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.

Results Based Consulting

Did you find value in this blog post? Imagine what we can do for your home care or hospice agency. Fill out the form below to see how we're leading the industry with innovation, affordability, and experience.

Contact Us

Home care and hospice coaching
By Ginny Kenyon September 12, 2026
When evaluating a mentor or advisor for post-acute care leadership, look for these non-negotiable qualities and capabilities to ensure you have what you need.
Unlocking fair reimbursement
By Ginny Kenyon September 9, 2026
The OASIS assessment and ICD-10 coding are not mere administrative paperwork—they form the financial baseline of the entire agency. And, the clinical must match.
practical teaching
By Ginny Kenyon September 2, 2026
Home health is a vital bridge between acute hospital intervention and long-term wellness which requires shifting focus from crisis management to patient empowerment.
interim management
By Ginny Kenyon August 29, 2026
An interim manager offers immediate stability, proven expertise, and a fresh perspective while the organization searches for a permanent leader in administration
Competitive advantage
By Ginny Kenyon August 26, 2026
Product features can be copied, and prices undercut, but a highly trained field team that consistently delivers stronger clinical outcomes is difficult to beat.
policy and procedure manual
By Ginny Kenyon August 22, 2026
A policy manual is only as good as its last update. Agencies should establish a routine—at least annually, and following regulatory shifts—to review and revise.
increase revenue
By Ginny Kenyon August 21, 2026
Chronic disease education is more than clinical compliance; it is business strategy. Staff becoming chronic care experts increases revenue and improves retention.
improve care
By Ginny Kenyon August 15, 2026
In an era of rising healthcare costs and widespread clinician burnout, healthcare organizations are facing a critical challenge: how to deliver superior patient care while maintaining a stable, motivated workforce and a thriving business model.
Stroke training
By Ginny Kenyon August 12, 2026
When a patient returns home after a stroke, the clinical landscape changes instantly. Survival is just the first hurdle; the real challenge lies in navigating the complex, often unpredictable journey of rehabilitation and long-term care. For home health and home care agencies and senior care facilities, caring for a stroke survivor requires more than help with Activities of Daily Living (ADLs). Stroke can affect a patient’s neurological, physical, and emotional functioning simultaneously. That’s why specialized, stroke-specific clinical training for caregivers is essential to improving patient outcomes, supporting staff retention, and strengthening the agency’s overall performance. The Multidimensional Complexity of Post-Stroke Care A stroke is not a singular event with a linear recovery path. Depending on the location and severity of the brain injury, caregivers may confront a baffling array of concurrent deficits: Physical and Motor Deficits: Hemiparesis (one-sided weakness) or hemiplegia (one-sided paralysis) completely alters transfer techniques. Improperly moving a patient can cause severe shoulder subluxation or skin tears. Cognitive and Communication Barriers: Aphasia (difficulty speaking or understanding speech) and dysphagia (swallowing difficulties) require immense patience and highly specific intervention techniques to prevent profound frustration or life-threatening aspiration pneumonia. Neurobehavioral Changes: Sudden emotional lability, post-stroke depression, or structural personality changes can easily overwhelm an untrained caregiver, leading to burnout or adversarial dynamics in the home. Without structured education, caregivers are left to rely on intuition. In complex neurological care, intuition is rarely enough to prevent adverse events. 4 Strategic Benefits of Specialized Stroke Education Investing in robust stroke-specific training programs transforms an agency's frontline staff from general monitors into clinical assets. 1. Drastic Reduction in Hospital Readmissions The first 30 to 90 days post-discharge are high-risk windows for stroke survivors. Educated caregivers act as the eyes and ears of the clinical team. They are trained to look past basic symptoms and identify subtle warning signs early: Recognizing micro-signs of silent aspiration during meals. Monitoring for deep vein thrombosis (DVT) in affected limbs. Identifying skin breakdown early on the hemiplegic side. Spotting the warning signs of a secondary stroke using the B.E. F.A.S.T. protocol (Balance, Eyes, Face, Arms, Speech, Time). Early identification allows for timely home health or physician interventions, keeping the patient safe at home and protecting the agency's rehospitalization metrics. 2. Safeguarding Staff and Patients (Risk Mitigation) The process of transferring a patient with dense hemiparesis requires precise biomechanical knowledge. Specialized education teaches caregivers how to support the affected side without pulling on weakened joints, how to properly utilize assistive devices (gait belts, sit-to-stand lifts), and how to manage one-sided neglect (where a patient completely forgets one side of their body exists). Proper training mitigates the risk of catastrophic falls and shields caregivers from debilitating musculoskeletal injuries, directly lowering workers' compensation claims and liability exposure. 3. Boosting Staff Retention and Professional Empowerment High turnover in caregiving is often caused by burnout and feeling unprepared for challenging cases. When an agency provides specialized clinical training, helping staff understand stroke-related behaviors and advanced transfer methods, it strengthens the caregiver’s role. Staff members feel empowered, confident, and valued as professionals rather than viewed as standard domestic labor. This professional dignity translates directly into higher job satisfaction and improved staff retention. 4. A Powerful Market Differentiator In a crowded marketplace, families and hospital discharge planners look for specialized expertise. An agency that can explicitly state, "Our caregiving staff undergoes advanced, competency-verified training in post-stroke neurological care, dysphagia management, and transfer safety," holds a massive competitive advantage. It builds immediate trust with families and establishes preferred provider relationships with local health systems and stroke centers. Building a Competency-Based Training Framework Effective stroke education cannot be a passive, check-the-box exercise. To truly impact care quality, an agency's training framework should combine foundational knowledge with hands-on validation: Neurological Fundamentals Core Focus Areas: Types of strokes, one-sided neglect, emotional lability, and aphasia communication strategies. Competency Verification: Written scenario analysis and communication roleplay. Mobility & Safety Core Focus Areas: Safe transfers (bed to chair), handling the flaccid or spastic limb, fall prevention, and skin integrity. Competency Verification: Hands-on return demonstration with a mechanical lift/gait belt. Nutritional Security Core Focus Areas: Dysphagia precautions, recognizing pocketed food, fluid thickening consistency, and aspiration prevention. Competency Verification: Direct observation of meal prep and feeding techniques. Conclusion: An Investment in Excellence The care of a stroke survivor is inherently complex, demanding, and volatile. Expecting caregivers to navigate these intricacies without targeted clinical education places an unfair burden on the employee and exposes the patient and the agency to significant risk. By prioritizing advanced stroke education, agencies and facilities do more than just improve compliance; they foster a culture of clinical excellence. The results are undeniable: safer patients, more confident and loyal caregivers, and a highly respected agency brand that stands out as a leader in complex home-based care. For in-depth education on caring for a person with a stroke, contact Kenyon HomeCare Consulting, which offers an 8-hour DSHS-certified continuing education course . Each chronic disease course includes a certification with a red-and-yellow flag guide that can be laminated for caregiving staff. To learn more, call 206-721-5091 or email gkenyon@kenyonhcc.com .
MS care
By Ginny Kenyon August 8, 2026
MS is notorious for its volatility. Understanding nuances like the MS Hug or Uthoff's phenomenon are crucial to providing the quality of care these patient's need.