Once you become a licensed home health care business, your next goal is to achieve home health care accreditation be it Private Duty or Medicare Accreditation. As a home health care business, you are licensed to offer skilled nursing services. You are a medical home health care business. If you are or are looking to become a licensed non-medical home care business such as a companion care or personal care business, home care accreditation is not a requirement nor necessary in most cases unless you are opening your home care business in the State of New Jersey. As a non-medical home care business, most of your patients are private pay patients, but this is not the case a home health care business. As a home health care business you are relying on reimbursement from Medicare, Medicaid and Private Insurance Companies. Without achieving home health care accreditation, Medicare Accreditation specifically, you will not be able to bill Medicare. In some states, Medicare Accreditation is also required if you are looking to take part in state funded Medicaid programs as well. In most cases, Medicaid as well as Insurance Companies will require that you are at a minimum, Private Duty Accredited.
So, what is the difference in home health care accreditation, Private Duty Accreditation and Medicare Accreditation? The difference is Medicare. In many states, home health care accreditation for Medicare Accreditation is not available to new home health care business startups leaving Private Duty Accreditation as the only option. Otherwise, most new home health care business startups are detracted from pursuing home health care accreditation, Medicare Accreditation due to the high capitalization requirement imposed by Medicare. In most areas the average Medicare capitalization requirement is $60,000, but can range anywhere from $20,000 to $160,000 depending on the state and county your home health care business is located.
The process of home health care accreditation for Medicare Accreditation and Private Duty Accreditation is not exactly the same, but will be found to be very similar. This process of home health care accreditation requires a 3rd party home health care accrediting body to audit your home health care business. This is an intense process and will require that you know all of the ins and outs of home health care accreditation, be it Medicare Accreditation or Private Duty Accreditation prior to proceeding. There are only 3 home health care accreditation organizations in the United States. They are CHAP, ACHC and JCAHO. The CHAP Accrediting Body is considered to be the best choice for home health care accreditation specifically. JCAHO, although better known, is known for its industry leading hospital accreditation as this is their specialty. As far as consistent site surveyors and relevant home health care accreditation policy changes are concerned, the CHAP Accrediting Body is the #1 choice for home health care accreditation, whether Medicare Accreditation or Private Duty Accreditation is the goal.
If your home health care business is in a state that allows new agencies to achieve Medicare Accreditation, the first step towards achieving Medicare Accreditation will require the completion of the 855a Medicare Application. Our home health care business consultants will complete your 855a Medicare Application for your home health care business and assure that it is properly submitted to CMS. 30 days after your Medicare Application is submitted, Medicare will ask that you provide proof of capitalization or IROF (Initial reserve operating funds). The capitalization requirement varies not only state by state, but county by county. Our home health care business consultants will help you to identify what this requirement might be prior to submitting the 855a Medicare Application. You will be given 7 days from receipt of the letter to provide CMS with a bank letter and bank statement showing the required IROF is available in your home health care agency’s business bank account. All in all, it will take about 4 months for CMS to approve your 855a Medicare Application.
While your 855a Medicare Application is being processed, we will assist you with enrolling with the CHAP Accrediting Body. CHAP Accreditation for Medicare Accreditation is our specialty at 21st Century Care Providers. Our home health care consultants are a mix of 19 senior CHAP site surveyors, JCAHO site surveyors, home health care accreditation and home care business startup experts. Our home health care consultants will complete the required CHAP Self-Study on your behalf and schedule an onsite visit at your home health care business office location to review the CHAP Medicare Accreditation process and to conduct a mock CHAP Medicare Accreditation audit.
Once your 855a Medicare Application is approved, you will need to have 10 patients in place prior to proceeding with the CHAP Medicare Accreditation process. Once these patients are in place and your 855a Medicare Application is approved, we will contact the CHAP Accrediting body to schedule the CHAP site survey. The CHAP Accrediting body will conduct an unannounced visit within 90 days. The CHAP Medicare Accreditation process requires a 3 day site visit. The CHAP Accrediting body will visit 5 of your 7 required active patients (3 of the 10 patients can already be discharged prior to the CHAP Accrediting Body’s arrival).
When the CHAP Accreditation site surveyor arrives you need to call our home health care consultants. Our clinical department will be available to consult you throughout the CHAP Medicare Accreditation audit to help assure your success. Should any deficiencies occur during the CHAP Medicare Accreditation Audit, the CHAP Accrediting Body will give you the opportunity to address each deficiency by completing a Plan of Correction. If necessary, our home health care consultants will complete your Plan of Correction for you to submit to the CHAP Accrediting Body. Once the CHAP Accrediting Body visits you to conduct the CHAP Medicare Accreditation audit and you achieve CHAP Medicare Accreditation, you can then begin taking on billable Medicare patients. You will not receive your Medicare billing number until approximately 3 months after achieving CHAP Medicare Accreditation, but you will be able to backbill Medicare once your billing number is received. You can now proceed with Medicaid enrollment as well as enrolling with Private Insurance Companies and other programs.
CHAP Private Duty Accreditation is a home health care business startups only option in many states. It is also a great option for those home health care business startups that are unable to meet the high Medicare Capitalization/ Medicare IROF requirements, or of course, those home health care business startups specializing in Private Duty Home Health Care without the need for CHAP Medicare Accreditation.
The CHAP Private Duty Accreditation process will require you to take on 8 patients. Once you have these patients our home health care consultants will enroll your private duty home health care business with the CHAP Accrediting Body, complete the CHAP Self Study requirement and schedule your CHAP Private Duty Accreditation Audit; the CHAP Accrediting Body will schedule the Private Duty Accreditation audit to be conducted within 90 days. The CHAP Private Duty Accreditation audit is 3 days long. Only 4 of the required 8 patients will need to be active by the time the CHAP Accrediting Body arrives. The CHAP Accrediting Body will visit all 4 of these active patients.
Our home health care consultants will visit your home health care business at your office location before the CHAP Accrediting Body arrives to prepare you for the CHAP Private Duty Accreditation site audit. Our home health care consultants will consult your private duty home health care business staff during the CHAP Private Duty Accreditation Audit and complete any necessary Plan of Corrections. Once your private duty home health care business achieves accreditation, you can then proceed with Medicaid and Insurance Company enrollment.
The only time it might make sense to forgo CHAP Private Duty or Medicare Accreditation is in the event you provide a specialty services and there are programs in your state that fund these services without CHAP Private Duty or Medicare Accreditation being a requirement. Although this is rare, Texas for example has Pediatric Medicaid Waiver program available for pediatric home health care businesses. In this example if you are only offering pediatric home health care business services, it may make sense to forgo accreditation.
Our home health care consultants will urge you that CHAP Private Duty or Medicare Accreditation is a must for any successful home health care business startup. Even the pediatric home health care businesses in Texas that we use as an example would benefit from either CHAP Accreditation process. CHAP Private Duty Accreditation would allow the pediatric home health care business in Texas to take part in the other Medicaid programs that do require CHAP Private Duty Accreditation. It is also important to note that Medicare is available to anyone over the age of 65, but also to anyone that has been handicapped for a period of 2 years or longer. This means that the pediatric home health care business in Texas can further benefit from CHAP Private Duty or Medicare Accreditation.
Contact 21st Century Care Health Care Consultants
Call 21st Century Care Health Care Consultants to find out how long this process takes in your state and what you will need to get started. We have all of the answers. Call us today and make your dream of starting a home care business a reality.