Skilled nursing revenue cycle

Paid,
not pending.

We run billing, denials, and Medicaid eligibility for nursing homes — so the money you already earned actually lands in your account.

Built for independent operators running one to five buildings.

What good A/R looks likeIndustry targets
Medicare Part A — days in A/R< 20
Medicare Advantage30–45
Medicaid45–60
Part A first-pass acceptance> 95%

Industry benchmarks we manage your book to — not a claim about your facility. Send us a month of aging and we'll show you where you actually sit.

Why this matters

Your billing isn't back office. It's the whole margin.

2.1%
All-payer total margin for freestanding skilled nursing facilities
MedPAC, March 2026 (2024 data)
41%
of revenue cycle leaders say at least one claim in ten is denied
Experian State of Claims 2025, n=250
63%
Share of nursing facility residents covered by Medicaid — the hardest payer to bill
KFF, July 2025

Put those together: a facility running a 2.1% margin, denying one claim in ten, on a resident base that's two-thirds Medicaid. There is no version of that business where billing performance is a back-office concern.

What we do

Four jobs, done properly

Not a software licence and a login. People who work your claims, chase your denials, and tell you where the money is.

Billing & claims

Every claim scrubbed before it leaves, filed on the day it's ready, and reconciled against the remittance line by line.

  • Medicare Part A and B, Medicare Advantage, Medicaid, managed care, private pay
  • Triple-check participation and documentation review
  • Short-pay identification the week it happens, not the quarter

Denial management & appeals

Denials get worked, not filed. We track every one to a root cause and fix the cause, not just the claim.

  • Appeal drafting and submission through all levels
  • Root-cause reporting so the same denial stops recurring
  • Timely-filing watchlist so nothing ages out silently

Medicaid eligibility & pending

The single biggest source of aged A/R in this industry, and the one most in-house teams don't have time to chase.

  • Application tracking from admission to determination
  • Private-pay to Medicaid conversion the month it's approved
  • Redetermination calendar so coverage doesn't lapse

A/R & reporting

One page, first business day of the month. Written so an administrator can act on it without a finance degree.

  • Aging by payer with the accounts that need a decision flagged
  • Days in A/R, clean claim rate, and denial rate against benchmark
  • A named person who answers the phone when you call about it
How it works

Live in 30 days

01 / WEEK 1

Free A/R review

Send one month of aging. We come back with what's collectable, what's aging out, and what it's costing you.

02 / WEEK 2

Scope and agreement

We agree the payers, the buildings, the reporting cadence, and the fee. BAA signed before anything moves.

03 / WEEKS 3–4

Onboarding

System access, payer enrolments, and a clean-up plan for the aged balances already on your books.

04 / ONGOING

We run it

Claims out, denials worked, eligibility chased, and a one-page report on the first business day of every month.

Why Trovana

Three reasons operators switch

01

Nursing homes only

We don't also do dermatology and dental. PDPM, MDS timing, triple-check, Medicaid pending, bed-hold rules, and the way a five-day assessment turns into a paid claim — that's the whole job here, and it's a different job from physician billing.

02

You get a person, not a portal

One named account lead who knows your buildings and answers the phone. Big outsourcers give you a ticket queue; the reason claims sit is almost always that nobody owned them.

03

We report against benchmarks, including when we're behind

Days in A/R, clean claim rate, and denial rate every month, measured against published industry targets. If a number is off, it's on the report with what we're doing about it.

The scoreboard

The numbers we manage to

Published targets for skilled nursing A/R performance. Your monthly report shows where you actually sit against each one.

PayerDays in A/R targetOver 90 daysDenial rate
Medicare Part Aunder 20under 5%under 5%
Medicare Advantage30–45under 10%under 8%
Medicaid45–60under 15%under 6%
Private pay30–45under 10%
All payersunder 45–50 under 15–20%

Benchmarks per published skilled-nursing A/R standards, 2026. Monthly write-offs target: under 1–2% of net revenue.

Client reference — to be added

"…"

Reserved for a named client quote once written permission is on file. We don't publish reviews we wrote ourselves.

Send us one month of your A/R.

We'll tell you what's collectable, what's aging out, and what it's costing you. No fee, no obligation.

Request the review Book a 20-minute call