Medicaid and Private Pay Turnaround Across High-Risk SNFs
Client Snapshot
Organization Profile
- Large SNF operator with 100+ facilities nationwide
- Facing record-high Medicaid Pending balances
- Private Pay receivables aging rapidly
- Third-party RCM vendor lacked oversight
Scope of Engagement
- Turnaround for 4 worst-performing facilities
- Training internal oversight team
- Workflow redesign & admissions screening
- RCM vendor management & accountability
Portfolio Challenge Analysis
Before engagement, these four facilities represented the worst-performing locations with significant receivables exposure.
| Facility | Medicaid Pending | Private Pay AR | Total Exposure | Status |
|---|---|---|---|---|
| Facility A | $0.85M | $0.32M | $1.17M | High Risk |
| Facility B | $1.20M | $0.45M | $1.65M | High Risk |
| Facility C | $0.92M | $0.28M | $1.20M | High Risk |
| Facility D | $1.10M | $0.38M | $1.48M | High Risk |
Total Portfolio Exposure
$5.07M
In aging receivables across four facilities
Root Cause Analysis
Vendor Accountability Gap
- Third-party RCM lacked direct oversight
- No weekly review of pending applications
- Renewals not tracked or proactively managed
Front-End Process Failures
- Admissions team unaware of Medicaid risk
- COVID-era blanket approvals now requiring reapplication
- Families unprepared for renewal complexity
Operational Gaps
- No structured admission risk screening
- Missing escalation protocols for high-risk patients
- Weak coordination between facilities and billing
Cash Flow Impact
- Medicaid denials went unaddressed
- Family communication delayed payments
- No proactive collection enforcement
Our Dual-Track Solution
We implemented immediate hands-on corrections at the facility level while simultaneously building a team to manage the vendor long-term.
Track 1: Facility-Level Turnaround
Weekly Vendor Meetings
Direct oversight of RCM performance
Pending Workflow Overhaul
Immediate action on all Medicaid applications
Denial Management
Addressed rejections within 24 hours
Collections Enforcement
Strengthened private pay collection discipline
Track 2: Internal Capability Building
Team Formation & Training
Corporate oversight team assembled
Admission Risk Screening
Built proactive pre-admission vetting
Medicaid Preparation
Audit & prep all residents for renewals
Sustainability Model
Handoff to internal team management
Key Areas of Focus
Facility-Level Turnaround
- •Direct control of Medicaid Pending
- •Weekly RCM vendor meetings
- •Real-time problem-solving
Oversight Team Development
- •Corporate team training & mentorship
- •Red flag identification
- •Long-term vendor management
Admissions Risk Management
- •Pre-admission Medicaid screening
- •High-risk admit escalation
- •Early financial liability flag
Proactive Medicaid Prep
- •Resident renewal audits
- •Early documentation collection
- •Denial prevention
What We Delivered
| Deliverable | Immediate Impact | Long-Term Value |
|---|---|---|
| On-Site Facility Turnaround | Stabilized cash flow at 4 facilities | Prevented future receivables deterioration |
| Medicaid Application Strategy | Cleaned up pending backlogs | Anticipated renewals before denial |
| Internal Oversight Team | Corporate team trained & operational | Sustainable vendor management model |
| Risk-Based Admission Screening | Early identification of high-risk admits | Reduced future exposure by facility |
| Resident Engagement Protocols | Improved family responsiveness | Higher Medicaid conversion rates |
Measurable Results
Key Metric
10x ROI
Recovered over 10x the cost of engagement within 6 months
Key Metric
Sustainable Model
Internal team now manages RCM vendor and prevents regression
Key Metric
Future-Proofed Process
Medicaid delays anticipated and proactively managed
Key Metric
Portfolio Scaling
Success model shared to replicate across remaining facilities
Why This Approach Worked
PartnersHCC's combined approach—direct problem-solving at the frontlines while building corporate capability behind the scenes—created both immediate results and long-term protection. We didn't just fix the billing breakdown; we helped the operator redesign how it governs its outsourced revenue cycle, preventing future losses at scale. By training an internal team to take ownership of the RCM relationship and implementing proactive admission screening and Medicaid preparation protocols, we transformed a crisis into a sustainable, scalable operation.