Skilled Nursing Facility Billing Services in Maryland

Maryland's healthcare market includes 22,000+ physicians, and skilled nursing facility practices here face a payer market dominated by CareFirst BlueCross BlueShield on the commercial side and Maryland Medicaid (HealthChoice managed care program) on the public payer side. Medicare claims are processed through Novitas Solutions (Jurisdiction L), which applies its own Local Coverage Determinations that directly affect skilled nursing facility procedure coverage and medical necessity requirements. Generic billing teams without MD specific knowledge leave revenue on the table.

Skilled Nursing Facility billing itself is complex. SNF billing under PDPM uses the Minimum Data Set (MDS) assessment to classify patients across five payment components: PT, OT, SLP, nursing, and non-therapy ancillary (NTA). Each component has its own case-mix group and reimbursement rate. Consolidated billing rules require the SNF to bill for virtually all services during a Part A stay, and the 100-day benefit period creates coverage-window management challenges. When you combine this coding complexity with Maryland's specific payer rules, authorization requirements, and 9 Maryland Medicaid (HealthChoice managed care program) managed care plans that each have their own billing rules, you need a team that understands both dimensions. Go Medical Billing provides that expertise at 2.49% of collections, serving skilled nursing facility practices from Baltimore to Frederick and across Maryland.

Maryland has about 22,000 physicians and the most unusual hospital reimbursement structure in the country. Under a federal waiver, the Maryland Health Services Cost Review Commission sets hospital rates that apply equally to all payers including Medicare, Medicaid, commercial insurers, and self-pay patients. This means a Maryland hospital charges the same rate for the same service regardless of payer. The All-Payer Model has been in place in some form since 1977 and was renewed as the Total Cost of Care Model in 2019. The HealthChoice Medicaid managed care program runs through nine MCOs, including unique provider-based plans like Priority Partners (Johns Hopkins HealthCare) and MedStar Family Choice (MedStar Health). The Baltimore-Washington corridor concentrates most of the state's physicians, with Johns Hopkins, MedStar Health, and University of Maryland Medical System as the three anchor academic systems. Maryland's Medicaid program ran a 2024 health equity incentive program that distributed payments based on socioeconomic disadvantage scores across the state.

Maryland-specific factors that shape skilled nursing facility reimbursement: Maryland is the only state with an All-Payer Model under federal waiver. Hospital rates are set by the Health Services Cost Review Commission and apply equally to Medicare, Medicaid, commercial, and self-pay. The model has been in place since 1977 and was renewed as the Total Cost of Care Model in 2019.; Maryland's HealthChoice program runs through nine MCOs, including provider-owned plans like Priority Partners (Johns Hopkins HealthCare) and MedStar Family Choice (MedStar Health). This is more provider-affiliated MCOs than any other state.; The 2024 HealthChoice agreement allocated health equity incentive payments ranging from about $226,000 for Aetna to about $2.2 million for Priority Partners, based on MCO membership in jurisdictions with the highest socioeconomic disadvantage scores.. Our MD coders build these into every skilled nursing facilityclaim — see how this works alongside our Maryland medical billing and skilled nursing facility billing teams.