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?
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:
- 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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