Medicare certification is the step that lets you bill Medicare for home health services. It’s tied to your state license and to a survey that checks whether you meet the federal Conditions of Participation (CoP). Here’s what actually happens and how to get ready.
When you can apply
You apply to CMS after you have your state home health license. The state survey agency (the same group that does state licensure surveys in most states) will typically conduct one survey that counts for both state and Medicare. So your “Medicare survey” is often the same visit as your state survey,which means your policies, records, and staff readiness need to be in place for both.
What surveyors look at
Surveyors use the CoP as their checklist. They’ll look at things like: patient rights, comprehensive assessment (including OASIS), care planning, quality of care, and infection control. They’ll want to see that you have policies that address each area and that you’re actually following them. They may pull charts, interview staff, and review how you handle orders and start of care. Gaps between what your policy says and what you do are a fast way to get a deficiency.
Common trouble spots
- Assessment and OASIS timing,SOC assessment within timeframes, and OASIS locked and submitted correctly.
- Physician orders and face-to-face,written orders before care, and a face-to-face encounter that meets the timing and documentation rules.
- Care plan and coordination,plan of care that reflects the assessment and is signed by the physician; evidence that you’re coordinating with the physician and others.
Getting your intake and documentation in order before the survey pays off. Many agencies use a readiness checklist that mirrors the CoP sections so nothing gets missed. We’ve put together a Medicare cert readiness checklist you can download and use.