To be eligible to receive a Medicare Billing Number, you must pass a three day Medicare Accreditation Survey administered by one of the three nationally recognized accrediting bodies: CHAP, JTC or ACHC..
Once you are Medicare Accredited you will receive official notice form your accrediting body in 30 to 45 days.
Once Medicare Accredited, you may discharge all your patients. You will then readmit all Medicare eligible patients. You will be able to bill Medicare for services provided retroactive to you Medicare Accreditation date once you receive your Medicare Billing Number.
Your Accrediting Organization will issue a recommendation for Medicare Certification to the CMS Regional Office (CMS RO-This is an actual Medicare office, not a privately operated Fiscal Intermediary, like Palmetto, NGS, or CGS). Before your Accrediting Organization issues this recommendation it must first get this approved by its own Board of Directors, which meets once a month at the end of the month. Therefore there can be up to a 45 days wait from your Medicare Accreditation Date until the Accrediting Body notifies the CMS Regional Office.
The CMS Regional Office will email your Fiscal Intermediary which will again review the Agency’s status (the “re-review”). In this process the Fiscal Intermediary will check the paper work submitted by the Accrediting Body, and other CMS related documents that the Agency has previously submitted. The Fiscal Intermediary will also ask the Agency to provide updated proof of Capitalization (the same paperwork that the Agency had already submitted).
Your state will also be notified by CMS. They will typically check the accreditation paperwork to see that the information matches what they have on file. They will also check that they are in receipt of your Civil Rights related documents (these documents will have been provided by you either at the time your state license paperwork or before the state issued you a Facility ID required for your test OASIS transmittal).
Your Regional Civil Rights Office will review your Civil Rights documents and send you a request for changes if necessary. This review will not typically hold up the issuance of your Medicare Billing Number, but it will hold up the issuance of your Submitter ID.
Once the Fiscal Intermediary is satisfied that the agency is in compliance, it will notify the RO and the RO will provide the Agency with a letter which will contain the Agency’s CCN number (“CMS Certification Number” which is the official denotation for “ provider number”).
The above process may take two to three months. One variable is the length of time the Accrediting Body will take. If your inspection is mid-month or late in the month it will delay the process by about 30 days. This is something that is out of the Agency’s control.
When the Fiscal Intermediary asks for reconfirmation of the Agency’ Capitalization amount, another delay will be caused. However, if the Agency responds immediately the delay will be short. If it takes the full 30 days allowable it will add a month to the process.
CMS has the right to once again ask you to provide proof of Capitalization once you receive your Medicare Billing Number. If you receive such a request from your Intermediary you will once again have 30 days to respond. It will take the Intermediary 10 days to process this information into their system and enter your agency into their EDI Data Base.
The Fiscal Intermediary has the right to request the CMS Regional Office to conduct a “drive-by inspection” of the agency. Thus far only Palmetto GBA has made such requests. The “drive- by” inspection is usually just what the name suggests. An inspector from CMS will pass by the office, and check that it is occupied by the Home Health Agency. On some occasions, the inspector will step into the agency and introduce himself. On one occasion an inspector visited after hours, called the telephone number posted and had the Administrator come to the agency and open it in order to conduct a walk through.
You will need to verify that you are in the Intermediary’s EDI Data Base before any application is submitted. You can do this by calling the appropriate numbers for the EDI Help Desk listed below:
Palmetto Agencies (855) 696-0705
NGS Agencies (877) 273-4334
As noted above, the Intermediaries do not ask for re-verification of capitalization on a consistent basis. You should therefore begin to call the appropriate number listed above ten business days after your receive your provider number (not ten days from the date of the letter.) You should the recheck by calling the number every three to five days.
If in the meantime if you receive a request from the Intermediary for capitalization re-verification you will know that the earliest date that you will be in the EDI Data Base system is ten days from the date that the Intermediary receives your response. So you should make your phone call to the EDI Help Desk to verify that you are in the EDI Data Base starting then.
If you attempt to enroll before you are in the EDI Data Base, your application will be rejected.
You will next have to submit EDI Enrollment forms, if you have hired a Billing Company, such as Imark to do this for you. If you wish to do this yourself, forms and instructions will differ according to which Intermediary is responsible for your state.
Once your EDI enrollment has been accepted you will be provided with a Submitter ID (widely referred to as a billing number). You will then be able to begin to bill Medicare and will also be able to back bill for services provided to Medicare patients beginning on your Medicare Accreditation Date.
Medicare Billing Number (Submitter ID) Timing
It will generally make take two months or more from the date you received your Medicare Billing Number until the date you receive your Submitter ID. Timing will depend on how quickly you respond to the additional request for proof of capitalization if you are required to submit one, how quickly you are put on the Fiscal Intermediary’s EDI system and how quickly your EDI enrollment forms are approved.