How a SNF Change of Ownership Affects Medicare/Medicaid Billing

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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 during Change of Ownership (CHOW).

Nursing homes that recently changed SNF management 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.