Skilled Nursing Facilities Billing in Virginia

Consolidated billing makes the facility responsible for most services, and Medicaid is the dominant long-stay payer in most states. In Virginia that plays out against a specific set of rules rather than a general one.

Claims for Virginia providers are adjudicated by Palmetto GBA (JM), which is also who hears the first level of appeal — so an appeal argument that works here works in every state that contractor covers.

Coding driver

Case-mix classification driven by assessment data, where the assessment itself sets the payment rate.

Medicare contractor

Palmetto GBA (JM)

Medicaid program

Cardinal Care

Auto injuries

Tort state — health plan sequencing applies

What changes in Virginia

Medicaid in Virginia runs as Cardinal Care and is delivered largely through commercial managed care plans, so most Medicaid claims are adjudicated by an insurer with its own filing window and its own authorization rules rather than by the state.

Virginia attaches criminal penalties to percentage-based fee-splitting arrangements. Our own pricing in Virginia is set accordingly. That describes what we charge; your own position is a question for your counsel rather than for us.

Where skilled nursing facilities claims fail

Assessment not completed inside the required window
Services billed separately under consolidated billing
Skilled level of care not documented daily

We work the claims. You practice medicine.

Coding, claim submission, denial management, and A/R follow-up — with nothing left for your front desk to chase.

Call (409) 880-5990 Book a Free Consultation

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How It Works

Review

We look at your Virginia skilled nursing facilities denials.

Scope

A written scope and price before any work starts.

Transition

Coding and submission move across without a gap.

Report

Denial causes segmented by payer and provider.