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Starting a home health agency is a rewarding way to contribute to the healthcare industry and provide quality care to individuals in the comfort of their own homes. However, if you want your home health agency to bill Medicare for services, you must obtain a Medicare license. This license is necessary to be reimbursed for the services you provide to eligible patients.

Here’s a step-by-step guide to help you navigate the process of obtaining a Medicare license for your home health agency:

Step 1: Ensure Your Agency Meets Medicare Requirements

Before applying for a Medicare license, make sure your agency meets the basic requirements. To qualify, your agency must:

• Be properly licensed in the state where you operate.
• Be accredited by an approved accrediting organization or meet the conditions of participation for Medicare-certified home health agencies.
• Employ qualified staff, including registered nurses, social workers, home health aides, and therapists.
• Have policies in place that ensure patient care is compliant with Medicare standards.

Step 2: Apply for a National Provider Identifier (NPI)

To bill Medicare, your home health agency must first apply for a National Provider Identifier (NPI) number. The NPI is a unique identifier for healthcare providers that is used by Medicare, insurance companies, and other health organizations. You can apply for your NPI through the National Plan and Provider Enumeration System (NPPES) online.

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Step 3: Complete the Medicare Enrollment Application

Once you have your NPI number, you can proceed with the Medicare enrollment application. The Centers for Medicare & Medicaid Services (CMS) website is the place to do this. The process involves filling out the CMS-855A form—the application for institutional providers, including home health agencies.

The CMS-855A form requires information about:

• The legal name and address of your agency.
• The kinds of services your organization offers.
• The ownership structure of your agency.
• A list of your agency’s staff and medical directors.
• A description of your agency’s operations and services.

Step 4: Submit Your Application to the Medicare Administrative Contractor (MAC)

Once you have completed the application, submit it to your Medicare Administrative Contractor (MAC). The MAC is a private company that handles Medicare enrollment and payment processing for your region. The contractor will review your application to verify that your home health agency meets the Medicare certification requirements.

Step 5: Schedule a Site Visit and Survey

After submitting your application, you will need to schedule a survey with the state’s health department or a CMS-approved accrediting organization. This survey involves a thorough review of your agency’s facilities, policies, and patient care practices. The goal is to ensure that your agency meets Medicare’s Conditions of Participation (CoPs), which include everything from quality of care to infection control protocols.

If you are using an accredited organization, they will conduct this survey on your behalf. If you are not accredited, the state will handle the survey.