Select PMB As Your Billing Agency When Applying To Be Medicare Certified

Article Highlights

  • Medicare is very concerned about fraud in home health care claims.
  • Indicating a billing agency on your CMS-855A application shows that you take this seriously.
  • Understand the role of accrediting agencies on the path to being Medicare certified.

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Becoming a Medicare-certified home health agency is a challenging, time-consuming process. CMS, which administers the Medicare program, has very strict requirements to certify home health agencies.

One of the reasons for such strict requirements is because there is, unfortunately, a significant amount of fraud and abuse around Medicare claims for services that may or may not have been provided. Some of the most high-profile schemes range from multi-million dollar defraudments to $1.2 billion schemes.

Therefore, Medicare spends a considerable amount of time and effort reviewing each home health agency that applies to be Medicare certified. That’s why it’s important to understand the Medicare certified home health agency requirements and to support your application by selecting a medical billing company such as Precision Medical Billing (PMB) on your application.

Applying to Become a Medicare Certified Home Health Agency

Home Health is billed under Medicare Part A, and home health agencies that want to become certified by Medicare must complete the Medicare Enrollment Application form (CMS-855A). There are some additional requirements that come with this process:

  • You must indicate that you are an established business and have a business license.
  • You will be asked to certify that you have financial resources to support your agency.
  • You should indicate that you are using a billing agency to handle your billings.
  • You must be accredited by one of the three major accreditation bodies.

The overall process of being approved by CMS and then accredited by a recognized accreditation organization takes a very long time to go through the entire application, review, and approval process. Typically, this is an 18-month process. To support your timeline, we will unpack the importance of indicating a medical billing company on your CMS application and help you understand the role of the accrediting organizations.

The Importance of Utilizing a Medical Billing Company

Section 8 of the CMS-855A application form asks you to state whether you are using a billing company to process and submit your claims. If you are using an outsourced billing company, you must indicate which billing company you will contract with before actually submitting the application. This is a critical step because one of the first things that CMS will review on your application is whether you are using an outsourced service or if you are trying to handle this in-house.

Agencies that indicate they are outsourcing their medical billing will be looked at more favorably than agencies that state they are doing this themselves. Why? The perception is that an agency handling its own claims leaves more room for fraud. Because of the prevalence of fraud in home health, CMS wants to see that agencies have already committed to outsourcing their medical billing versus trying to do this internally.

We recommend working with our company because we have a good reputation in home health and are in good standing with CMS. We specialize in home health medical billing, which enables home health agencies to establish credibility right away on the application.

Then, once you eventually become Medicare certified, we help address common headaches that home health agencies experience trying to handle ongoing billing and compliance issues on their own. Many agencies that try to handle billing in-house run into problems with the very complicated Medicare claims process, which affects revenue collection and cash flow.

To ensure that you receive prompt payment for services, we recommend working with an outsourced agency that can handle the intricate details of billing for home health services so that you can receive what you are owed for the services provided.

The Role of Accreditation To Become Medicare Certified

Most — if not all — home health agencies must go through the accreditation process. Medicare does not do this themselves anymore, which means home health agencies need to go through one of the three main accreditation bodies:

  • ACHC (Accreditation Commission for Healthcare)
  • CHAP (Community Health Accreditation Program)
  • JCAHO (Joint Commission on Accreditation of Healthcare Organizations)

– ACHC requires that home health agencies seeking Medicare certification must have an approved CMS-855A Medicare Enrollment Application form to begin the accreditation process. You will also need to demonstrate that you have served a minimum amount of patients and that you provide specific services that fulfill the Initial Medicare Certification Home Health survey requirements. There are other requirements that you should review on their website.

– CHAP requires that you are a legal entity, suggests that you are licensed in the cities and states where you offer services, and recommends that you offer certain services that CHAP accredits. There are other requirements that you should review on their website. Notably, going through CHAP for accreditation typically takes 6-9 months.

– JCAHO follows a thorough, 10-step process to accredit a home health agency. These steps include reviewing your readiness to be a Medicare certified home health agency, addressing any gaps uncovered during a site survey, and completing any post-survey follow-up. There are other requirements that you should review on their website. Going through JCAHO for accreditation typically takes about 5-6 months.

Each accreditation organization has different strengths and weaknesses. They can help walk you through your specific situation and timeline to help you identify the best option for your home health agency.

Remember to Select PMB on Your CMS-855A Application!

Before completing your Medicare Enrollment Application, talk to us about including PMB in Section 8 of the application. We will provide you with all of our billing agency information to include on the application.

Contact us today for a free consultation on the billing aspect of applying to be Medicare certified. We can help you on the path to meeting the Medicare certified home health agency requirements.