How a SNF Change of Ownership Affects Medicare/Medicaid Billing

Image by <a href="https://pixabay.com/users/Capri23auto-1767157/?utm_source=link-attribution&utm_medium=referral&utm_campaign=image&utm_content=3100563">Capri23auto</a> from <a href="https://pixabay.com/?utm_source=link-attribution&utm_medium=referral&utm_campaign=image&utm_content=3100563">Pixabay</a>How a SNF Change of Ownership Affects Medicare/Medicaid Billing

 

You recently acquired a skilled nursing home where rehab and/or nursing services are provided. Here’s what you need to know about how this will affect your reimbursement with Medicare and Medicaid.

Nursing homes that recently changed SNF management (CHOW) should be aware that it will take some time following the acquisition before becoming certified and approved to begin billing for the services it provides. While the delay can prove quite problematic for cash flow, certain states may allow a viable solution that a new skilled nursing facility owner should be informed about.

The answer for you may be including a provision in the operations transfer agreement that allows the provider to bill and get reimbursed through the seller in the crucial first few months of operation.

Does Your State Allow Billing through the Seller?

Prior to negotiating a contract with the seller about billing facilitation, it’s important to understand that rates often change and the varying state laws about Medicare and Medicaid billing can be complicated.

LTC Contracting provides the following summary highlighting the different billing allowances in the 9 key states we deal with.

  • New York allows a SNF to bill through the seller.
  • New Jersey does allow billing through the seller for fee-for-service, however, most of the MLTSS MCOs will only provide a new contract once you are certified with Medicaid.
  • Maryland, Connecticut and Pennsylvania do not allow billing through the seller.
  • Massachusetts does not allow seller billing, nor does it allow you to apply for a Medicare number until you are approved.
  • Georgia requires you to be approved prior to applying for a Medicare billing number, but you can bill through the seller.
  • Wisconsin does not allow billing through the seller; however, you can bill Medicare before Medicaid is approved and then tie it in once you have been certified.
  • Florida does not allow billing through the seller and approval is a long process, often up to 9 months. Moreover, the HMO utilizes its own agreement based on rate changes that generally go into effect after a sale, prompting many new SNF owners to forgo the seller billing process and swallow losses to circumvent the snags involved in the aftermath of lower rate adjustments.

LTC Contracting’s specialists are trained to assist your newly acquired SNF in obtaining and negotiating a favorable deal with the insurance company, whether it be a Commercial, Managed Medicare, or Managed Medicaid plan. Constantly keeping abreast of changing state laws, we are experienced in helping you navigate and procure a reasonable contract with the seller so that your nursing home will benefit from the best possible billing scenario during the Medicaid and Medicare certification wait-time.

For a professional review of the Medicaid/Medicare billing options for your newly acquired SNF and for any other related information, contact us at LTC.

 

LTC Contracting Helps Strengthen Providers’ Businesses; NJAMHAA

NJAMHAA Winter 2020 News

Council Members help Strengthen (Mental Health) Providers’ Businesses

 

LTC Contracting

 

The LTC Contracting staff guides mental health providers through licensure and business setup procedures and ensures compliance with all regulations, whether the providers are opening new organizations or adding new service lines to their existing businesses.

“We have helped many providers set up their businesses. They often come back to us when they want to add other service lines,” said Steve Shain, COO.

“The integrated license is very exciting. We don’t often see licensing reform in health care,” Shain said, referring to single licensure that will soon be available for providers to offer mental healthcare, substance use treatment and primary healthcare services. “We anticipate it will be a smoother process for providers: a streamlined process with everything managed under one roof.” He noted that LTC is already working with its clients to prepare for the integrated license.

LTC’s services also include getting providers credentialed and on the Managed Care Organizations’ (MCOs’) networks, which is especially important now that the MCOs are covering substance use services for special populations (Managed Long-Term Services and Supports clients, individuals served by the Division of Developmental Disabilities and people who are Fully Integrated Dual Eligible for Special Needs Plans [FIDE-SNP]) and additional populations will inevitably be covered by MCOs.

“Providers who have worked with commercial MCOs out of network are realizing that the market is shifting to in network, so they’re trying to get into networks as soon as possible,” Shain stated. “Some are playing it by ear. By waiting, they’re losing their leverage with MCOs and not helping to create adequate networks.

“Providers need to constantly verify and re-verify their clients’ eligibility, not just at admission,” Shain advised.

He explained that if providers are not aware when their clients switch MCOs, they could experience problems in reimbursement and disruptions to delivery of care. For those providers already participating with MCOs’ Medicaid plans, LTC helps with “anything on the financial end,” Shain said. “LTC partners with a company that does the billing and utilization review for LTCs’ client facilities, and LTC looks at this from a financial approach to ensure accuracy.”

 

LTC Consulting Services is the long term care industry’s premier medical billing service and off-site central business office. LTC’s custom business management packages for health care facilities offers peace of mind while substantially increasing and maximizing their revenues.

Watch “The Quid Pro Quo Video” by LTC Contracting

The Quid Pro Quo Video.

Hey everyone!

If you’ll notice this video looks a little bit different.

I’ll get to that in a moment, but I want to talk to you about today are two points that are making a lot of news. That is Medicare for All  – which is pretty easy to pronounce, and something that’s not so easy to pronounce: Quid Pro Quo.

Now, one of them can make you very electable the other one can make you very impeachable. Really they don’t really have much to do with each other – Medicare for All and Quid pro Quo; however, they converge when we’re talking about healthcare. And this is what I’d like to clear the air about.

Medicare for All is really a fundamental argument: the fundamental argument on how healthcare should be provided in this country. There is the concept that maybe Medicare for All is a good model, or maybe we should take the current model and adjust it and tweak it to make it better.

But keep in mind that aside for this argument, there are Political Action Committees (called PACs). These PACs are on the Medicare for All side that is a deep pocketed well-funded organization that is coming from companies as well as other organizations that will benefit in a quid pro quo style from Medicare for All and therefore they’re pushing to influence that.

On the other hand, the anti-Medicare for All, there is a Partnership for Americas Healthcare Future which is a huge PAC that is trying to go against Medicare for All. Again, they’re company backed organizations that will benefit from not having Medicare for All.

Aside for this fundamental argument about Medicare for All being the right choice or not, there is really another argument  through corporations and organizations that would like to influence the decision here. So keep in mind that policy is often driven by politics.

And when you’re dealing with politics, nothing is ever just black and white.

Thank you so much for watching we’ll see you next time!

 

Steve Shain, COO

LTC Contracting