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What is a change of ownership (CHOW) in Medicare?
A CHOW is what happens, in Medicare terms, when a certified provider is sold. It is also one of the most consequential decisions in a healthcare acquisition, and it is public.
Assignment versus termination
On a change of ownership the buyer has a choice. Accept assignment of the existing provider agreement and the facility keeps its certification, its CCN and its billing continuity — along with its compliance history, outstanding overpayments and civil monetary penalties. Or let the agreement terminate and enroll as a new provider, which means a clean history and a gap in billing while certification is rebuilt.
Why buyers usually accept assignment
Continuity of revenue. A skilled nursing facility that stops billing Medicare while it re-certifies is a facility burning cash with no offsetting income.
What a CHOW filing shows you
Buyer, seller, CCN, effective date, CHOW type and the full owner list on both sides. Read across a market it shows you consolidation in real time — who is accumulating, who is exiting, and how fast.
The lag you need to know about
CMS's change-of-ownership file trails reality by months. Recent quarters look quiet because they are incomplete, not because the market stopped. Never read the most recent period as a trend.
Common questions
What does CHOW stand for?
Change of ownership.
Does a CHOW change the facility's CCN?
Not if the buyer accepts assignment of the existing provider agreement. The CCN and the compliance history carry over.
Is CHOW data public?
Yes. CMS publishes change-of-ownership files for skilled nursing facilities and hospitals, free to download.