How to Obtain Medicare Certfication of Home Health Agencies

Home health agencies are organizations that provide healthcare services to patients in the home setting. Agencies can be non-profit or for-profit, operated by hospitals and clinics or by individuals. Although licensed by the state in which they operate, home health agencies can also receive certification to bill Medicare for services rendered to elderly patients. Obtaining Medicare certification of home health agencies is a complex process.

Instructions

• 1

  Obtain state licensure to operate a home health agency in your state. Each state's requirements and process vary, but generally speaking, the process will include completion of an application, payment of an application fee, completion of criminal history background checks for your staff and completion of a survey of your agency by state department of health officials. The application contents vary from state to state as well, but generally will require organizational details about administrators, clinical partners and owners, as well as contact information, a description of services, a copy of your business license and proof of insurance. (See Resources for examples.)

• 2

  Apply through your state department of health to receive copies of the federal Medicare regulations and application packet for certification. According to federal Medicare regulations, because state licensure is a prerequisite for Medicare certification, state departments of health connect potential applicants to the certification process. Some states require licensed home health agencies to obtain a certificate of need (CON) before allowing them to apply for Medicare certification; others do not. Check with your state department of health to see if your state requires a certificate of need.

• 3

  Schedule and pass an onsite survey of your agency and its staff by the state department of health. Although state departments of health require a survey before approving state licensure, the federal government requires a second survey for Medicare certification. State departments of health use this second survey to evaluate home health agencies on Medicare standards and criteria for certification; agencies that pass this survey receive state department of health endorsement for Medicare certification. Medicare regional offices review the application and endorsement and make a decision on certification.