When a hospital discharge planner calls with a referral, the clock starts. The facility that responds first, with a clinical screen, a payer confirmation, and a bed offer, wins the admission. The one still chasing paperwork loses it to a competitor down the road.
An SNF admissions checklist is a phase-by-phase operational guide that walks admissions coordinators through every required step from first referral contact through the end of the resident’s first week. It covers clinical screening, insurance verification, document collection, room assignment, and the billing triggers that determine reimbursement for the entire stay. This checklist is built for the people who run the process, not for families preparing for it.
Why Most SNF Admissions Checklists Get This Wrong
Search SNF admissions checklist and look at what comes up. Medicare.gov has a checklist for families evaluating nursing home quality ratings. Silverts has a guide about what clothing to pack. Most of what ranks is written for the patient or family preparing to move in, not for the admissions coordinator whose job it is to run the admission from the moment the phone rings.
They Are Written for Families, Not for You
The distinction is operational, not cosmetic. A family checklist answers: what do we need to bring? An operator checklist answers: what do I need to confirm, in what order, and who on my team owns each step? Those are different questions. The first is about preparation. The second is about execution under time pressure, across multiple departments, with billing consequences attached to almost every step.
If your admissions workflow is organized by document type, clinical records, legal documents, financial forms, you have a filing system, not a process. A filing system tells you what to collect. It does not tell you that insurance verification needs to happen before the bed is offered, or that the ARD decision in the first 48 hours will set the reimbursement rate for the entire stay.
Organizing by Document Type Is the Wrong Framework
Most admissions errors are not missing-document errors. They are sequencing errors, the right document arrived at the wrong stage, owned by the wrong person. The insurance card collected on arrival day instead of at referral. The physician order received after the MDS ARD window opened. The prior authorization logged after HMO-covered days had already started accumulating without confirmed approval.
A document-type checklist cannot catch a sequencing error. It has no concept of time or ownership. A phase-based checklist, organized by when things must happen and who is responsible, does.
For a deeper look at how digital intake systems address these sequencing gaps, see our overview of patient intake management software for skilled nursing facilities.
How to Use This Checklist
This checklist runs across four phases: Before Arrival, Day of Arrival, First 48 Hours, and First Week. Each item carries a role assignment.
- AC – Admissions Coordinator
- BOM – Business Office Manager
- DON – Director of Nursing
- RN – Floor Nurse
- MDS – MDS Coordinator
Items marked Billing Critical have a direct reimbursement consequence if missed or delayed, not a paperwork inconvenience.
Phase 1: Before the Resident Arrives
From First Referral Contact Through Admission Confirmation
This is where most revenue is won or lost. The pre-admission phase is the only window where your facility can confirm coverage, screen for clinical fit, and establish the payer before the bed is offered. Every step skipped here becomes a recovery problem, and recovery in SNF billing is slow, expensive, and sometimes impossible.
Here is the real issue: insurance verification is not a billing step. It is an admissions decision. By the time your billing team runs the check, the resident is already in the building, the family has signed consents, and correcting the payer requires a conversation nobody wants to have.
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#
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Step
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Owner
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Billing Critical
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|---|---|---|---|
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1
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Log referral in tracking system within 2 hours of receipt
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2
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Request hospital discharge summary and H and P
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3
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Complete clinical pre-admission screen, confirm skilled care need
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DON
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Yes
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4
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Verify Medicare Part A: 3-day qualifying stay, benefit period status, remaining days
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BOM
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Yes
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5
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Verify Medicare Advantage / HMO: confirm in-network status, obtain prior authorization, log auth number, approved level of care, approved days, start date
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BOM
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Yes
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6
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Verify Medicaid: active status confirmed or pending protocol initiated
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BOM
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Yes
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7
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Confirm payer and level of care with referring hospital
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AC
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Yes
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8
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Obtain signed physician admission orders, must precede or accompany admission
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AC / DON
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Yes
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9
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Collect Medicare/Medicaid card and supplemental insurance information
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AC
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-
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10
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Obtain signed financial responsibility agreement
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BOM
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-
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11
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Assign room and notify floor nursing
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AC
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-
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12
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Confirm admission date and time with family and hospital
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AC
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-
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Steps 4, 5, and 6 are the most commonly delayed items in pre-admission, and they generate the most expensive denials. The standard failure: a referral arrives Friday afternoon. The admissions coordinator confirms clinical acceptance, the bed is offered, and insurance verification gets handed to billing on Monday morning. The resident is already in the building. Medicare Part A is not active because the qualifying stay was observation, not inpatient. The HMO required prior authorization that was never requested. There is no clean path forward. There is a write-off and a family conversation that should never have been necessary.
For a complete breakdown of payer-specific verification steps, including what to do when coverage cannot be confirmed, see our SNF eligibility verification workflow.
Phase 2: Day of Arrival
The First Four Hours Set the Tone for the Entire Stay
Arrival day runs three departments simultaneously, admissions, nursing, and business office, and the handoffs between them are where items disappear. The most common version: the admissions coordinator assumed the BOM collected the insurance cards during intake paperwork. The BOM assumed the admissions coordinator handled it during the tour. Neither did. The claim goes out without verified coverage.
A role-specific checklist eliminates the assumption that someone else handled it.
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#
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Step
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Owner
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Billing Critical
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|---|---|---|---|
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13
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Greet resident and family; confirm room assignment
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14
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Complete and sign all admission consent forms and resident rights documentation
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15
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Collect and copy all insurance cards, originals not self-reported numbers
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BOM
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Yes
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16
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Confirm physician admission orders are signed and on file
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DON
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Yes
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17
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Conduct nursing admission assessment
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RN
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Yes
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18
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Orient resident to room, call system, and meal schedule
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RN
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-
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19
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Log admission in census system; notify billing of exact admission date
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BOM
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Yes
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Item 19 carries more weight than it appears to. The admission date entered in the census system is the date Medicare billing begins. A one-day error, a typo, a delayed entry, a date logged as the family arrival rather than the resident arrival, can misalign the entire PDPM payment period, create a discrepancy between the MDS and the claim, and trigger a documentation request that holds payment for weeks.
LTC Apps’ admissions and patient intake software captures this data at the point of entry and routes it directly to billing, eliminating the manual census log and the transcription errors that come with it.
Phase 3: First 48 Hours
The Clinical and Compliance Window That Determines Reimbursement
The first 48 hours after admission contain the most billing-critical deadlines in the entire stay. Most admissions coordinators are not aware of all of them, because most are owned by other departments. That gap in cross-functional visibility is exactly what this phase of the checklist closes.
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Step
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Owner
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Billing Critical
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|---|---|---|---|
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20
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Set MDS 5-day assessment ARD (Assessment Reference Date)
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21
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Initiate interdisciplinary care plan
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22
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Confirm physician initial visit is scheduled within required timeframe; document date
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DON
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Yes
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23
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Begin therapy evaluation if ordered, PT, OT, SLP
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Therapy Director
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Yes
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24
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Verify HMO / Medicare Advantage authorization covers days being billed; log renewal window
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BOM
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Yes
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The ARD is the single most consequential decision made in the first 48 hours, and it almost never involves the admissions coordinator or business office. It is made by the MDS coordinator, often without full visibility into a clinical picture that is still developing. A rushed ARD set too early locks in a lower PDPM grouping before therapy evaluations are complete, NTA diagnoses are confirmed, or nursing complexity is fully documented. Facilities that consistently capture appropriate PDPM reimbursement treat the ARD as a collaborative clinical-billing decision, not an MDS clerical task completed in the background while the rest of the team moves on to the next admission.
For context on how referral tracking connects to first-week clinical setup, see our overview of SNF referral management.
Phase 4: First Week
Closing the Loop Before the Billing Cycle Opens
By day seven, the resident is settled and clinical routines are running. Most facilities consider the admission complete. The business office has a different definition of complete, one that requires confirming every billing prerequisite is locked before the first claim generates.
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#
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Step
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Owner
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Billing Critical
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25
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Confirm Triple Check readiness: MDS, billing, and clinical documentation aligned
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26
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Verify all physician orders are signed and authenticated in the medical record
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27
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Confirm family has received all required notices, Medicare NOMNC if applicable
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AC / BOM
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Yes
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28
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Schedule follow-up with family at day 7 to 10
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AC
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-
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Item 25, Triple Check, is the final quality gate before the claim goes out. It requires three people in the same conversation: the MDS coordinator confirming the assessment is accurate and locked, the billing coordinator confirming the claim matches the MDS, and a clinical representative confirming the documentation supports the level of care billed. Facilities that skip this step, or treat it as an informal email thread, are one ADR away from a payment delay they cannot explain and a documentation gap they cannot close retroactively.
For a practical breakdown of how intake workflows support a cleaner first-week billing cycle, see 7 proven ways to improve patient intake in nursing homes.
What Happens When the Checklist Breaks Down
Three failure modes account for the majority of admissions-related revenue losses. They are not random. They follow a predictable pattern every time.
The late insurance verification. A referral is accepted clinically before coverage is confirmed. The family is told a bed is available. Consents are signed. When the business office runs verification the next morning, Medicare Part A is not active, the qualifying hospital stay was observation, not inpatient. The facility now owns a billing problem and a family conversation that neither party was prepared for.
The early ARD. The MDS coordinator sets the Assessment Reference Date within 24 hours of admission to stay ahead of the deadline. Therapy evaluations are not complete. The NTA score reflects only the diagnoses on the hospital discharge summary, not the comorbidities documented in the nursing assessment two days later. The PDPM grouper runs on incomplete data. The facility collects a lower rate for the entire stay with no mechanism to reopen the assessment without penalty.
The unauthenticated physician order. The claim goes out on day 30. An ADR arrives on day 45. The reviewer requests signed physician admission orders. The orders are in the chart but they were never authenticated with a wet or electronic signature. The claim is denied. The appeal takes 60 days. The facility collected nothing for a resident who received 30 days of skilled care.
Each failure has a corresponding checklist item. The checklist does not solve the underlying clinical problem. It closes the documentation and sequencing gap that turns a manageable situation into a denial.
How Digital Admissions Systems Change This Checklist
A paper checklist confirms what was checked. It cannot show you what was missed, flag an incomplete step in real time, or catch a date entered incorrectly three days ago.
If the person responsible for step 4 is out sick, the paper checklist does not surface that insurance verification never ran. If step 19 was logged with the wrong admission date, the checklist does not catch the discrepancy before the claim generates. Paper confirms completion by whoever last held the pen. It cannot confirm accuracy, enforce sequence, or catch omission.
A digital admissions system changes the accountability structure entirely. Required fields cannot be bypassed. Insurance verification must be logged before the admission record closes. The census update happens at the point of entry. Role assignments make it visible, in real time, which steps are open and who owns them. The 28-step checklist above works in either environment. On paper, it gives your team a structured workflow that most facilities do not have. Inside a digital system, most of these steps become enforced rather than remembered.
LTC Apps’ admissions and patient intake software was built specifically for SNF admissions workflows, not adapted from hospital intake or home health systems.
Frequently Asked Questions
Core required documents include physician admission orders, hospital discharge summary, history and physical, Medicare and Medicaid cards, supplemental insurance documentation, prior authorization records for HMO and Medicare Advantage residents, signed consent forms, resident rights acknowledgment, and a signed financial responsibility agreement. For Medicaid-pending residents, the pending application and any spend-down documentation should be collected at admission, not requested later.
From referral receipt to physical admission, most SNFs complete the process within the same day to 72 hours depending on referral complexity and payer verification timelines. The internal processing window, clinical setup, billing alignment, and care plan initiation, runs through the first 48 hours. The billing cycle does not fully close until end of week one, when Triple Check confirms MDS, clinical documentation, and the pending claim are aligned.
SNF admissions is a multi-role process, and that is precisely where most facilities run into problems. Each role assumes another handled a step. The admissions coordinator owns referral tracking, document collection, and family communication from first contact through arrival. The business office manager owns insurance verification, financial agreements, and census entry. The DON owns clinical screening, care plan initiation, and physician order management. Floor nursing owns the arrival assessment. The MDS coordinator owns the ARD and 5-day assessment. No single person can run a compliant admissions process alone.
Insurance verification that runs after admission rather than before it. Clinical acceptance happens, the bed is offered, the family signs consents, and payer confirmation happens the next morning when billing opens the file. If Medicare Part A is inactive, if the HMO required prior authorization that was never requested, or if Medicaid is not active and no pending protocol was initiated, the facility has no clean billing path. The fix is not faster billing. It is moving verification to the referral stage, before the bed is offered.
The facility assumes the full financial risk for those dates of service. If the claim is denied on eligibility grounds, the facility must appeal with retroactive documentation, identify an alternative payer, or bill the resident directly, but only if a valid Advance Beneficiary Notice was issued at admission. Without an ABN, the facility's ability to collect from the resident may be legally restricted.
Pre-admission verification is owned by the admissions coordinator. Mid-stay recheck is owned by the business office manager, who maintains the coverage milestone calendar and conducts weekly reviews. Post-denial recovery is owned by the billing coordinator, with escalation to the business office manager for high-dollar or aging denials. Root cause findings from Stage 3 flow back to the admissions coordinator to close the loop on upstream workflow failures.
Is LTC Apps the Right Fit for Your Facility?
LTC Apps is built for you if:
- You operate a skilled nursing facility or small regional SNF group
- Your admissions process runs on paper checklists, shared spreadsheets, or one coordinator’s institutional knowledge
- You want to reduce eligibility denials, accelerate referral response time, and give your business office real-time visibility into admission status without replacing your entire clinical system
- You are evaluating modular operations software and want something built for SNFs, not repurposed from hospital or home health platforms
This is not the right fit if:
- You need a full clinical EHR with physician-facing charting
- You are managing assisted living only, with no skilled nursing component
- You require an enterprise contract with a dedicated implementation team before going live
What Happens After You Request a Demo
Here is exactly what to expect, no ambiguity, no sales maze:
- A member of our team reaches out within one business day to schedule a call
- We run a 30-minute live walkthrough of the modules most relevant to your facility, admissions, eligibility verification, or both
- You receive pricing specific to your facility size and module selection
Most facilities have a clear picture of fit and pricing within one week of reaching out.
Common questions before booking: No long implementation timelines, most facilities are live on their first module within two to four weeks. No minimum facility size, we work with single-facility operators and regional groups. Mid-contract with another vendor? We can run a parallel evaluation so you are ready to move at contract end without a gap in operations.
Stop Running Admissions on Memory and Paper
If your admissions process depends on a paper checklist, a shared Excel file, or the institutional memory of one coordinator, you are one staff turnover away from a gap that costs you a denial. The 28 steps above are not bureaucracy. They are the operational difference between a clean claim and a family conversation no one was prepared for.
LTC Apps gives SNF admissions coordinators a system that catches what paper misses, and gives the business office the real-time visibility to know every billing-critical step was completed before the claim goes out.
