Frequently Asked Questions
Licensing Process
1What are articles of formation?
Proof of registration of your company from your Secretary of State; Can be a corporation or LLC
2What is an EIN?
Also known as Tax Identification, a unique nine-digit number assigned by the Internal Revenue Service (IRS) to business entities operating in the United States; Must match the business entity registered with the Secretary of State (Corp or LLC)
3What is an NPI?
A unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS) that is used for billing and identification purposes
4Can I have a home office?
This depends on state regulations, but you must have a physical location.
5Do I need office space right away?
This depends on state regulations; if a commercial space is required, an executed lease will need to be provided prior to submitting your application
6Does the 21st Century fee cover all costs?
No. There may be third party costs including, but not limited to: secretary of state fee, state license fee, CLIA waiver application fee, Medicare provider enrollment fee, and accreditation fees
7What staff do I need?
Each agency is required to have administrative and clinical oversight. Staff requirements will be dependent on your state and the services you are offering
8Will 21st Century help me find staff?
No. However, once you have chosen staff, resumes will be reviewed to ensure individuals meet regulatory requirements
9I’m an RN, can I be the Administrator?
If you have the appropriate supervisory experience, and your resume reflects such, you may qualify as the Administrator
10Can I have one person be both the Administrator and the Clinical Manager/Director of Nursing?
If that person has the appropriate experience, you may use one person for multiple positions
11I’m an owner, do I need to meet any qualifications?
This depends on your state; Some states will require you, as an owner, to pass a criminal history check
12Do I need a license to operate?
This depends on your state; most states require licensure
13How long will it take to get a license?
This depends on your state, typically licensure can take anywhere from 3 to 18 months
14What are policy extracts?
Policies that are extracted from your manual that need to accompany state licensure applications
15What are corrections?
When an application is returned due to incorrect information.
16What are omissions?
When an application is returned due to missing or incomplete information (state forms, resumes, policies, etc.)
17Does my state require a CEMP?
Only Florida, Texas and Connecticut require a CEMP
18What is a CLIA Waiver?
A CLIA Waiver allows simple tests to be performed in the home that have a minimal margin for error
19What is a fiscal intermediary?
A private company contracted by Medicare to pay claims on behalf of Medicare, as well as perform administrative functions. For Home Health these are Palmetto GBA, CGS, and NGS
20What is capitalization?
Also known as initial reserve operating funds (IROF); Funds sufficient to operate your agency during enrollment and for the three-month period after Medicare billing privileges are granted exclusive of actual or projected funds received from Medicare
21How much will my capitalization be?
This depends on your city and state, and the current operating budget of agencies around you; Typically ranging from $35K to $205K
22How is the capitalization amount calculated?
Medicare calculates the actual average cost per visit of three or more similarly situated agencies in their first year of business and multiplies that number by 22.5% of the average number of visits reported by the comparison agencies
23What is a Civil Rights Information Request?
The Office of Civil Rights must provide your agency clearance prior to becoming a Medicare provider. This clearance is proof that your agency and agency policies are compliant with all Civil Rights statutes and Acts
24Do I have to be accredited?
An initial Medicare provider is required to be certified. Some states require that an accrediting organization be employed to provide the certification, which would require accreditation. For skilled providers, not pursuing Medicare, we strongly recommend accreditation, but it is not required; Some states, such as Florida and New Jersey, require accreditation as a condition of licensure regardless of Medicare provider status or type of services provided.
25What are my accreditation choices?
Accreditation Commission for Health Care (ACHC). Community Health Accreditation Program (CHAP). The Joint Commission (TJC). We currently partner with ACHC and CHAP.
26Does 21st Century recommend a specific accrediting body?
21st Century Health Care Consultants are currently partnered with ACHC and CHAP. We will provide information on both organizations to assist with choosing your accreditor
27What is OASIS?
OASIS (Outcome and Assessment Information Set) is a standardized assessment tool required by Medicare for home health agencies to evaluate and monitor patient outcomes, ensure quality care, and determine reimbursement rates. OASIS is a key component of the comprehensive assessment required for Medicare-certified home health patients. It helps evaluate the patient's clinical, functional, and service needs to develop a personalized care plan
28What is an OASIS Coordinator?
An OASIS Coordinator is a designated individual responsible for managing the administration, accuracy, and submission of OASIS data. They provide guidance on data collection, ensure compliance with Medicare requirements, and assist with technical issues related to OASIS transmissions.
29What kind of patients do I need?
A home health agency pursuing Medicare accreditation typically needs 10 skilled patients, with at least 7 being active at the time of the survey. At least one patient will need a secondary skill.
30How many patients do I need for survey?
A skilled home care agency may require up to 5 patients for a licensing survey, with at least 3 being active and 1 having received skilled care. A non-skilled personal or companion care agency may require 1 to 3 active clients for a licensing survey, depending on state requirements. It's best to confirm specific regulations with your state's licensing agency
31What is a deficiency?
A survey deficiency in home health is an error or non-compliance issue identified during a state or accreditation survey. Deficiencies indicate that the agency has not fully met specific regulatory or operational standards and require corrective action to ensure compliance. Deficiencies can be classified as standard-level (less severe) or condition-level (more serious, potentially jeopardizing accreditation or licensure)
32Will a deficiency keep me from becoming accredited?
Not necessarily. A survey deficiency may not prevent accreditation if it is standard-level, as these typically require a corrective action plan to address the issue. However, condition-level deficiencies are more serious and may require a follow-up survey or additional corrective measures before accreditation is granted
33How many times will proof of capitalization be requested?
At least 4 times. Before your Medicare application is approved, after the application has been approved but before your accreditation survey, after your accreditation survey but prior to your billing number being issued, and once again up to 3 months after your billing number has been issued
Clinical Process
1Do I get to pick the date of my mock visit?
No. While our clinical consultants strive to collaborate closely with the agency, we prioritize maintaining the integrity of the survey process by mirroring real-life accreditation scenarios within the accreditation process timeline
2Who needs to be there for the mock survey?
The presence of the Administrator is required. We highly recommend the Clinical Director's participation in the mock survey and any additional agency staff members deemed appropriate.
3Will I know when my accreditation survey is scheduled for?
No, accreditation surveys for Medicare-certified home health agencies are typically unannounced to ensure an accurate evaluation of the agency's compliance with standards and regulations. However, certain private duty state surveys or non-Medicare-related surveys may be announced, depending on the accrediting body or state requirements
4What if I fail my survey?
An agency rarely fails a survey. If an agency fails its licensing or accreditation survey, it must address the identified deficiencies through a corrective action plan. Depending on the severity of the issues, the agency may need to undergo a follow-up survey or restart the application process entirely. Failure to resolve significant deficiencies can delay licensure, accreditation, or Medicare certification
5Who fixes my deficiencies?
Our clinical consultants will develop a corrective action plan for a specified number of deficiencies, as the contractual agreement outlines. It is the responsibility of the Agency Administrator to implement and ensure proper follow-through of the action plans as required.
Publishing Process
1When will I receive my policies?
Typically, this takes 4-6 weeks after signing your contract; This will also depend on how much has been paid towards your contract, at least 50% of the contract must be paid before your policies are released
2Can I have my policies in hard copy?
Policies will be delivered to the agency via a secure ShareFile link. Upon accessing the folder, the agency can download the policies directly to their computer. It is strongly recommended that the policies also be saved onto two separate flash drives as a backup in the event of computer failure. Please note that the link to access the policies will only remain valid for 30 days, so prompt downloading is essential. While we do not provide hard copies of policies and procedures, the agency may print them internally or utilize a local printing service if desired
3Do the Agency Materials have everything I need to admit a patient?
Yes, except for Medicare-certified agencies, which are required to use OASIS forms. These forms are typically integrated into your EMR system if you have one. If not, they will need to be ordered separately
4What if my agency information changes after I receive my policies?
We provide you with editable versions of the individual policies that will need to be updated any time that your agency information changes
5What if regulations change after I receive my policies?
While your contract is active, we will provide you with updates to your policies any time there is a regulatory change
6Will someone walk me through what is in my policies?
Our clinical team is available to answer any questions about your policies as you review them as well as guiding you through navigating your agency materials