Medicare certification and business management consultants
Frequently Asked Questions and Glossary of Terms

 

Frequently Asked Questions:

How can I become Medicare certified?
What can I expect to be reimbursed by Medicare?
Can I certify a business based from my home?
How large does my office need to be to meet Medicare guidelines?
How long will it take to become Medicare certified?

How can I become Medicare certified? It depends upon what type of provider you are. If you are a Home Health Agency, Rehab Agency, or CORF, you will need to contact your State Agency for guidance. There are 2 applications: one that will be submitted to the State Agency, and one that will be submitted to your fiscal intermediary. If you are an independent professional, such as a physician, physical therapist, occupational therapist, social worker, or registered dietician, or are part of a group, you would need to contact your local Medicare carrier and submit an application to them. We will be happy to assist you through this process. You may contact us at julieh@certconsultants.com.

Effective 7/1/2009, Speech Language Pathologists are now eligible for independent Medicare provider numbers.  Please contact us for more information or for our assistance with your application.


What can I expect to be reimbursed by Medicare? Medicare pays professionals, Rehab Agencies, and CORF’s based on the Medicare fee schedule, which varies according to locality. Home Health Agencies are paid based on their case-mix.


Can I certify a business based from my home? Yes, some professionals, such as physicians, physical and occupational therapists, social workers, and dieticians may obtain Medicare certification for a business based from home, if you only see patients in their homes. You must maintain private office space in your home used solely for your business office. Additionally, you must make sure that no special permit is required from your city, township, or association to operate a business from your place of residence.

Home Health Agencies, Rehab Agencies, CORF’s, and DME suppliers must have a business office that is zoned for commercial use.


How large does my office need to be to meet Medicare guidelines? CMS does not give specifications as to a minimum office size. However, your office must be large enough to accommodate your expected patient and/or staff volume. For Rehab Agencies and CORF’s, your office must be barrier-free and must have a sink located within your office.


How long will it take to become Medicare certified? Independent professionals, such as physicians and physical therapists, can be approved by Medicare in as little as 6 weeks. For a home health agency, you should plan on at least 10-12 months before you’ll be able to bill for services rendered. Rehab Agencies and CORF’s in most states should expect to be certified in approximately 6-8 months. In Michigan, however, Rehab Agencies and CORF’s are taking a great deal longer. Currently, the State of Michigan is not performing many surveys for initial certifications of Rehab Agencies and CORF’s. Instead, they’re focusing their attention and resources more on recertification surveys.


Glossary of Terms :

CORF = Comprehensive Outpatient Rehabilitation Facility

Minimum services provided:
• Physician services (related to injury)
• Physical therapy
• Psychological/ vocational counseling or social work services

May also provide:
• Occupational therapy
• Speech/ Language pathology
• Respiratory therapy
• Nursing services (in office only)
• Medical equipment


OPT / Rehab Agency = Outpatient Physical Therapy Facility. Must provide services in an office, and may also provide services in a patient’s home.

Minimum services provided:
• Physical therapy or Speech/Language pathology
• Social or vocational counseling services

May also provide:
• Occupational therapy
• Speech/ Language pathology


A Home Health Agency can provide the following services in a patient’s home:

• Skilled nursing
• Physical therapy
• Occupational therapy
• Speech/Language pathology
• Social work
• Home health aide
• Registered dietician
• Home medical equipment

A Hospice may provide services in a facility, such as a hospital or nursing home, and/ or in a patient’s home.

Minimum services provided:
• Skilled nursing
• Counseling
• Social work

May also provide:
• Physical therapy
• Occupational therapy
• Speech/Language pathology

 
 
 
 
 

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