Healthcare Provider Enrollments: What You Need to Know

…and How Outsourcing to LTC Ally Can Help

Whether you’re a new healthcare provider or are working on expanding your offerings, enrolling with the right payers is essential to receiving reimbursements and maximizing your potential revenue. 

Provider enrollments with Medicare and Medicaid can be a complex process. This often requires the assistance of a third party that is experienced in submitting applications accurately and understands the unique requirements of each payer in each state. By expanding the number of payers you’re enrolled with, you can deliver care to more patients and increase potential revenue.

Why Credentialing Matters for Provider Enrollments

Healthcare providers must be enrolled with payers to receive reimbursements for the care they deliver to residents. In order to be enrolled with payers, providers need to go through a process that certifies compliance with standards of care and ensures necessary licenses and credentials are current and valid. 

For most providers, enrolling with state and federal payers is essential, as over 60% of nursing home residents are covered by Medicaid. Medicare is the single largest payer in the United States. 

Provider Enrollments: Medicare and Medicaid

The first step in enrolling as a provider with Medicare or Medicaid is to ensure you are a licensed provider with CMS. Every provider must be licensed before they can enroll as a provider and bill Medicare or Medicaid for care delivered to their beneficiaries. 

Next, providers must understand their state’s specific requirements as they pertain to enrolling with Medicaid. Each state has different requirements, which makes the process highly variable and complex. Operators must do their homework to ensure they have everything required to be licensed and enrolled with their state’s Medicaid agency. A common alternative to handling licensure and enrollment yourself is to outsource the process to experts in credentialing and provider enrollments, such as LTC Ally’s Contracting department. 

Once enrolled as Medicare or Medicaid providers for reimbursements, providers can begin billing for the care they deliver.

It should be noted that any time a change of ownership occurs, Medicare must be informed within 30 days. Ideally, providers will inform Medicare well ahead of time to ensure there is no disruption in their reimbursements when a change of ownership occurs.

Timing Matters with Provider Enrollments

At LTC Ally, we help healthcare providers across the United States enroll with the right payers and improve their cash flow and revenue. Our experts in provider enrollments are a complete solution for licensure and credentialing services, helping healthcare providers of all types expand their offerings and deliver care to more people.

In 2022 alone, we executed over 1100 change of ownerships, including licensure and provider enrollment services tailored to the needs of each individual provider.

As proven experts in change of ownerships, we have exceptional experience in understanding the requirements of state, federal, and private payers in almost every region in the United States. This allows us to submit accurate applications well ahead of time, enabling reimbursements to flow without delay or disruption.

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Founded in 2006, LTC Ally serves the long-term care industry with an unbound dedication to improving back office and financial operations. With a mission to reduce burdens and increase peace of mind, LTC Ally set out to revolutionize the way facilities handle their revenue cycle management. With a full suite of financial, case management, and contracting solutions for healthcare providers, LTC Ally is your partner in long-term care and skilled nursing.

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