The decision to replace your billing company may already be made. The harder question is how to change your SNF billing company without losing track of claims, payments or residents whose Medicaid applications are still pending.
A handoff touches more than claim submission. Your old team may hold the history behind an appeal, receive electronic remittance files or know which Medicare Advantage authorization expires next week. At LTCPro, we work with skilled nursing and assisted living operators, so the transition conversation starts with those operational details, not just a contract start date.
This billing vendor transition plan covers two paths: moving from one outsourced billing company to another, and moving from an in-house business office to an outsourced team for the first time. Sixty days is a working schedule, not a guaranteed completion date. Your notice period, payer setup, access and billing calendar may require more time.
How Long Does It Take to Change SNF Billing Companies?
Allow roughly 60 days to prepare, transfer and test the work, then review performance again at day 90. The first independent month-end close may fall before or after day 60, depending on your cutover date. Do not force a go-live simply to meet the calendar if the new team cannot submit claims or receive remittances for a major payer.
An SNF billing transition transfers responsibility for claim submission, payment posting, denials and accounts receivable follow-up from one team to another. The goal is not just for the new team to begin billing. Every claim, remittance, pending application and appeal should have an owner throughout the change.
Before You Switch SNF Billing Companies
Before giving notice, establish what “normal” looks like and decide who will work balances that predate the cutover.
Pull three months of results, ideally by facility and payer, and have your CFO or administrator approve the baseline:
- Cash collected each month, separated by Medicare, Medicare Advantage, Medicaid and other payers.
- AR aging by payer, including balances over 90 days.
- Days in AR, using the same calculation at each checkpoint.
- Unbilled, held and returned claims, in both count and dollars.
- Denials, open appeals and approaching filing or appeal deadlines.
- Medicaid pending residents, with application dates, amounts outstanding and next actions.
- Medicare Advantage authorizations, approved dates and upcoming reviews.
Now assign the old AR. The outgoing company might work pre-cutover claims under a defined runout agreement. The incoming team might take them over. Or the facility might commission a separate cleanup project. None of those choices is inherently wrong. An undocumented split is.
Write down who handles unbilled prior-period claims, returned-to-provider claims, corrected claims, denials, appeals and payments that arrive after cutover. Include a handoff date, reporting frequency, system access and an end condition for runout. Under the Medicare claim-filing time limit, Original Medicare claims generally must be filed within one calendar year. For institutional claims spanning dates of service, the “Through” date is used to assess timeliness. Other payers and appeals have their own deadlines, so flag the nearest ones before assigning the backlog. (Read the Medicare claim-filing time limit).
A calendar-month boundary can make the cutover easier to manage, but “old dates to the old vendor, new dates to the new vendor” is not a complete instruction. SNF Medicare claims are submitted monthly and in sequence. List any billing periods and open claims that cross the cutover, then name one submission owner for each.
If the backlog needs dedicated attention, our guide to turning aged claims into revenue covers the recovery work that follows an AR review.
Know what your old AR needs before you switch
Changing your SNF billing company is easier when every open balance has an owner. Talk with us about your AR aging and Medicaid pending list so you can identify the accounts, deadlines and handoff questions that need attention before cutover.
Talk with us about your AR aging and Medicaid pending list so you can identify the accounts, deadlines, and handoff questions that need attention before cutover.
The 60-Day SNF Billing Transition Plan
| Timing | Main work | Facility decision or proof |
|---|---|---|
| Before day 0 | Approve baseline, cutover rule and old-AR ownership | Written handoff plan |
| Days 1–15 | Give notice, request data, inventory access and review Medicare enrollment information | Named owners for each system and payer |
| Days 16–30 | Confirm claim submission, ERA delivery and EFT details payer by payer | Test results and payment-routing checks |
| Days 31–45 | Review the first billing cycle together | One submission owner for each claim |
| Days 46–60 | Complete the first independent close when the billing calendar permits | Reconciled close and open-issues log |
| Day 90 | Review cash, AR, denials and unfinished runout | Corrective actions by payer and facility |
Days 1 to 15: Give Notice, Recover Data and Secure Payer Access
Check the outgoing agreement before sending notice. It may govern the notice period, data return, fees, access after termination and responsibility for old AR. If the notice period exceeds your target schedule, resolve that conflict before announcing a cutover date.
Request claim and payment history, open AR detail, denial and appeal logs, unapplied cash, credit balances, Medicaid pending records, authorization trackers, payer correspondence, and a list of systems and portals used on your behalf. Ask for the data in a usable format and specify a delivery date. A PDF aging summary alone will not tell the incoming team what happened on each account.
Create an access inventory for the Medicare contractor portal, state Medicaid portals, Medicare Advantage and commercial payer portals, clearinghouse, billing system and shared mailboxes. Record the account holder, administrator, users, multifactor-authentication method and recovery contact. Where access is tied to the outgoing vendor or a departing employee, arrange facility-controlled access rather than asking people to share passwords.
Put a business associate agreement in place before the incoming billing company receives protected health information. (Read HHS guidance on business associates) identifies billing as a function that can make a vendor a business associate and describes the written assurances a covered entity needs for that relationship.
Review your Medicare enrollment record too. CMS-855A Section 8 covers billing-agency information, including an agency you add, change or remove. An institutional provider can report enrollment changes through PECOS or the applicable paper form. A billing-agency change generally falls under the 90-day reporting period for other enrollment changes; confirm the effective date and submission details with your Medicare administrative contractor. (Read CMS-855A Section 8, Read the 90-day reporting rule).
Days 16 to 30: Verify ERA and EFT Routing
Treat electronic remittance advice and electronic funds transfer as separate checks. An ERA, commonly delivered as an 835 file, tells the billing team how claims were processed. EFT sends the money. (Read CMS’s remittance advice guide) — signing up for an ERA does not itself change how Medicare pays your claims.
For each payer, record where claims are submitted, who receives acknowledgments and ERAs, where EFT lands, and who posts the payment. Start with Original Medicare and your highest-cash Medicaid and Medicare Advantage payers. Ask the incoming team to demonstrate that it can receive and read a remittance, not merely show that enrollment paperwork was submitted.
For Medicare, the facility may authorize a billing service or clearinghouse to receive ERAs on its behalf. CMS also notes that when a billing service or clearinghouse is already receiving ERAs, paper remittances may stop when ERA setup is completed. Do not treat paper as a dependable backup while waiting for the new 835 route to work.
A new billing company does not automatically require a new Medicare EFT authorization. Check the current bank details before making any changes. If banking information needs to change, the CMS-588 EFT instructions describe the supporting account information and the pre-certification period before direct deposits begin. Avoid combining a bank change with the billing cutover unless necessary.
Repeat the routing check with each state Medicaid program and relevant managed care or commercial payer. Their portal, enrollment and payment arrangements should be recorded individually, not assumed to mirror Medicare.
Days 31 to 45: Run a Parallel Month
“Parallel” should mean parallel review, not duplicate billing. Assign one team to submit each claim or billing period. The other team can help check the work, answer historical questions and verify that nothing was left between systems.
Before submission, have the billing lead and facility staff compare census, payer changes, covered days, MDS-related information, authorizations and held claims. For Original Medicare SNF claims, preserve the monthly claim sequence across the handoff.
Walk the Medicaid pending and Medicare Advantage authorization lists resident by resident. For each item, record its status, documentation needed, deadline, owner and next review date. Reconcile posted remittances with deposits, and investigate payments that arrive without a matching remittance or remain unapplied.
The incoming team should also demonstrate that it can retrieve a denial, identify its deadline and locate the documents needed to work it. A successful test claim is not enough to prove the whole revenue cycle has transferred.
Days 46 to 60: Close the Month and Review Old AR
Let the new team complete its first independent close when the billing calendar and payer setup allow it. Reconcile billed days and submitted claims, payment posting, unapplied cash, credit balances and bank deposits. Compare results with the signed baseline, noting changes in census or payer mix before interpreting a cash difference.
Request a runout report from the outgoing company showing each remaining claim or balance, last action, next action, owner and deadline. A clean close means the new workflow is functioning independently. It does not mean every pre-cutover balance or appeal is finished. Keep runout reporting active until the agreed work is resolved or formally transferred.
Check Your SNF Billing Handoff Before Cutover
A transition can look ready on paper while old AR, payer access or remittance routing still has no clear owner. Tell us where you are in the switch, and we’ll discuss the handoff questions to resolve before the new billing team takes over.
Tell us where you are in the switch, and we’ll discuss the handoff questions to resolve before the new billing team takes over.
Outsourced Billing Onboarding: Moving From In-House Billing
The outsourced billing onboarding timeline may follow the same 60-day working plan, but the information is often held by people rather than in an outgoing vendor’s reports. Ask the business office manager to document payer-specific practices, recurring claim holds, portal administration, Medicaid pending contacts, authorization reviews and current work queues.
Agree which responsibilities remain at the facility. Admissions, census accuracy, source documentation and conversations with residents or families cannot simply disappear into a billing handoff. The service agreement should state how the outsourced team receives updates and who acts when information is missing.
If a billing manager has already left, begin with access recovery, the unbilled-claims queue and near-term deadlines. Do not wait for a full process redesign before ensuring the current billing period has an owner. LTCPro’s billing and accounts receivable services address the billing and AR capacity a facility may need in addition to its remaining staff.
30-60-90 Day Checkpoints for an SNF Billing Transition Without Cash-Flow Disruption
Look for a missing payer stream early. A total-cash figure can hide a problem when other payers are still paying.
| Checkpoint | What to verify | Warning sign |
|---|---|---|
| Day 30 | Access works; claim submissions and acknowledgments are visible; ERA delivery and EFT destinations are checked for major payers | Claims go out, but nobody can retrieve a payer’s remittance |
| Day 60 | The first independent close is reconciled, or a dated plan explains what remains; held claims and Medicaid pending accounts have owners | One payer’s cash or claim acceptance falls away while the total looks acceptable |
| Day 90 | Review cash by payer, days in AR, 90-plus-day AR, denials and remaining old-AR work against baseline | Aged balances rise without an identified cause or action plan |
Do not use “cash returned to baseline” as the only pass-or-fail test. Occupancy, payer mix and the starting backlog can change the expected number. Look at payer-level movement and its explanation. If one payer’s cash is short, check claim acceptance, remittance routing, held claims and authorizations before assuming the payer has stopped paying. For longer-term improvement, see how to reduce accounts receivable days in nursing homes.
Five Mistakes That Cause a Cash Dip When Changing Nursing Home Billing Companies
- Leaving old AR between contracts. Put prior-period claims, appeals, adjustments and payment posting in a written runout schedule.
- Treating ERA setup as proof that deposits are routed correctly. Verify both the 835 destination and EFT account for each major payer.
- Discovering too late that the old vendor controls access. Inventory portal administrators, clearinghouse credentials and recovery contacts in week one.
- Calling duplicate submission a parallel month. Have both teams review the billing cycle, but give each claim one submission owner.
- Handing over a balance without its next action. Medicaid pending residents and managed care authorizations need dates, documents and a named person responsible, not just a spreadsheet total.
How LTCPro Approaches an SNF Billing Transition
LTCPro works with skilled nursing and assisted living facilities on billing, revenue cycle and financial back-office operations, including facilities with 50 or more beds and multi-state operators. Its published approach to long-term care back-office support emphasizes understanding the facility’s immediate financial problem before determining the work to take on.
If you are changing billing arrangements, we can start by discussing your payer mix, current team, old AR, access gaps and intended cutover. Those details shape the handoff responsibilities and checkpoints. They also tell you whether the 60-day working schedule is realistic for your facilities.
FAQ: Switching Nursing Home Billing Companies
Do we need to change EFT when we change billing companies?
Not necessarily. ERA delivery and EFT deposits are different functions. Verify both, but do not assume that a new billing company requires a new Medicare bank account or EFT authorization when the existing payment details are unchanged. (CMS distinguishes ERA from Medicare payment).
Do we need to tell Medicare about a new billing agency?
If your institutional provider’s billing-agency information changes, CMS-855A includes a section for reporting that information. Confirm the effective date, reporting period and submission method with your Medicare administrative contractor. (Read CMS-855A).
Who works the old AR after we switch?
The party named in your handoff agreement. That could be the outgoing company under runout terms, the new team or a separate cleanup team. Specify who owns claims that are unbilled, denied, appealed or paid after the cutover.
Can an outsourced billing company handle Medicaid billing across multiple states?
Yes, but the operating plan must account for each state and its relevant managed care plans separately. Give each state a payer-access inventory, Medicaid pending list, remittance check and performance checkpoint. LTCPro says it works with multi-state long-term care operators and adapts to state-specific Medicaid requirements.
Can we switch while Medicaid applications are pending?
Yes, if each application is handed over with its submission date, outstanding requests, resident balance, next follow-up date and named owner. The risk is not that an application remains pending during a transition. It is that nobody continues the follow-up.
What happens when an SNF billing manager quits mid-month?
First find out who can access the billing system, clearinghouse and payer portals. Identify unbilled claims, work already submitted, near-term authorization reviews and filing or appeal deadlines. Then assign coverage for the current billing period while deciding whether to rebuild the in-house role or outsource it.
How long should the old billing company keep working?
There is no universal runout period. Agree on the work to be completed, access required, reporting frequency and conditions for closing or transferring remaining accounts. Do that before the outgoing company’s regular services end.
Plan Your Switch Before You Give Notice
Tell us which facilities, states and payers are involved. We’ll discuss a practical SNF billing cutover, including who works the old AR and what needs to be verified before the new team takes over.
We’ll discuss a practical SNF billing cutover, including who works the old AR and what needs to be verified before the new team takes over.
About LTCPro
LTCPro provides long-term care billing, revenue cycle and financial back-office services for skilled nursing and assisted living facilities in the United States. Its services include medical billing and accounts receivable, prior authorization, accounts payable, bookkeeping and general ledger support, and payroll. LTCPro also offers long-term care software that can be used on its own or with its back-office team.
