How does SeniorCRE bill bed-hold and leave-of-absence days correctly under state-specific Medicaid rules?
Design target · Internal estimate
State-rule billing applied systematically
Modeled estimate from SeniorCRE engineering. Not a result: no approved Evidence Record supports it, and business outcomes remain contributory. See Industry Findings for methodology.
Incumbents this workflow touches
Proposed in-platform scope: Hand-tracked LOA log at the nursing station
Roadmap integration targets (not live): PointClickCare Census · MatrixCare · State Medicaid bed-hold portals
The operator may retain existing systems or select SeniorCRE for defined functions. Alongside existing systems, this workflow would depend on approved source access, implementation and operator acceptance. Named vendor integrations are roadmap targets, not completed connections.
The problem
Bed-hold and LOA day billing varies by state — some states pay a percentage of the per-diem for hospital leaves, some require a written family election, some cap at a number of days per year. The rule lives in the business-office manager’s head. When the manager is on vacation, the LOA days get billed wrong, the state denies the days, and revenue is lost or — worse — the operator bills days it was not entitled to.
How the platform is designed to run it
Each state’s Medicaid bed-hold and LOA policy is encoded with effective dates, eligibility rules, daily rate calculation, family-election requirements, and per-year caps. A hospital transfer or therapeutic leave triggers a workflow: required notice timing, family election form, payer notification, and the per-diem the system bills against the LOA day. The 24-hour and 5-day clocks run automatically; missed family elections surface before the day is billed.
Proposed operating behavior, not a live deployment. Source access, implementation and operator acceptance must be established before this workflow can operate in a community.
On the shift (illustrative)
Illustrative example on synthetic data. Names, figures, and events are not from any operator community.
A long-stay Medicaid resident is sent to the hospital at 2 a.m. The night-shift charge nurse documents the transfer; the system opens the bed-hold workflow at the same moment. The state’s bed-hold rule for this Medicaid program — percentage of per-diem, family-election requirement, day-count cap — is already encoded. The family-election form generates and goes to the responsible party with the required 24-hour notice. The bed-hold days bill at the correct per-diem; if the family declines the hold past the cap, the workflow closes the days cleanly and the bed is released for re-admission.
Design target
Bed-hold revenue captured against the state policy goes from "whatever the BOM remembered" to systematic. State Medicaid audits find no overbilled LOA days because the rule applied was the rule the system encoded.
Design target only: not measured or validated in any community. Actual results require an operator baseline and pilot acceptance.
What goes wrong without it
On the manual workflow, the business-office manager catches the transfer Tuesday morning, calls the family to ask whether they want to hold the bed, gets the form signed three days late, and bills the days the state will deny. Or — worse — the family election was never captured and the state-Medicaid auditor finds days that should not have been billed. Either direction is money: lost on one side, recouped on the other.
Show me the evidence
Operators do not buy claims. They buy proof. If anything on this page reads as aspirational, ask us to walk you through exactly what is built, what is designed, and what is not yet in production in any community.
Where this connects in the platform
Every financial workflow runs on the same record. These are the feature pages, head-to-head comparisons, and pillar articles that go deeper on the surfaces this workflow touches.
Feature surfaces
Compared head-to-head
Regulatory and accounting references
Financial workflows on this page reflect CMS PDPM and PDGM payment rules, GAAP revenue recognition (ASC 606), and the state Medicaid case-mix programs that drive reimbursement.
- Patient Driven Payment Model (PDPM) — SNF Payment Methodology
CMS
Component scoring (PT, OT, SLP, Nursing, NTA) and the variable per-diem adjustments that drive Part A revenue.
- Medicaid Case-Mix Reimbursement — RUG-IV and successor systems
Medicaid.gov
State-level case-mix methodology overview; each state files its own State Plan Amendment with rate calculation detail.
- ASC 606 — Revenue from Contracts with Customers
FASB
The GAAP standard for revenue recognition; governs how room-and-board, ancillary, and Medicaid revenue is recognized over the resident stay.
- OIG Compliance Program Guidance for Nursing Facilities
HHS OIG
Federal expectations for billing integrity programs — drives audit-log requirements and segregation of duties around claims.