Unlock Revenue: Certify Your Assisted Living Facility for Medicaid
Oct 15, 2024
Starting an assisted living business is a rewarding investment that meets a rising demand in our communities. As people age, the demand for quality care facilities grows, making this a viable market for entrepreneurs. However, being a registered Medicaid provider ensures your assisted living facility's long-term profitability and sustainability.
This blog will discuss essential topics to help you understand why certification is necessary and how it may benefit your business. Becoming a Medicaid provider will make your institution eligible for Medicaid reimbursements. This accreditation broadens your prospective client base and provides consistent cash streams, ensuring your company's financial stability and growth.
Join us as we explore all the details of the Medicaid certification process, including the benefits and processes required to obtain it. Whether you're just starting or trying to expand your current facility, recognizing the value of Medicaid certification is critical to your success in the assisted living sector.
Check out the video too:
Understanding Medicaid Providers
A Medicaid provider is a healthcare organization, such as an assisted living facility, that provides services to Medicaid recipients. These are Medicaid beneficiaries, and your services include bathing, dressing, and feeding assistance. To become a Medicaid provider, your facility must first be licensed in the state where it operates. Following licensure, you must complete an application to become a Medicaid provider.
Steps to Become a Certified Medicaid Provider
First, you must get a license from your state health department. This step entails meeting several health and safety regulations to ensure that your institution can operate legally in the state. Medicaid is administered differently in each state, so it is important to contact your State Department of Health to learn about specific rules and application processes. Several states use Managed Care Organizations (MCOs) to administer Medicaid benefits. If necessary, you will also need to register with these organizations. For detailed steps, visit their websites and look for the "credentialing department."
Next, collect all essential documentation. This includes your Tax ID (EIN), which you acquired when you registered your LLC, and your bank account details to ensure that refunds are made by direct deposit. You must also supply your facility's mailing and physical addresses, insurance information such as a Certificate of Liability Insurance (COI), and the Articles of Organization to confirm your LLC is lawfully registered. Additionally, you must submit your facility license number, which you will get upon state licensure, and any state-specific criteria.
Submit your application once you have compiled all of the required documentation. The process usually takes 4-6 weeks; however, it may take longer if there are any problems or missing information. For example, delays caused the process in Colorado to take five months. Once accepted, you will be trained on the billing procedures relevant to your state's Medicaid administration. This training will help you understand how to bill for services and avoid payment delays correctly.
Key Considerations and Tips
It is essential to have all required paperwork organized and easily accessible. Digital storage alternatives, such as Google Drive, can be used for easy access. Also, ensure you have enough operating money to pay expenses during approval. This may entail seeking additional funds in your loan to cover 2-3 months of operational expenses. Prepare for potential delays and have a cash flow management plan during this time, as the application process can be slow and require follow-ups.
Launching an assisted living facility is significant, but becoming a certified Medicaid provider is crucial in securing your facility's financial health. Download our Business Plan Checklist here for a comprehensive guide on building your assisted living business plan. This tool will help you outline every necessary step to ensure your facility's success.
Need help figuring out where to start? Join the next Roadmap Challenge and build your launch plan with me.
p>If you want to dive deeper into the assisted living business, download our free underwriting calculator. Visit Assisted Living Investing for more resources and to schedule a consulting call. Join our community and take your first step towards a successful assisted living business!
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Transcript
00:00:01
[Music] hey it's brandon gustafson welcome back to assisted living investing happy to have you on the channel today i just want to remind you uh connect with me on assistedlivinginvesting.net we'd love to see you over there so you can get access to free resources and subscribe to my newsletter for future content and uh also make sure you're liking commenting and subscribing to my videos ring the bell so you get notified when i get new content out there and then follow me on all my other social
00:00:40
media platforms quick recap on the last two videos we've been getting into what medicaid and medicare are how they work in assisted living and what the process is and i'm hoping that that information was was helpful to you and giving you a base understanding of what those different programs are how they work and the difference between the two of them and make sure you comment down below if those were helpful i'll be putting them up here in some cards so make sure you follow that and get some information there and uh
00:01:08
we'll jump into the topic for today today we're going to get into how to get certified as a medicaid provider so we've talked about being a medicaid provider that you can get reimbursed by medicaid but what is the process to becoming a certified medicaid provider so what is a medicaid provider a medicaid provider is a healthcare entity like your assisted living facility who renders service to a medicaid beneficiary quick terms here rendering service just means that they're the people that you're
00:01:39
providing healthcare services to you know you you provide them with care whether that is helping them go to the bathroom take a shower feeding them that is the the kind of care that you are providing to your residents so that's the care that you are rendering the next term is a medicaid beneficiary so this is a person who has health care benefits through medicaid when i talk about beneficiaries medicaid beneficiaries it's the the person it's your resident um the person that has the health care benefits there so medicaid
00:02:09
provider must be licensed in the state in which they are practicing and they then must complete an application to be a certified medicaid provider so you first get your facility licensed you work with the department of health to get that license in place so that you can practice as as an assisted living facility and then once you have that you can start the process becoming a certified medicaid provider in your state so how do i become a medicaid provider that's a great question you can become a
00:02:38
medicaid provider by starting out you want to reach out to the state department of health to learn what their requirements are and how to apply to become a medicaid provider since medicaid is administered at the state level each state is going to be different so reaching out to the state department of health is going to give you the information that you need to learn what you need to do to become a certified medicaid provider they'll also be able to tell you the department of health can tell you if
00:03:08
there are any mcos managed care organizations that we talked about last week in your state that you'll also need to register with if there are they can point you in the right direction and you'll be able to to figure out what the process is for applying uh with that mco so that you can then um become a medicaid provider with them the group that you would want to look for the term that you would want to look for as you're getting into those mco the mco website getting on on their portal to see how
00:03:40
you go in and become a medicaid provider you want to look for credentialing department is is the phrase you're kind of looking for you want to be a credentialed provider with the mco it's kind of what they're going to call it once you figure out what their process is through their website then you just complete that process and you become a medicaid provider now that application process um whether it's with the state or with an mco is going to be quite similar it's going to be actually very
00:04:08
similar to the process that you went through as you were receiving your license to operate as a facility in the state they're going to need a lot of the exact same paperwork so make sure you kind of have that on file put it in a folder you're going to need this information whether it's for your insurance for the lender for the state for an mco you're going to need a lot of this same information so save yourself some time put it in a folder on google drive on your computer wherever it is that you are storing your
00:04:36
information but you want to make sure that you have that information handy the information that they're going to be asking for are things like a tax id or an ein text ids and eins are the exact same things a social security number is also a tax id but ein i can't remember what it stands for it's like a unique identifier it's basically yeah it is a tax id um that's what it is but it's a business um business tax id so um you'll when you set up your llc you'll be able to get that paperwork
00:05:06
that gives you what that ein is and oftentimes they want to see that paperwork that says yes this entity has been set up um just kind of your approval uh letter there for your tax id number your ein number uh you'll want to they'll need your bank account information this is so they can do direct deposit for the funds that they're going to be paying you um so they'll need like a bank letter or something like that that has the um the bank account number and the routing number for your bank on it and
00:05:33
oftentimes like on letterhead from the bank just so that they can verify that yeah this is true like this is a real bank account it's legit um and you also want that it helps protect you making sure you have everything set up there correctly they're gonna want mailing and physical addresses um so you for us we have a separate mailing address that's in cedar city utah that we've set up through our our attorneys just as a registered agent address just as a way to kind of give us a veil of where our personal residences
00:06:05
are and things like that but the physical address would be the physical address of the facility where that's located but they'll want to have that information they'll want contact information from you as well so phone numbers emails you know simple stuff like that oftentimes they're going to want insurance information so they want what's called a coi um or an insurance accord letter um and then sometimes they'll want their their name at the bottom of that so they'll give you that information on
00:06:32
it's it seems complicated it's actually very easy to generate one of those letters if you're working with an insurance broker they can do it for you simply or if you're able to just log into your insurance company oftentimes they'll have a way for you to generate those those letters so they'll need insurance information oftentimes they're also going to want the articles of organizations this is paperwork that will be given to you by the state when you register your llc so
00:06:56
it's not you don't have to go and find it it will be given to you as you go through that process of setting up your entity but it's something that oftentimes they'll want whether it's for the facility license to actually operate as a facility just to make sure you're a legit company or the uh the process of getting your medicaid um in place they'll want that information just to make sure you're a legit business they'll want your facility the license number so once you
00:07:26
become a licensed by the state to operate your facility you'll get a nice paper that says yeah we're a real facility on it it's going to have a little number on there that's your facility license number the medicaid agency who's administering medicaid for you is going to want that so they can verify it oftentimes it's just easiest to give them a copy of that license um so just make sure you scan that in and just have it available so you can hand it off to them and then each state because it's administered at
00:07:54
a state level is going to have other state requirements but those are just kind of a good overview of the types of things that you might need as you're doing your medicaid application um to get certified for medicaid so what is the application process like as you're trying to get certified for medicaid first you're going to complete your application so all those things that i listed uh just barely you're gonna have to get that information to them uh turn it in so that they can then process it
00:08:22
and and they start you know you hand them the information and they'll tell you thank you we received all your information we'll be in touch if if we need anything else typically i've heard from a lot of people that it takes four to six weeks is kind of what you could expect it to take for them to process that application with the understanding that if you're missing something sometimes they're going to start over and it is it's extremely frustrating when that happens it can take longer for for
00:08:50
example for us in colorado it took us five months to become a certified medicaid provider and it was it was rough during that five month process we had just a lot of uh instances where we had to put in personal funds to make payroll everything is is fine now we were able to back bill and we got reimbursed for all of those five months where we were not able to build medicaid um so we've been able to kind of get ourselves whole again but it was frustrating and that's something that you'll want to just kind
00:09:18
of be aware of that as you're going through the process of getting a loan work with the bank to try to get some extra operating capital in your underwriting process looking at the calculators that uh that i went through last time you can find those up above here get into those and there's a line in there that talks about operating capital that you want to build into your loan doing two three months of operating capital is going to help you be able to operate in the event that you have a lot
00:09:45
of medicaid residents and medicaid just takes a long time to process your uh your application so just make sure you're aware of that that's something that you want to just have and be aware of as you're going through the process because you just don't it's out of your hands you can call them as much as you want they're still probably going to go slow unfortunately once you are a an approved medicaid provider most of the medicaid administrators are going to provide you with some training so that you can learn
00:10:12
the specific billing process to how they administrate medicaid each one while they are very similar each one does have subtle differences and being able to understand how they work is is going to be key but all the ones that we've worked with have been great to work with some of them are not as responsive as as i would like but overall they do a great job and so that's something that you kind of want to be aware of make sure you take advantage of those resources they're going to help you out
00:10:41
a lot and getting started billing for medicaid helping you find and identify issues so you can get past them so you can start getting paid for the services that you're renting rendering for your medicaid residency your facility so just a quick recap we talked today about how to get certified as a medicaid provider we went into what is a medicaid provider it's the definition of that how do you become a medicaid provider and what is that application process like what you can expect the types of documents you need
00:11:13
to provide i really hope that that was helpful make sure you comment down below if there's something i was missing in that process or what your experience was like as you were trying to get certified as a medicaid provider for your facility i'd love to hear from you learn about your process what you've experienced in the different states that you're that you're working in i'm sure everybody else would love to hear it as well because each state is different and getting more information on it is just
00:11:38
going to help everybody out next time we're going to get into the secret about medicaid payments and assisted living how it works just like how the actual structure of getting paid in assisted living for a medicaid resident what it looks like so you can know what to expect i'm really excited to share this with you it's something that i think a lot of people don't know um and i i'm excited to kind of share the the process and help you understand what it looks like make sure you comment down
00:12:03
below uh make sure you like the video give me a big thumbs up uh subscribe to the channel and ring that bell so you get notified when future content comes up doing all those things just helps other people find the channel and it's going to help them on their journey and and we can go on this together and and kind of learn exactly what it looks like and how to how to get it done together make sure you visit assistedlivinginvesting.net for free resources and to join my mailing list for future content and thanks for
00:12:29
watching today i'm excited to see in the next video have a great one and we'll see you next time [Music] you
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