How To Obtain Medicare and Medicaid Certifications For Your Home Health Care Agency

Starting a home health care agency can be a lucrative business venture, but in order to provide services to Medicare and Medicaid beneficiaries, you must first obtain certification from both programs. This article will outline the steps necessary to become certified and the benefits to your agency of doing so.

 

Obtain Your National Provider Identifier Number

The first step in the process is to obtain a National Provider Identifier (NPI) number. This can be done by completing an NPI application through the Centers for Medicare and Medicaid Services (CMS) website. The NPI is a unique 10-digit number that is used to identify health care providers who participate in the Medicare and Medicaid programs.

 

Determine Medicare Provider Eligibility

In order to be eligible for Medicare certification, your home health care agency must meet certain requirements. These include being licensed as a home health agency by the state in which you operate, providing skilled services on a part-time or intermittent basis, and having a written plan of care for each patient that is approved by a physician.

 

Obtain Medicare Certification

Once you have determined that your agency is eligible, you can begin the certification process by completing the Medicare Application for Provider Enrollment. This can be done online through the Centers for Medicare and Medicaid Services (CMS) website or by requesting a paper application from your Medicare Administrative Contractor (MAC).

 

Complete the Medicare Enrollment Application through PECOS

The next step is to complete the enrollment application through the Provider Enrollment Chain and Ownership System (PECOS). This can be done online or by mailing in a completed paper application.

 

Find Your Medicare Administrative Contractor

Each state has a different Medicare Administrative Contractor (MAC) that handles provider enrollments and certifications. You can find contact information for your state’s MAC on the Centers for Medicare and Medicaid Services (CMS) website.

 

Establish Electronic Data Submission for Payments and Claims

In order to receive payments from Medicare, you must establish electronic data submission for both claims and payments. This can be done through the Centers for Medicare and Medicaid Services (CMS) website or by contacting your Medicare Administrative Contractor (MAC).

Once you have completed all of the steps above, you will be fully certified to provide services to Medicare and Medicaid beneficiaries. The benefits of certification include increased patient volume, higher reimbursement rates, and the ability to participate in quality-improvement initiatives.

 

Understand the Renewal Process

Medicare and Medicaid certification must be renewed every three years. The renewal process is similar to the initial certification process and includes completing the enrollment application through the Provider Enrollment Chain and Ownership System (PECOS) and providing proof of continued compliance with program requirements.

 

Medicaid Services Provider Certification Process

The Medicaid Services provider certification process is similar to the Medicare certification process, but there are a few key differences. First, you will need to obtain a state-specific Medicaid provider number in addition to your NPI number. Second, you will need to complete a Medicaid Provider Agreement (MPA) before you can begin seeing patients. The MPA is a contract between you and the state Medicaid agency that outlines the terms and conditions of your participation in the program. Finally, you will need to complete a Medicaid provider enrollment application through the Centers for Medicare and Medicaid Services (CMS) website.

Once you have completed all of the steps above, you will be fully certified to provide services to Medicaid beneficiaries. The benefits of certification include increased patient volume, higher reimbursement rates, and the ability to participate in quality-improvement initiatives.

 

Conclusion

The Medicare and Medicaid certification processes have several steps, but are necessary for any home health care agency that wants to participate in these programs. By following the steps outlined above, you can ensure that your agency is properly certified and ready to provide care to patients. These certifications will allow you to provide services to a wider range of patients and receive higher reimbursement rates.