Both Medicare and Medicaid have specific requirements that healthcare providers must meet to accept these programs from their clients. While Medicare requirements are mostly uniform across the country, Medicaid requirements can vary by state. Here’s what you need to know.

Medicare Requirements

Medicare is a federal program, so the requirements to become a Medicare provider are generally consistent nationwide. Here’s a list of the key requirements:

  1. Obtain a National Provider Identifier (NPI)
  2. Complete the Medicare Enrollment Application
  3. Meet State Licensing Requirements
  4. Undergo Screening
  5. Sign a Participation Agreement

These requirements do not vary significantly by state, as Medicare is a federally managed program.

Medicaid Requirements

Medicaid is a state-administered program, so the requirements to become a Medicaid provider can differ from state to state. Here’s a general overview of the common requirements:

  1. Obtain a National Provider Identifier (NPI)
  2. Meet State Licensing Requirements
  3. Complete the State Medicaid Enrollment Application
  4. Undergo Screening and Background Checks as required by the specific state
  5. Sign a Provider Agreement
  6. Compliance with State-specific Requirements

Because Medicaid is administered at the state level, specific requirements can vary significantly. It’s important to check with your state’s Medicaid office for detailed information and this is where Kounsel comes in, to relieve the administrative burden that comes with submitting the necessary documents for enrollment.

At Kounsel, we’re prepared to do the heavy lifting so that you can focus on what matters most, your clients. To learn more, feel free to reach out to us at hello@kounsel.io