Medicare accreditation for a home hospice agency
Medicare accreditation for a home hospice agency is a complicated process. A home hospice agency must complete a Medicare accreditation survey in order to become Medicare certified. Medicare accreditation for a home hospice agency is required to ensure that the agency meets all of Medicare’s conditions of participation in operations and clinical patient care procedures.
Medicare accreditation for a home hospice agency is a process that entails a complete review of the health care agency’s organization and agency operations. The home hospice agency must demonstrate the ability to meet predetermined criteria and standards of accreditation established by a professional accrediting agency.
The goal of home hospice accreditation is to ensure that the agency is credible, reputable and is dedicated to ongoing and continuous compliance with the highest standard of quality. Medicare accreditation surveys are performed at the agency and last for a minimum of three days.
A comprehensive review is conducted of organizational structure, compliance with federal/state/local laws, fiscal operations, policies & procedures, leadership, patients’ rights & responsibilities, provision of care, patient records, quality outcomes, performance improvement, infection control, human resource management, and patient/employee safety.
Medicare accreditation organizations employ industry experts who will conduct these surveys ensuring that the agency’s business operations and patient care provides the highest level of quality care and this is maintained throughout all aspects of the organization.
Home hospice agencies are required to be re-certified every three years. At that time a similar process and survey will take place for a minimum of three days to ensure that home hospice agency can demonstrate that they have maintained continuous compliance with the standards required by the accrediting body.
There are three organizations that have been approved by the federal government and CMS to preform Medicare surveys for Medicare accreditation for a home hospice agency. They are as follows:
- CHAP - The Community Health Accreditation Program
- ACHC - The Accreditation Commission for Health Care
- JCAHO – The Joint Commission
Below are the seven most important steps for Medicare accreditation for a home hospice agency.
The first step for Medicare accreditation for a home hospice agency is to file a Home Hospice licensure application with your state. Every state is very different and have different requirements for approval. We suggest you consider working with a Home Hospice Consulting Company who can not only assist you with this but also help with the filing with the Secretary of State to form your company. They will hold your hand every step of the way thru the certification process.
STEP 2The second step Medicare accreditation for a home hospice agency is to register with one of the accreditation organizations. The fees for the three day surveys range from $5000.00 and up, depending on which accreditation organization is chosen. Our Clinical Team can help you decide which accrediting agency is right for your agency.
The Accreditation Organization will require certain criteria be met in order to be considered eligible for the Medicare accreditation for a home hospice agency. The following are the four requirements;
- CMS Medicare application 855A has been accepted by one of three state specific subsidiaries of CMS. They are Palmetto GBA, NGS and CGS.
- An online agency self-study or preliminary evidence report has been completed.
- The agency has 5 hospice care patients.
A Medicare accreditation for a home hospice agency survey is unannounced and typically will take place within forty five days of readiness.
The agency must maintain 3 active patients out the 5 that are required in order to submit site visit readiness. Patient care must be performed in the patient’s place of residence. All patients must have a doctor’s order for hospice care and all appropriate documentation must have been completed within the appropriate time-frames (Certification of Terminal Illness, Nursing Initial Assessment, Social Work Initial Assessment, Spiritual Care Initial Assessment, Bereavement Assessment as well as the Initial Plan of Care and Comprehensive Plan of Care). All patients are to be treated as if they are Medicare eligible. This requires the completion of all required Medicare documentation for this survey. Out of the 5 patients, the agency is allowed to have up to 2 discharged patients.
All Core Services must be provided by employees:
- RN/Case Manager
- Social Work
- Spiritual Care
While the Medical Director is also a Core Service, he/she may be a contracted employee.
The following services must be offered, but can be contracted:
- Hospice Aide (we recommend that they are a hired employee as it is more cost effective)
- Physical Therapy
- Occupational Therapy
- Speech Therapy
While Dietary counseling is a requirement, in most states it is acceptable for this service to be provided by an RN. (your Hospice Consultant can advise you regarding this.)
It is also a requirement that you are able to show the surveyor your Bereavement and Volunteer programs. (Even though you may not be using them as of yet.)
When the Medicare survey has been completed, the agency will be informed of the findings within a few weeks. There are several possibilities that may occur. They are listed below.
- Agency has passed with no deficiencies (no further action required)
- Agency has passed but has MINOR deficiencies (and action plan must be written and accepted by the accrediting body)
- Agency has condition level deficiencies (these are considered major deficiencies and will require another full 3 day survey by the accrediting body to determine if all deficiencies have been resolved)
- Agency has failed the survey (this will require the agency to repeat the process … starting from the beginning.)
Once the agency has officially passed its Medicare accreditation for a home hospice agency survey and all plans of correction are accepted, the survey results and plan of correction (if there were deficiencies) will be looked over by the Board of Review. This review typically occurs within 30 days from the date of the survey, or from the date the plan of correction was accepted in the event there were deficiencies at the time of survey. Pending the approval of the Board of Review, the agency will be issued an accreditation letter. A copy of your accreditation letter will also be forwarded to your CMS Regional office and the state department of health. If there were no deficiencies at the time of survey, the accreditation date will be from the last day of the survey. In the event there are deficiencies, the accreditation date will begin the day the plan of correction is accepted. From the date of accreditation, any Medicare patients that the agency services can be eligible for payment reimbursement when the agency receives its billing number. (The patient’s will have to be discharged and re-admitted in order to be eligible for billing.) Now that the state has received notification of your successful accreditation, the state will confirm that the agency still meets their requirements to be Medicare eligible. We suggest that the agency call their state contact one week after you receive the accrediting organizations letter. CMS will then contact agency’s fiscal intermediary and ask them to recheck all paper work. If the agency does not hear from the Fiscal Intermediary (Palmetto, NGS, or CGS) within three weeks, they should call the person who signed their Medicare application approval letter. CMS will verify that agency is operating from their physical address. They will “drive by” the agency’s office, they may come in, but they will not inspect. Within another ten days, the agency will be issued a CCN number. The term CCN is a relatively new word that CMS uses instead of “Provider Number.” In total, the process will take approximately four to five months from the date of the accrediting organizations Medicare survey.
The next step is for the home hospice agency to receive its Submitter ID. Submitter ID is the official term for Billing Number. The process described for your CCN number is basically repeated for your Submitter ID, except that the agency’s state now will be involved. The agency will have to submit EDI enrollment forms to its fiscal intermediary, but they cannot be submitted until you are in their EDI data base. The agency should have a billing company by this time and we strongly recommend that the agency uses IMARK Consulting. If the agency hires them they will also complete your EDI Enrollment forms. If the agency’s EDI enrollment forms are submitted correctly, it will receive its Submitter ID in 21 days and be ready to bill Medicare. Once the agency has its Submitter ID it will be able to back bill Medicare for the services they have provided since the date of their Medicare accreditation. In total this part of the process should take approximately two to three months from the date you received your CCN number.
About 21st Century Health Care Consultants.
During its existence, 21st Century Health Care Consultants has successfully helped establish obtain licensure and home healthcare Medicare accreditation for more than 4000 Home Health Care and Hospice businesses. 21st Century Health Care Consultants have assisted clients in the establishment of such home care businesses in all states that do not require a certificate of need (meaning the state is not accepting new license applications). We pride ourselves in our ability to complete state Home Health Care license applications, Medicare applications quickly, without error. We successfully prepare our clients for their home care license inspections and Medicare Accreditation surveys.
In our long history, we have never had a Home Health Care business fail to obtain its state license or home health care Medicare accreditation.
Today 21st Century has 48+ full time employees located at its Florida headquarters as well as Las Vegas, Nevada locations. We have assisted clients in the establishment of such Home Care Businesses in 48 of the 50 states.
Unlike most companies who offer diluted consulting in many different areas, we offer and pride ourselves at being the best in this one area of “Medicare, Medicaid and Private Duty Accreditation Preparation and Certification”.