If you’re starting or growing a home health agency or hospice, Medicare enrollment is the key to getting paid. This guide walks you through the full home health agency Medicare enrollment process, from getting ready to final approval.
You’ll learn how to fill out the CMS‑855A form, use PECOS for home health and hospice providers, and meet Medicare site visit and fingerprinting rules without unnecessary delays. We’ll also cover key institutional provider credentialing steps, common mistakes that cause denials, and how hospice enrollment compares to home health.
Use this as a practical checklist to follow CMS rules, avoid costly errors, and set your agency up for a smoother survey and billing start.
Who Needs to Enroll as a Home Health Agency or Hospice with Medicare?
Any organization that wants to bill Medicare for home health or hospice care must enroll as an institutional provider. This includes home health agencies (HHAs) that provide skilled nursing, therapy, and other home health services under a physician’s plan of care, as well as hospice providers that deliver end‑of‑life care, including nursing, physician services, counseling, and support for terminally ill patients. The process for hospice provider enrollment Medicare is similar to home health, with some differences in survey focus and conditions of participation.
Both HHAs and hospices must use the CMS‑855A application. You must enroll if you are starting a new Medicare‑certified agency, changing ownership or legal structure, or revalidating your existing Medicare enrollment. Getting this right matters because errors can delay your PTAN, block billing, and cause problems during your home health agency Medicare enrollment and survey process.
Medicare Enrollment Steps at a Glance
| Step | What You Do | Why It Matters |
| 1. Get state license/certification | Obtain required state license or certification (if your state requires it). | You can’t enroll or operate without proper state approval. |
| 2. Get your NPI | Apply for a Type 2 (organizational) NPI. | Medicare uses your NPI to identify your agency. |
| 3. Complete CMS‑855A | Fill out the Medicare enrollment application. | This is the main form Medicare uses to approve you. |
| 4. Submit via PECOS | Submit online through PECOS (recommended) or by paper. | PECOS is faster and makes tracking easier. |
| 5. Pay the fee | Pay the Medicare enrollment application fee (if required). | Your application won’t be processed without it. |
| 6. Fingerprinting | All owners and managing employees get fingerprinted. | Required background checks for Medicare approval. |
| 7. Site visit/survey | State survey agency or MAC visits your agency. | Confirms you meet Medicare rules before you can bill. |
| 8. Respond to MAC | Answer any requests for more information. | Slow or incomplete responses can delay or deny approval. |
| 9. Get PTAN & approval | Receive your PTAN and Medicare approval letter. | You need this to start billing Medicare. |
Step 1: Get Ready Before You Start Your CMS‑855A
Before you open the CMS‑855A, gather your key info and documents. Good prep reduces the risk of denials and long delays.
Meet Basic Medicare Requirements
Basic Medicare requirements for home health agencies include being properly licensed in your state, meeting Medicare’s Conditions of Participation (or holding CMS‑approved accreditation), employing qualified staff (such as RNs, therapists, home health aides, and medical social workers), and having policies and procedures that ensure patient care meets Medicare standards.
Confirm Legal Structure and Ownership
Start by confirming your legal structure and ownership. Clearly define your legal business name and any DBA, your legal structure (corporation, LLC, partnership, sole proprietorship), and all owners and managing employees with at least 5% ownership. Medicare requires detailed ownership info, and mistakes here often cause delays.
Meet Special Capitalization (Operating Reserve) Rules
If you are opening a brand-new home health agency or undergoing a change of ownership that results in a new provider number, CMS enforces strict special capitalization requirements (42 CFR § 489.28). You must prove you have enough initial reserve operating funds to cover three months of operations without relying on Medicare payments. Your MAC sets this target using regional peer data, and you must submit bank account statements accompanied by a financial institution attestation showing that at least 50% of these operating reserves consist of unencumbered, non-borrowed cash.
Obtain and Verify Your NPI
Next, obtain and verify your NPI. Apply for a Type 2 (organizational) NPI if you don’t have one, and make sure the NPI record matches your legal name, address, and taxonomy. Mismatched NPI data is a common source of PECOS errors.
Gather Required Documents and Forms
Finally, gather your required documents. You’ll typically need your state license or certification (if required), articles of incorporation or organization and operating agreements, IRS documents such as your EIN letter or tax‑exempt letter, a list of all owners, officers, and managing employees with ownership percentages, information on any prior Medicare/Medicaid enrollments or terminations, and key policies and procedures that are often reviewed during the site visit.
For initial enrollment, many MACs also expect:
- IRS CP575 (or equivalent) confirming your TIN and legal name
- IRS Determination Letter if you’re a non‑profit
- An organization structure diagram/flowchart showing all entities you will list in Section 5 (Other Disclosures) of the CMS‑855A
- For EFT: CMS‑588 form plus a voided check, deposit ticket, or bank verification letter
Depending on your MAC and state, you may also be asked to submit additional forms such as the OASIS G325 Compliance letter, CMS‑1561 (Health Insurance Benefit Agreement), HHS‑690 (Assurance of Compliance), Civil Rights Information Request (OMB 0945‑0006), and nondiscrimination policies and notices.
Having these ready before you start PECOS will make the process faster and cleaner.
Step 2: Fill Out the CMS‑855A
The CMS‑855A is the main Medicare enrollment form for institutional providers, including HHAs and hospices. You can complete it online via PECOS or on paper, but PECOS is preferred.
CMS 855A Enrollment Guide
- In Section 1 (Provider/Supplier Information), you enter your legal business name, DBA, and addresses, along with contact info like phone, email, and website. You also provide your organizational NPI and taxonomy codes. Choose taxonomies that match your services (home health or hospice) and your state license.
- Section 2 covers billing information. Include whether you bill Medicare directly or through a billing agent, your pay‑to address, and EFT and ERA details if applicable. Correct billing info helps avoid payment delays after you get your PTAN.
- In Section 3, list all practice locations where you provide services. This includes your main office and any branch offices. For HHAs, include service areas and satellite locations. For hospices, include inpatient units, respite locations, and contracted facilities if required. Each location may be checked during the site visit, so keep addresses accurate.
- Section 4 (Ownership and Managing Employees) is closely reviewed. Disclose all individuals and organizations with at least 5% ownership, officers, directors, managing employees, and anyone with control, plus any recent changes in ownership or control. For each person or entity, provide name, SSN or EIN, date of birth, and address, along with ownership percentage and role, and any prior Medicare/Medicaid exclusions, sanctions, or terminations. For complex ownership structures, many MACs recommend including an organization chart/flowchart that shows all entities listed in Section 5 (Other Disclosures) of the CMS‑855A. Errors or missing info here often trigger extra requests and delays.
- Section 5 (Other Disclosures) asks about other disclosures, such as prior Medicare or Medicaid enrollments, any adverse actions, exclusions, or criminal convictions, and relationships with other providers like common ownership. Be complete and consistent with your other applications.
- In Section 6, an authorized official must sign the form. This is usually an owner, officer, or managing employee with legal authority. The signature can be electronic in PECOS or handwritten on paper, and it confirms that all info is true and complete. False info can lead to denial or penalties.
Step 3: Submit via PECOS and Pay the Fee
Once your CMS‑855A is complete, submit it and pay the fee. PECOS is CMS’s online portal for provider enrollment. PECOS enrollment for home health agencies and hospices is faster and easier to track than paper. To submit, log in with your IAM account, start a new CMS‑855A for your organization, complete each section while saving often, and use PECOS checks for errors. Then electronically sign and submit to your MAC. PECOS offers faster processing than paper, real‑time status tracking and messages from your MAC, and easier updates and revalidation later. Paper submissions take longer and require more manual follow‑up.
Most new HHAs and hospices must pay an enrollment fee when submitting the CMS‑855A. The fee amount is set each year by CMS, payment is usually made online in PECOS by card, and the fee is non‑refundable, even if you’re denied. Some providers may be exempt (for example, certain government entities), so check with your MAC or the latest CMS guidance. If you don’t pay or pay the wrong amount, your application will be rejected or put on hold.
Signature and submission tips
- For paper forms, many MACs require original signatures in blue ink.
- Section 15 (Certification Statement) must be signed and dated by the authorized official. Faxed, photocopied, or stamped signatures are often rejected.
- Submit all required forms and documents together; incomplete packets are commonly returned or delayed.
- Signature errors are one of the top reasons for processing delays.
Step 4: Fingerprinting and Site Visit
After you submit your CMS‑855A and pay the fee, your MAC will start background checks and schedule a site visit.
Medicare Site Visit and Fingerprinting Requirements
CMS requires fingerprint‑based background checks for all owners with at least 5% ownership, as well as managing employees and anyone with operational or financial control. Your MAC or its vendor will send fingerprinting instructions, and each person must go in person to an approved site. Results go directly to CMS/MAC; you don’t send them yourself. Delays in fingerprinting are a common cause of enrollment hold‑ups, so make sure all required people schedule quickly and bring proper ID.
The site visit checks that your agency meets federal and state rules before Medicare certification. Surveyors review policies and procedures, interview staff, observe operations and documentation, and check your physical environment. For HHAs, the focus is on skilled nursing, therapy, care coordination, and home health rules. For hospices, it’s on hospice philosophy, team structure, pain and symptom management, and bereavement services. You cannot bill Medicare until you pass the survey and get formal approval.
Operational Readiness for the Survey
Before the survey, make sure your agency is fully operational. Surveyors will look for working systems for patient admission and intake, scheduling, care coordination, and monitoring of patient progress. They will review clinical documentation (assessments, plans of care, visit notes, orders, and medication records) and may interview staff about patient rights, infection control, documentation standards, and complaint reporting. Many agencies conduct mock surveys and keep a “survey‑ready” binder with licenses, organizational charts, policies, QAPI and infection control records, and personnel files.
Accreditation and Deemed Survey Options
Some agencies use accreditation instead of (or in addition to) a state survey. Common CMS‑approved accrediting bodies for home health include CHAP, The Joint Commission, and ACHC. An approved “deemed” survey from one of these organizations can satisfy Medicare’s survey requirement.
Step 5: Respond to MAC Requests and Get Your PTAN
After your application, fingerprinting, and site visit, your MAC will review your file and may ask for more information. How you handle this step often decides if you’re approved quickly or delayed.
Your MAC may contact you via:
- PECOS messages if you applied online
- Letters or emails for paper applications or specific issues
Common requests include:
- Clarification on ownership or managing employees
- More documents such as licenses, policies, or org charts
- Explanations of prior enrollments, terminations, or adverse actions
Best practices are to reply by the deadline (often 30 days), send complete, clear, and well‑labeled documents, and reference your application ID or PTAN in all messages. Late or incomplete responses can lead to denial or closure of your application.
Once approved, your MAC will send a PTAN unique to your agency or hospice, plus a Medicare approval letter with your effective date and any billing limits. Your PTAN is needed to:
- Enroll in Medicare billing systems
- Submit claims and check claim status
- Complete revalidation and future updates in PECOS
Keep your approval letter and PTAN secure and share only with authorized staff.
Common Mistakes and How to Avoid Them
| Common Mistake | How to Avoid It |
| Incomplete or inconsistent ownership info | Map your full ownership chain before applying. Match info across state license, Medicaid, and Medicare. Disclose all required owners and entities. |
| Mismatched NPI, taxonomy, or license data | Check your Type 2 NPI in NPPES before starting. Match taxonomy to your services and license. Update NPI first, then use that exact data on the CMS‑855A. |
| Poor or late responses to MAC requests | Keep a dedicated enrollment folder. Assign one person to track PECOS messages and letters. Respond fully and on time, even if you send partial info first. |
| Underestimating fingerprinting and site visit timing | Schedule fingerprinting as soon as you get instructions. Do a mock survey before the real one. Make sure policies, files, and records are ready. |
Avoiding these errors can save weeks or months in your enrollment timeline.
Revalidation and Ongoing Compliance
Medicare enrollment is not one‑time. To keep billing, you must revalidate and stay compliant.
Medicare Revalidation Requirements
CMS requires HHAs and hospices to revalidate at regular intervals, usually every 5 years. Your MAC will notify you via PECOS or letter, and you must submit a new CMS‑855A (or updates) and pay any fee. Missing the deadline can deactivate or terminate your billing privileges, so treat revalidation as a core task, not an afterthought.
Updating Your Enrollment Information
You must also report certain changes to your MAC within set timeframes, often 30 days. These include legal name, DBA, or ownership changes; new or removed owners, officers, or managing employees; address or billing info changes; and adverse actions, exclusions, or license issues. These updates are usually done through PECOS using the right CMS form.
Ongoing Compliance and Survey Readiness
After approval, you must pass periodic surveys and complaint investigations, meet quality reporting and data submission rules, and follow Conditions of Participation for home health or hospice. Strong documentation, training, and quality systems reduce risk in future surveys.
Conclusion
Medicare enrollment for home health agencies and hospices is detailed, but following a clear process reduces delays and denials. From preparing your documents and completing the CMS‑855A to passing fingerprinting and the site visit, each step must align with CMS and MAC requirements.
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FAQs
How long does Medicare enrollment take?
Typical timeline is 3–6 months from a complete CMS‑855A to approval and PTAN. MACs generally have up to six months to review and decide on your application. After approval, it can take an additional 4–6 weeks to receive your tie‑in notice and provider number. Delays in fingerprinting, site visits, or MAC responses can push the overall process to 6–9+ months. Early prep and using PECOS can help keep it closer to 3–6 months.
How much does enrollment cost?
Main costs are the Medicare enrollment application fee (set yearly by CMS) and possible costs for fingerprinting, state licensure, survey fees, and consultant or legal help. The application fee is non‑refundable, even if you’re denied.
What’s the difference between NPI and PTAN?
The NPI is a 10‑digit ID from NPPES. You need a Type 2 NPI before enrolling. The PTAN is a number from your MAC after approval, used for billing and MAC communication. Your NPI stays the same; your PTAN is tied to your Medicare enrollment with a specific MAC.
What happens if my enrollment is denied?
Your MAC will send a notice with reasons. Often you can fix the issues (ownership info, missing docs, etc.) and reapply. In serious cases (false statements, major compliance issues), you may face longer‑term barriers. Review the denial carefully and fix all cited problems before resubmitting.
Can I bill Medicare before approval?
No. You cannot bill Medicare until your CMS‑855A is approved, you have your PTAN and effective date, and you’ve passed all required site visits and surveys. Billing early can cause claim denials, overpayments, and compliance problems.
Do I need Medicare certification to operate a home health agency?
No. You can operate without Medicare certification if you only serve private pay or other insurance patients. However, certification is required to bill Medicare and serve Medicare beneficiaries.
What are the penalties for non‑compliance with Medicare standards?
Non‑compliance can lead to fines, corrective action plans, loss of Medicare certification, or suspension of Medicare payments. In serious cases, it can also affect your ability to enroll in other government programs.
