctly code the patients chart. Part A

Now, Long Term Acute Care hospitals utilize DRG's but I am not up to speed on this process and they are a whole different animal. 

Since nursing homes do not have large budgets (usually) they use nurses or CNA's to do their coding and manage their HIM dept. However, if you can find a large nursing home/SNF they may look for coders.  Hopefully I did not just give any misinformation.


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## ecaissie (Apr 16, 2010)

*Nursing home billing*

I am currently working as a billing coordinator in a nursing home.  It is the second such position I have held.  The person who gave the information about RUGs was correct - the charge generating is different in nursing homes from hospitals.  In addition, most nursing homes use software that is specifically designed for nursing homes, and the RUG scores and diagnosis codes are integrated with the software.  Nurses complete questionnaires based on the resident's condition; the software then offers a RUG score, which is ocnfirmed or edited by the nurse.


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## George55 (Apr 19, 2010)

*Thanks for the great feedback!*

Thanks for the great feedback!  Much appreciated!

Sincerely

George


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