Next Steps After Medicaid Certification at Your Assisted Living
Jan 20, 2025
Congratulations on becoming a Medicaid-certified provider! This is a huge milestone for your assisted living business, opening doors to serve more residents while securing a stable revenue stream. But now that you’re certified, what’s next? Let’s dive into the essential steps to maximize your Medicaid certification and set your business up for long-term success.
Check out the video, too:
What Does Medicaid Certification Mean?
Being Medicaid-certified means you can provide care to residents who qualify for Medicaid benefits. This allows you to bill Medicaid for their care, helping cover their expenses and ensuring consistent payments to your facility.
However, certification is just the beginning. To truly thrive, you’ll need strong systems, good relationships, and a plan to attract Medicaid-eligible residents.
Step 1: Set Up Your Documentation and Systems
Getting organized is the first step to smooth operations. Here’s what you need:
- Certificate of Insurance (COI): Update your COI to include Medicaid as an insured party. Your insurance broker can help with this.
- Banking Details: Ensure you’ve submitted accurate bank info to Medicaid for direct deposit payments. This ensures you get paid on time.
- Billing System: Set up a reliable billing system. Learn your state’s Medicaid billing codes and establish a schedule for submitting claims—bi-weekly billing works well for many providers.
Step 2: Work with Third-Party Administrators (TPAs)
In many states, Medicaid payments are handled by TPAs. For example, in Idaho, Molina Healthcare and Blue Cross of Idaho are key players.
- Research TPAs in Your State: Understand which ones operate locally.
- Complete Contracts: Each TPA may have its own certification process. Ensure you’re contracted with all major TPAs in your state.
- Keep Contracts Active: Regularly review and renew contracts to avoid losing reimbursement opportunities.
Step 3: Fill Your Facility with Medicaid Residents
Once certified, it’s time to connect with Medicaid-eligible residents. Here’s how:
- Build Relationships with Case Managers: Medicaid residents often have assigned case managers. These professionals can refer potential residents to your facility.
- Partner with Medicaid Agencies: Your state’s Medicaid office can provide lists of case management companies or resources to help you find residents.
- Engage the Community:
- Hospitals and Rehab Centers: Work with discharge planners for referrals.
- Social Media: Use Facebook ads to target local families.
- Local Events: Participate in senior fairs or community events to meet families.
Step 4: Market Your Facility
Even Medicaid families want the best for their loved ones, so marketing is still key.
- Highlight your Medicaid certification in ads.
- Showcase your quality of care, staff, and amenities.
- Use testimonials to build trust.
- Combine online efforts (social media, Google) with offline outreach (flyers, networking).
Step 5: Master Medicaid Billing
Getting paid is critical, so make billing a priority.
- Daily Rates: Work with case managers to set accurate daily reimbursement rates based on care needs.
- Assessments: Conduct regular resident assessments to ensure rates align with care levels. Notify case managers of any changes.
- Accurate Records: Document all services provided. This reduces delays and ensures smooth reimbursement.
- Billing Frequency: While Medicaid pays weekly, bi-weekly billing often balances cash flow well.
Key Takeaways
- Stay Organized: Ensure your documentation, contracts, and systems are up to date.
- Build Relationships: Strong connections with case managers, TPAs, and Medicaid agencies are essential.
- Market Your Facility: Highlight your Medicaid certification and quality of care to attract residents.
- Keep Cash Flow Steady: Stay on top of billing and maintain accurate records to avoid payment delays.
Final Thoughts
Becoming Medicaid-certified is a big accomplishment, but it’s just the start. By taking these next steps, you can grow your business, fill your facility, and continue making a meaningful impact in your community.
What’s your next move? Let’s get started on making your Medicaid certification work for you!
Next Steps?
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.
Show full transcript 👇
Transcript
00:00:00
hey friend I'm Brandon Gustafson I help new and aspiring Real Estate Investors launch their Assisted Living business in today's video we're going to be talking about what do you do after you become certified as a Medicaid provider for your Assisted Living business if you're interested in learning about that make sure you stick around for today's [Music] video hey friend before we get started on our topic for today I want to remind you to get over to the website Assisted Living investing. net we have our free
00:00:30
underwriting calculator links down below for a bunch of other free resources make sure you take advantage of those and it will help you along your journey to help you launch that Assisted Living business that you've been hoping to launch for today's video we're going to be talking about what to do after you get certified as a Medicaid provider in your Assisted Living business so the first thing that you need to understand is what that certification process looks like so the certification process and we've got a
00:00:52
video on this so make sure you go and watch that it's going to go really deep into it um but at its core what you're going to do is you have to start with the the governing body that does Medicaid and that's going to either be like Health and Human Services or Health and Welfare each state is slightly different you just have to find the the state agency that is in charge of doing Medicaid and that can be as simple as doing an internet search for um who administers or who's in charge of
00:01:15
Medicaid in my state and that's going to allow you to find that information once you know exactly which department you're working with to get certified as a Medicaid provider you're going to get an application form that you're going to have to fill out this form is very similar to the form that you're filling out to obtain your facility license and there's just you know it's I don't know 3 to five pages long asks a bunch of questions which population you want to serve where you're located um how many
00:01:42
beds all of these things what's your your provider number as well it's going to ask you a bunch of questions about that um but very similar to that application form that you fill out to obtain your facility license you're also going to need to give them uh Certificate of Insurance um so you need to work with your insurance broker to make sure you get that and and provide that the Medicaid agency is going to want to be listed as an insured body on that which is very simple to do your
00:02:04
insurance broker your insurance agency they're going to know exactly what that is it's very easy to to do it's called a COI a Certificate of Insurance super easy to get and then you're also going to need to get Bank information and this is because they need that information so that they can pay you when you build them they need that information so that when you say I we need $1,000 we need $10,000 we need $50,000 for the services that we provided they're going to they're not giving you a check for it
00:02:32
they will directly deposit it in we've talked about this actually with residents so I'm going to link this video up as well but um setting up payments for residents and doing that through a uh it's just it's game-changing so you want to make sure that you do that and this is how you're going to set up the payments here with Medicaid so it's core those are the things that you're going to need to set up that to get that certification in place now let's talk for a second really
00:02:55
quick about what it means to be certified so as a certified Medicaid provider it basically means those residents who qualify for Medicaid and they go through their own process to be qualified and and be accepted into receiving a Medicaid benefit it means that you are able to serve that population that that is on Medicaid so they as as a person with a Medicaid benefit can come to you for services and their insurance Medicaid is going to pay for those services so that's what it means you're able to now accept Medicaid
00:03:28
residents and get paid for that from Medicaid if that person does not have Medicaid or you do not you are not certified as a Medicaid provider you can bring them in but you are not going to collect from them because they don't have the money for it and you can't bill the insurance because you're not a certified Medicaid provider so there you have to make sure these things go hand inand that they are they have their insurance in place and that it is active and current and that you are certified
00:03:55
as Medicaid once those two things come together it's beautiful and you can get reimbursed Medicaid for the services that you are rendering the other thing to note is you can build Medicaid directly but some states often States will have a third party administrator and some states have multiple thirdparty administrators they are the ones that you need to bill with and there's probably a different certification type process not as deep as the one that you go through that we just talked about
00:04:20
before to become a Medicaid provider but you have to get kind of certified and contracted with these different third-party administrators and once you do that you're able to accept anybody any of those um Medicaid providers those third party administrators if a resident is on any one of them you can accept them if you are kind of contracted with them so as an example in Idaho there's actually three um administrators of Medicaid there's the state based there's Molina Healthcare and there's a Blue
00:04:47
Cross of Idaho and we are contracted with all three of those so we can accept anybody but let's say we decided not to do Molina or we didn't renew Molina for whatever reason we would only be able to do Blue Cross of Idaho and the state and that means that um anybody that was on Molina we would not be getting reimbursed for so um you want to make sure that you are understanding exactly what that looks like in your state so that you are getting the appropriate contracts in place you're working with
00:05:13
the different insurances and making sure that you can get reimbursed the way that you need to to run your facility and be profitable as as you're going about doing that now let's talk about finding those residents um and this is this is key now that you are you are a Medicaid certified provider you need to find those Medicaid residents you need out and and go talk to them and bring them into the facility and fill those beds with those Medicaid residents so where do you do that uh it's a great question
00:05:38
and something that I actually have had a lot of conversations with people recently about there's a it's very similar to private pay you're going to be looking and advertising and and socializing who you are and the population you serve to very much the same population that you would if you're looking at a private pay maybe it's uh you know unless you're a super high-end high-end amenities and things like that maybe you're looking at something slightly different but for the most part
00:06:03
you're working with the same types of people and the same lead sources to help you get um those beds full and help find those Medicaid residents so some of those ways that you can do this is working with their case managers so working each Medicade resident is going to have a case manager um and oftentimes those are case management companies if you start developing relationships with those case management companies it's going to allow you to get a good lead source and and start bringing people
00:06:29
into the home uh the next one would be to like get with um Medicaid with Health and Welfare or Health and Human Services whoever that governing body is oftentimes they'll have some kind of a list that gives you an idea of either who those case management companies are or ways that you can reach out to these Medicaid residents so you can get in front of them what are some of the programs that they are involved with and can you do some partnership things with them and get in front of those people
00:06:55
that need your services that may not be aware of who you are so getting in contact with them getting that list or or some resources around that from the people that are administering Medicaid is also something that's be really useful to you and finding where those people are and how you can um bring them into the facility you also want to just kind of become active and involved in the world where these people are so this could be um different programs it could be um being on Facebook a lot of these
00:07:24
people are on Facebook and and creating some advertising um from that standpoint it could be going to you know if they have uh they have a fall or something somewhere maybe they've been in the hospital um talking to the discharge nurse is great talking to rehab facilities um going out and going to hair salons there's so many different places where this group of people is congregating and and where they're active and you want to find out where they are in your specific geographic location and spend some time there and
00:07:51
make sure you're advertising yourself and um getting your name out there because this is how people are going to know who you are you can't just throw up a sign and be like cool cool everybody is going to come this is not the Field of Dreams where you if you build it they will come this is something you got to work for and and you've got to go find those residents and bring them in they are out there you can find them but you have to put forth an effort for you to be able to make some progress and
00:08:13
actually get those residents and start bringing them into your facility and the next thing I wanted to talk about was billing for Medicaid so once you become a Medicaid certified provider you are actually able to build Medicaid and the way that that works is you're going to um I've talked about this several times we'll link up one of my Medicaid vide up up above so you can go really deep into this but you're getting paid two ways one of them is coming from the resident through their social security and the
00:08:37
state will actually tell you how much of that money you can collect they often times are reevaluating that on an annual basis um at least annually so you want to make sure you stay on top of that and and figure out exactly what you can build the next way is billing a daily rate directly to Medicaid or the third party administrator who is helping make those payments the daily rate that you Bill is set by that case management company in conjunction with doctors and nurses and and the care team for that
00:09:05
Resident what you want to do on a regular basis and I've talked about this if you're interested in learning about how to do assessments comment assessment down below because it will let me know that this is a really good topic for you but you're going to be looking at um doing an assessment at least annually certainly when they come into the facility at least annually or when there is a big shift in the care that they are provided you want to do that and then you want to hand that off to cas
00:09:29
managers and be like hey we are we're doing a lot more for the for Susie over here um can you re-evaluate this and see is is it appropriate to raise the rate you as an individual cannot do that but you can go through a process to get higher rates um based off of the amount of care that you're providing to your residents it's it's just not as cut and dry as it is for a private pay resident where you just do it and it's good um it is a more lengthy process what's nice is you can actually back build this if you
00:09:58
do it correctly but um I digress so once you um do this you want to make sure you're keeping accurate um records you want to make sure you have the billing codes that you need for your state for the services you're providing and you're going to go in on a regular Cadence and you build them often times you could build them as often as you want most of the time though each of those third party administrators or Medicaid itself will only pay out on a weekly basis so you just kind of want to get into a good
00:10:26
Cadence we actually build every other week so we can get some decent cash flow coming in it helps us out um and and and makes the process of billing go much more smoothly because we're in there so frequently and we know it's what's going on and when there's an issue we're aware of it but we can do that we build that that billing code we set the daily rate um we put it in there and and we build and then on a typically within 5 to 10 business days they are paying us um and and getting us the information that we
00:10:55
need so that we can then um you know just kind of get get the and the more consistent you are at at billing that and and being consistent with that the more prompt they become in responding to your emails and seeing Yep this the this provider is actually really good for me to work with and then those payments start coming and you kind of get into a groove of exactly how those payments are going to come so that's kind of how you deal with billing with Medicaid um and it's you know it's super beneficial so
00:11:21
in today's video just to quickly recap we've been talking about what to do after you become certified as a Medicaid provider we went through a little bit deeper into how get certified what it means to be certified then we started getting into how to go find those residents and how to build which at its core are the two things that you have to do you also want to make sure that you're paying attention to make sure that your coverage is not going to lapse that you remain certified as a Medicaid
00:11:45
provider and that your residents also don't have aaps in coverage with Medicaid because if one of those two things happens we talked about how this thing just like comes together and it's great one of them is off up here it doesn't work and and you have issues so you have to be you have to stay on top of it this is a biger reason why people don't like Medicaid is you have to just make sure everything is always aligned or you're going to have some friction and and some issues and it can delay
00:12:08
payments and things like that so just want to make sure that you're aware of that as you get into doing this if you found this video to be helpful make sure you like uh subscribe and ring the bell as well so you get notified when we put out this content we're putting things out twice a week uh Tuesdays in a live session and Thursdays here in the long form content uh to give you information that is helpful to you comment down below if you have topics that would be helpful to you as you are trying to
00:12:31
launch your Assisted Living business and make sure you get over to the website Assisted Living investing. net have a bunch of free resources linked down below you can get the free underwriting calculator as well by going over to the website and I I have a few other programs the business planning guide is going to help you build that business plan do the underwriting to help you really get a leg up in uh starting that business and and getting to where you want to be to achieve your goals and we also have the Mastermind so Assisted
00:12:56
Living investing. netmaster we will link that down below as as well so you can go there uh learn a little bit more about the Mastermind see if it's a good fit for you but really at its core it's a 12month program where we get to work together group coaching some one-on-one situations uh and we're going to help you build that business plan find the property get the funding in place and get the facility license so you can launch that Assisted Living business does residential Assisted Living sound
00:13:20
interesting to you but you don't know how to get started at Assisted Living investing. net we are here to help you through the process start to finish helping you launch your Assisted Living business to create that time of Financial Freedom that you're looking for and I want to remind you it doesn't take a lot just a little bit keep going step by step by step if you keep going and you're consistent and persistent I promise you're going to be successful thanks for watching and have a great day
00:13:45
[Music]
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