Becoming a Medicare Certified Provider

Becoming a Medicare Certified Provider?

Want to know how to become a medicare certified provider? The CMS accreditation process requires a survey (inspection) performed by Sate Survey Agencies conducted to ascertain whether or not a provider or supplier meets all applicable requirements for participation in the Medicare and/or Medicaid programs.

During the survey your company’s performance and effectiveness to render safe and effective quality care, will be evaluated. Sections of the survey include your efforts to prevent contagion, fire, contamination, structural design, maintenance problems, staff credibility, organization etc..

Why do you want to be CMS accredited?

Currently there are 44 million Americans enrolled in Medicare programs and 1 in 5 people are enrolled in Medicaid. Combined that’s about one third of the US population using Medicaid and Medicare. If you’re not affiliated, you’re potentially missing out on a lot of clientele, and depending on what your practice is, this could be your most beneficial clientele. 

          Compared to other private insurance companies, Medicare as a federal insurance policy, has much quicker reimbursement turnarounds as a streamlined payment mechanism. Although Medicare holds a limited margin of profits at 10-15% and will not substantially grow your business, rather it results in an excellent source of cash flow for any practice, and aiding in income loss prevention that may come from down time.

         We will also note it’s very important to make this decision very early on in the formation of your practice, Medicare certified, or no? Let’s go over why this is important.

When applying for CMS Accreditation, established practices over 6 months in business must follow the Rule of 2. The Rule states that the facility must have a minimum of 2 patients at any given time, the average stay is 2 days, and the average inpatient stay is 2 days. This is nearly impossible to achieve for some, especially smaller boutique or micro hospitals. If you decide to become CMS Accredited before 6 months into business, this rule will be waived and will not apply to you.

         So you’ve decided to go through with CMS accreditation, here’s what you can expect to happen throughout this process.

Submitting your application for accreditation for becoming a medicare certified provider should not be done until you know you are 100% prepared and ready for your survey. When submitting you will be able to choose a preferred time line of the survey but no response will be given. Although the survey is unannounced, they will visit your facility within 180 days of applying. Someone from the agency will give you a call the day of prior to visiting your facility. With such short notice, you must be prepared at all times.

         The survey takes place over the course of 3 days. The first day consists of visiting your policies and procedures which should be separated by organized binders. Your written procedures and actions must reflect what the staff is actually doing. Each department is evaluated separately and must each pass individually. There will be a hyper focus on infection control and quality control as these are the agencies top priorities. The will be checking for detailed  well organized charting and medical records as all of this must be concurrent.

         Day 2 consists of all things “life safety”, making sure a fire marshal has done and passed fire inspections, fire drills and plans are in place, patient care areas are safe and accessible, bathroom safety is well implemented, emergency preparedness plans are in place, equipment inspections etc. Even the slightest structural,  sanitation, or safety flaws in any section can earn you a red flag. Attention to detail in this area is a must.

         Day 3 will be digging into the records. They will go through HR files and medical records, predicting employee issues if they might exists and determining potential risks that might come with them. Checking employees degrees and credibility making sure they’re verified. They will also be digging through medical records, checking for inconsistencies and anything that might indicate that someone trying to cheat the system, and expect to be evaluated on your methods of protecting confidential documentation.

         By the end of the survey, they will go over deficiencies and where you may have fell short. It’s rare that they don’t find any inconsistencies, so you can expect them to tell you where you need to improve. At this point you then will need to provide a corrective action plan with supporting pictures and documentation before being accepted and officially Medicare certified.

         Becoming a medicare certified provider sounds like a long dreadful process, but it’s worth it. Once you’re officially a CCM (CMS Certified Member) you’ll be glad you made the choice. It doesn’t end at become certified. Holding the title requires continuous improvement and reporting, but with the right healthcare management company the whole process from the beginning to the end to the upkeep, will be a breeze.