Medicare, a health care program funded by the federal government is aimed at providing affordable services to the eligible US residents. It’s necessary for Medicare recipients to visit a Medicare provider in addition to meeting certain criterion, to be eligible for the benefits. These Medicare providers later get reimbursed for the services they offer to the recipients. Before we move on to the procedure to become a Medicare Provider, let’s try to know who is or can be a Medicare Provider. A Medicare Provider, also termed as a Provider of services is defined as a skilled nursing facility, CORF (Comprehensive Outpatient Rehabilitation Facility), hospice, home health agency or a hospital such as rural primary care hospital. A Medicare Provider can also be a public health agency, rehabilitation agency or a clinic meeting the criterion for participation for the purpose of delivering outpatient occupational therapy services, outpatient speech pathology and outpatient physical therapy. The term further extends to CMHC (Community Mental Health Center), just for the purpose of delivering partial hospitalization services.

A participating provider must comply with applicable provisions of the 1964 civil rights act, title VI. The provider must sign an agreement under social security act §1866 that states:

• The provider doesn’t charge any persons for services and items covered by the health insurance program except for coinsurance amount and deductibles.
• The provider returns any amount incorrectly charged on any individual on his/her behalf as dictated by statue.

For becoming a qualified participating provider, you must meet all criteria for certification on your onsite survey date. If you fail to meet any criterion on your onsite survey date, your effective date of agreement commences on:

• The date you meet all criteria.
• The date you submit correction plan accepted by HCFA.
• The date you provide an acceptable waiver request.

For the reimbursement to the provider for services and items delivered to the beneficiary, it must have the required record-maintaining facility to determine the cost of services offered.

Mentioned below is the procedure on becoming a Medicare Provider. Although Medicare providers have to submit a lengthy application, the procedure is quite simple once you complete the documentation.

• You need to be aware of both; federal regulations and regional policies devised by the state applicable to you. Review the guidelines given by Medicare.
• Identify the differences between various Medicare policies. For instance, if you are working in a hospital or nursing home, you will need Medicare part A, whereas group practices and private doctors will more than likely need Medicare part B.
• You should have a 10 digit number called an NPI number that ensures HIPA (Health Insurance Portability and Accountability) compliance.
• You can receive an application for a Medicare provider from the Medicare carrier in your area. The carrier is the point of contact for all your Medicare concerns. The carrier also helps you out regarding any queries on the enrollment procedure.
• You will need to submit an entirely completed application along with a copy of DEA (Drug Enforcement & Administration) certificate, Medicare provider letter, form W-9 from the IRS and a copy of state business license.
• Reread the Medicare certification terms. For becoming a Medicare provider, you need to possess a valid business license in addition to agreeing for a non-discrimination standard. You should also abide by all the other terms dictated in the program.
• Mail copies of all the documents and forms to a Medicare carrier in your area. It may take up to 7 weeks for your application to be processed.