Whether you are considering starting a home healthcare agency or are in the process, the following steps will guide you in the right direction and inform you of what to expect through the application process. All in all, it takes approximately nine months to become government approved as a home healthcare agency.
Although starting an agency is lengthy, it is not difficult when you break down the process step-by-step.
1. Set clear objectives. First start by deciding what type of provider you want to be and what payer source(s) you want to work with. Be clear on your objectives and mission statement.
2. Know your competition. Research their target market, marketing strategies, web presence, social media tactics, company culture, physician referrals, demographics, company size and policies and procedures.
3. Devise a business plan. Write a 1-year, 3-year and 5-year business plan. A solid business plan can help you secure a business loan. Also, it keeps you on track throughout the process.
4. Get insurance. Sign up for insurance including workers’ compensation insurance, liability insurance and a surety bond.
5. Establish a formal business. Set up a business entity that will best fit your needs. For example, you can choose from a sole proprietor, partnership, limited liability, S corporation and C corporation. Register a business name from the county and obtain a Federal Employer Identification Number (EIN) from the Internal Revenue Service (IRS).
6. Apply for a Medicare ID. Apply for a Submitter ID and password from Centers for Medicare & Medicaid Services (CMS). A Submitter ID identifies your organization to the HIPAA Eligibility Transaction System (HETS). You need a Submitter ID to access Direct Data Entry (DDE).
7. Find a business location. Your office should have room for five to ten employees and be in a city that has a growing need for elder care.
8. Establish policies and procedures. Write policies and procedures related to new client admissions, plan of care, scheduling, employee records, payroll, orientation, training and billing.
9. Build brand awareness. Create your website and marketing material. Many agencies use the same stock photos of nurses and stethoscopes. Stand out from the crowd by arranging your own photo shoot or by using original concepts and ideas. A free-lance graphic artist can help you create your brand identity.
10. Hire staff. Initially you will need a licensed nurse and a superstar administrator. Once your agency gets off the ground, you will want to consider hiring an accountant, marketing coordinator and additional licensed nurses.
11. Outreach to the community. Contact local physicians, hospitals, senior centers and rehab outpatient centers for prospective clients. Initially, you need to recruit ten patients. Seven of those ten must be active at all times.
12. Research software. Demo different home healthcare software systems. The main features to evaluate include billing, scheduling, accounting, point of care, human resources and web-based.
13. Get a license. Obtain an Agency for Health Care Administration (AHCA) license. As part of the process, one of the following organizations will evaluate your business practice: Accreditation Commission for Health Care (ACHC), Community Health Accreditation Program (CHAP) or The Joint Commission (JC).
14. Enroll with Medicare. Once you have your AHCA license, enroll with Medicare and Medicaid by completing the 855A form. The approval response can take up to four months.
15. Test. Take the Outcome and Assessment Information Set (OASIS) test. It verifies your ability to send claims electronically amongst other things. Allot approximately six months to become OASIS approved.
16. Schedule a survey. ACHC, CHAP or JC will come out again to evaluate your business. Once they approve your agency, you will receive a Medicare Provider ID.
17. Enroll with EDI. Complete the Electronic Data Interchange (EDI) Enrollment Package to get a Submitter ID. It will either start with GC or SP. This process takes up to two months.
From the moment you begin the process until the government approves your agency, you must maintain at least $100,000 in your business account at all times. Other expenses to consider are salaries, rent, overhead costs and supplies. It is not until your company is approved as a home healthcare agency that you can submit claims for payment. Therefore, you need funds to manage your business without pay for at least nine months, possibly longer.
It is important to always be ready for an audit. The government wants to see that you have all your policies and procedures in a binder and that the data on your patients is thorough and complete.