Are You Basically A Medicaid Home Health Provider And Want To Dip Your Toe Into The Medicare Pool? What Do You Need To Consider First?

February 6, 2022

Have you wanted to start up a new program or diversify services in your agency? Many home health agencies see patients with private payers as well as Medicaid, but have stayed clear of the Medicare world. If that is you, then let’s talk about some things to consider when making your decision to become Medicare certified.

Top 5 Things To Consider When Becoming Medicare Certified:

Many owners consider the larger profit margin potential with Medicare, but don’t go into the process with eyes wide open. Here are the things to research prior to submitting an 855 form to Medicare:

  1. Do you have the money you need? If you want to start in this business with Medicare out of the gate, then you need to anticipate start-up costs in the area of $150,000-$350,000. Now, for those already established with infrastructure in place, it will not be as much, but you still need money in the bank to operate on while you await certification. You will need to continue to serve clients on your dime while you await survey. This also leads to the question of accreditation versus state survey. Many states are now requiring the initial survey be completed by an accrediting body. If you are not in one of those states, then you need to know how long the state is backed up on completing initial surveys. If the state is backlogged by 6 months once you declare survey readiness, you have the costs of maintaining patients and paying staff a lot longer than the accreditation route. So, you need to make the best decision financially.

   2.  Know your regulations and steps to certification: This is a must. Agency owners and administrators must know the Medicare certification process and what regulatory compliance will mean in terms of staffing and operations.

   3.  Complete a competitive analysis: You need to know if you have a shot a market share in your area. Do a deep dive into the competition to know if you can break into the Medicare market in the communities you wish to serve.

   4.  Know the patient market: As part of the competitive analysis, you will find out who your potential competition serves. This will also guide you to know if there are gaps you can fill. Maybe your communities have specific needs your other Medicare competitors don’t adequately serve. We see this often in diverse communities where language is a barrier. Cultural sensitivities may unlock an underserved client base in your area. You can be the agency these underserved populations want to have in their homes because you have taken the time and effort to educate yourself on different cultural needs.

   5.  Consulting: If you are new to Medicare certification, having a seasoned consultant on board makes the process much easier. You can eliminate the question marks you have with the steps of the process. Yes, this will be an additional cost, but if you can avoid errors in your 855, decrease time in the process of getting started, and get through surveys successfully the first time, the money is beyond worth it. We hear from agencies trying to do it themselves for extended periods of time unsuccessfully who now want the help. Whether it has been issues with policies, survey failures, hiring the right staff, operations, education, or software implementation, it is a lot to handle. The mistakes and lost time costs agencies a lot more.

Kenyon Homecare Consulting Can Help!

At Kenyon Homecare Consulting , we can help brand new start-ups or those looking to diversify into new service lines. We have seasoned consulting staff with decades of experience doing it themselves. If you would like to look further into the Medicare certification process, give us a call at 206-721-5091 or contact us online to see how we can help you succeed.

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controlling chronic diseases
By Ginny Kenyon April 25, 2026
In the rapidly evolving landscape of healthcare, the burden of care is increasingly shifting from clinical facilities to the home. As the population ages, the prevalence of chronic conditions—such as heart disease, diabetes, and respiratory disorders—has reached unprecedented levels. For home care agencies, the quality of service is no longer just about assistance with daily living; it is more and more defined by the clinical competencies and disease-specific knowledge of your field staff. Chronic disease education for home care staff is not a luxury, is a strategic necessity that directly impacts patient outcomes, caregiver confidence, and the business’s bottom line. 1. Enhancing Clinical Outcomes and Safety Home care staff are the "eyes and ears" of the healthcare system. When aides and clinicians are highly educated on chronic disease processes, they can identify subtle shifts in a patient's condition before they escalate into emergencies. · Early Intervention: An educated caregiver can recognize the early signs of fluid retention in a Congestive Heart Failure (CHF) patient or skin changes in a diabetic patient, allowing for proactive adjustments rather than reactive ER visits. · Medication Adherence: Understanding why a medication is prescribed for a specific chronic condition helps staff reinforce the importance of adherence to the patient, reducing the risk of complications. 2. Reducing Hospital Readmissions Hospital readmission rates are a primary metric for home health success. Chronic diseases are the leading cause of "revolving door" hospitalizations. By providing specialized education, agencies empower their staff to implement Evidence-Based Practices at the bedside. When staff can effectively manage symptoms and educate patients on self-care, the likelihood of a patient staying stable at home increases dramatically. This not only benefits the patient but also strengthens the agency’s reputation with referral sources like hospitals and physician groups. 3. Boosting Staff Confidence and Retention The home care industry faces significant challenges with staff turnover. Often, burnout is fueled by the stress of feeling unprepared for complex patient needs. Knowledge is Empowerment: When staff members receive robust training, they feel more confident in their roles. This professional growth fosters a sense of value and belonging within the organization, leading to higher job satisfaction and lower turnover rates. 4. Improving Documentation Accuracy In an era of increased regulatory scrutiny, clinical documentation must be precise. Education on chronic diseases ensures that staff members use the correct terminology and focus on the most relevant clinical indicators during their assessments. · OASIS Accuracy: For Medicare-certified agencies, a deep understanding of chronic conditions leads to more accurate OASIS scoring, which directly influences reimbursement and quality ratings. · Audit Readiness: Well-educated staff produce notes that clearly reflect the necessity of care, making the agency much more resilient during regulatory surveys or audits. 5. Bridging the Communication Gap Effective chronic disease management requires a multidisciplinary approach. A caregiver who understands the nuances of a disease can communicate more effectively with: · Physicians: Providing clear, clinical updates that help doctors make informed decisions. · Family Members: Offering clear explanations and peace of mind to stressed family caregivers. · The Internal Team: Ensuring a seamless transition of care and consistent messaging across all disciplines. Conclusion Investing in chronic disease education is an investment in the agency’s future. By elevating the knowledge of the frontline workforce, home care providers can transform from basic service agencies into high-value clinical partners. In the end, the goal is simple: providing the highest quality of life for patients in the comfort of their own homes, a goal that can only be met through a highly trained and knowledgeable staff. If you do not know where to get comprehensive education for Chronic diseases, contact Kenyon Homecare Consulting at gkenyon@kenyonhcc.com or call 206-721-5091. We are here to help
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