There Are Two Independent Steps to Becoming a Medicare Provider

Initial Hospice Medicare Provider Enrollment

There are two independent steps to becoming a Medicare provider:

Application

Medicare operations are managed by independent ‘fee-for-service contractors’. The Medicare fee-for-service contractor that processes hospice enrollment applications is known as a Medicare Administrative Contractor (MAC). A geographic listing of these contractors may be found on the Centers for Medicare & Medicaid Services (CMS) web site at

The Medicare enrollment application (Form CMS-855)may be downloaded from the above website. Itmust be completed and submitted to the appropriate MAC. The CMS-855requests background, contact, service and provider information that is essential to the approval process. Applications are reviewed and recommended for approval or denial by the MAC. The MAC will forward the recommendation to the Agency for Health Care Administration’s Home Care Unit. If the application is approved, unit staff will then inform the hospice of additional requirements such as documentation of Civil Rights compliance.

Certification

Hospice providersare required to demonstrate full compliance with Medicare quality and safety requirements during an onsite survey. The CMS-855 must have been approved and the provider fully operational in order for a survey to be conducted. Please refer to the Federal Regulation Set used by surveyors, which is linked to the hospice webpage on the Agency’s website at The hospice will need to be providing services to patients prior to the unannounced federal certification survey, which would require that the hospice first be approved by the Agency for Health Care Administration (Agency) for state licensure.

Initial applicants for Medicare must have provided care to a minimum of 5 hospice patients (not required to be Medicare patients)in order that compliance with all federal requirements can be determined. At least 3 hospice patients should be receiving care at the time of the initial Medicare certification survey. The hospice must be providing all services needed by the patients being served and demonstrate the operational capability of all facets of its operations.

CMS issued a memo on the prioritization of initial surveys for new providers (S&C 08-03) on November 5, 2007, which isalso posted on the Agency’s webpage listed above.

Hospice providers have the option to be accredited with deemed status by a CMS-approved accrediting organization. Thisdeemed status accreditation is equivalent to a recommendation by the State for CMS certification. Three national accrediting organizations have been approved by CMS to conduct deemed status surveys for Medicare certification of hospice providers:

Accreditation Commission for Health Care

(919) 785-1214

Community Health Accreditation Program

(202) 862-3413

The Joint Commission

(630) 792-5000

Questions should be referred to Mary Boortz of the Home Care Unit at (850) 412-4403.