Reimbursement Intelligence

Medicare Bridge
Capital Architecture

CMS reimbursement cycles average 14–30 days. Acquisition timelines do not wait. Bridge capital eliminates the lag between delivered care and received revenue — preserving cash flow during ownership transitions.

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Capital Intelligence

The Reimbursement Gap Problem

For optometry practices acquiring Medicare-heavy patient panels, Lumina Medical Capital structures bridge liquidity to span the interval between day-one service delivery and the actual deposit of CMS funds — ensuring your balance sheet never signals distress during a critical ownership transition.

The CMS Lag Window

Medicare processes clean claims in 14 days, but real-world cycles — including supplemental billing, coordination of benefits, and remittance reconciliation — extend effective cash receipt to 21–45 days post-service. For a $1.2M/year Medicare revenue practice, that lag represents $70K–$148K in perpetually float-suspended capital.

Acquisition-Phase Exposure

During the 60–90 day post-close transition, incoming owners assume operational expenses immediately — payroll, rent, supplier invoices — while the acquired practice's Medicare revenue stream resets billing cycles. Bridge capital closes this exposure window without requiring personal guarantees against receivables in motion.

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Structural Placement

Medicare bridge facilities are structured as working capital lines — not term instruments — positioned above the senior acquisition note in the capital stack's liquidity tier. They carry independent covenants calibrated to receivables aging rather than EBITDA ratios, which preserves headroom on the primary acquisition facility.

CMS Mechanics

Medicare Optometry Billing Universe

Understanding which CPT/HCPCS codes generate Medicare revenue — and their reimbursement timelines — is the foundation of accurate bridge sizing.

Service Category Representative CPT 2025 AZ Allowable Avg. Payment Lag Denial Rate
Comprehensive Eye Exam 92004 / 92014 $95–$130 14–21 days 6–9%
Diabetic Retinal Exam 2022F / G0000 $55–$80 18–30 days 9–14%
OCT — Retina 92134 $48–$68 14–25 days 11–17%
Visual Field Testing 92083 $68–$92 14–21 days 8–12%
Glaucoma Suspect Eval. G0117 / G0118 $42–$58 21–35 days 13–19%
Weighted Portfolio Average $72 avg. 21–28 days 9–13%

Allowable rates based on CY2025 Medicare Physician Fee Schedule — Arizona MAC (Noridian). Denial rates reflect first-pass national benchmarks; practice-specific rates vary.

Sizing Intelligence

Bridge Facility Sizing Framework

Proper bridge sizing requires understanding the practice's receivables velocity — not just its top-line revenue.

Illustrative: $800K Medicare Revenue Practice

Annual Medicare Revenue $800,000
Monthly Run Rate $66,667
Avg. Collection Lag (28 days) $61,333
Denial Reserve (11%) $6,747
Transition Overhead (60 days) $133,333
Recommended Bridge Facility $200,000

Bridge Facility Parameters

Facility Type
Revolving Working Capital Line
Facility Size Range
$100K – $750K
Term
12–24 months, renewable
Collateral
Medicare receivables assignment + blanket business lien
Advance Rate
70–85% of eligible Medicare A/R
Covenants
Days Sales Outstanding ≤ 45; denial rate ≤ 20%
Deployment Scenarios

Four Bridge Capital Deployment Scenarios

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Acquisition Transition

Covers the billing cycle reset that occurs when a new NPI or group takes over an existing Medicare provider number. Bridge capital funds 60–90 days of operating overhead while credentialing and remittance routing stabilize.

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Credentialing Gap

New associate ODs and expanded service lines require CMS credentialing that takes 60–180 days. Bridge capital allows the practice to begin delivering billable services on day one while the provider enrollment processes in the background.

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Volume Surge Coverage

Seasonal demand spikes — snowbird season in Scottsdale, post-deductible-reset in January — create temporary receivables surges. A pre-arranged bridge facility absorbs the A/R spike without disrupting vendor payment terms or payroll cadence.

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Expansion Ramp

When adding a second location, Medicare credentialing for the new site runs parallel to construction and equipment installation. Bridge capital maintains system-wide cash flow while the new site's revenue pipeline builds to steady state.

Multi-Location Intelligence

DSO/OSO Multi-Location Capital

Bridge capital is one instrument in the multi-location capital stack. Explore how DSO and OSO structures deploy integrated liquidity solutions across Arizona networks.

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Capital Deployment

Bridge the Reimbursement Gap

A 28-day CMS payment cycle should not constrain your practice's acquisition ambition. Lumina Medical Capital structures bridge facilities that eliminate the lag — permanently.

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