Medicare Accreditation Process

The first two steps in obtaining Medicare Accreditation are for a home health agency to submit a Medicare Application to its Fiscal Intermediary and to apply to an Accrediting Body to enroll in its Medicare Accreditation process.

It will take on average about three months for a Medicare Application to be accepted. During this time an agency will complete its patient enrollment, provide its Accrediting body with materials requested and prepare itself for the Medicare Accreditation Inspection. CHAP and ACHC each require that extensive questionnaires be completed, the Joint Commission does not. The CHAP questionnaire is referred to as a Self-Study and the ACHC questionnaire is called a Performance Evaluation Review or “PER.”

Prerequisites for a Medicare Accreditation survey include the completion of the aforementioned questionnaires, the receipt of an acknowledgment from the home health care agency’s Fiscal Intermediary stating that its Medicare Application has been accepted, a successful test transmittal to OASIS and the admission of ten skilled patients.

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The ten patients that are admitted need not be Medicare eligible, but if they are, they must be homebound. One of the ten patients must have more than one discipline (e.g. skilled nursing, plus a therapy or home health aide services). Patients admitted may be discharged, but at least seven must be active when the Medicare Accreditation Survey occurs.

Medicare Accreditation Surveys will not occur until an agency notifies its Accrediting Body that it has met the prerequisites and is ready for the Medicare Accreditation Inspection.

All Medicare Accreditation Surveys will be unannounced and all will be of three day duration. During this time the agency office, its personnel files and it policies and procedures will be reviewed. The Accrediting Body surveyor will seek to determine that Agency staff members have a understanding of the policies and procedures. Each patient chart will be reviewed and five patients will be chosen for visits. The Accrediting Body surveyor will accompany the Agency’s RN to determine that proper nursing procedures are being followed.

The survey will have one of three outcomes:

  1. You may pass the Medicare Accreditation Survey with no deficiencies in which case you will be Medicare Accredited effective the last day of your Medicare Accreditation Survey.
  2. You may have been given a “Medicare Condition Level Deficiency” in which case your Medicare Accreditation will be deferred and you will be re-inspected. You will be given a plan of correction from the Accrediting Body which will note your deficiencies and ask to note how you have corrected them and what steps you haven taken to assure that they will not recur. Once the plan of Correction has been accepted you will be re-surveyed, generally within 30 days. If you receive another condition level deficiency during your second three day inspection or if receive a large number of less serious deficiencies, referred to as “standard level deficiencies” your Medicare accreditation will be denied and you will have to reapply.
  3. You may receive only standard level deficiencies during your survey. You will be sent a plan of correction as noted in the above paragraph and if you only had a few deficiencies you will be Medicare Accredited effective the last day of your survey once your plan of correction is accepted.

If you received a high number of deficiencies during your Medicare Accreditation Survey, you may be subject to a one day “Focus Visit.” If during this visit it is determined that you have adequately addressed your deficiencies you will be Medicare Accredited effective the last date of the original Medicare Accreditation Survey undertaken by the Accrediting Body.

Once you are Medicare Accredited, you will receive an official letter from your Accrediting Body within 30 to 45 days. CMS will then provide you with a Medicare Certification Number (CCN) and then with a Medicare Billing Number.

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