Congratulations! Your home health or hospice agency has passed its accreditation survey—a major milestone. However, now you face a new challenge: the waiting period before receiving your Medicare provider number, which can take anywhere from two to eight months. Without the ability to bill for services yet, you may be wondering: How can I use this time wisely to set my agency up for success?
At The Home Health Consultant, we’ve helped countless agencies navigate this transition successfully. We know exactly what steps you should take to prepare.
In this article, we’ll walk you through actions to take during this waiting period. After reading, your agency will be ready to operate the moment you receive your provider number.
1. Why Is It Important to Build a Reliable Clinical Team Before You Start Accepting Patients?
A successful home health or hospice agency depends on having the right clinicians in place before patient referrals start coming in. Many agencies underestimate the time required to hire and onboard staff. Since care is provided in patients’ homes, you need a reliable team ready to cover your geographical service area (GSA).
During this waiting period, you should focus on recruiting and onboarding as many qualified clinicians as possible. The more staff you have in place, the smoother your operations will run once your provider number arrives. However, finding direct hires is not always easy.
Not having the right clinicians ready to go when referrals start coming in can cause serious delays in agency operations. A lack of coverage in certain areas means that even when you receive referrals, you may have to decline them simply because you don’t have a nurse, therapist, or aide willing to travel to that location.
On the other side, you may have recruited staff members who are ready to work but end up waiting indefinitely because referrals aren’t coming in fast enough. This mismatch can lead to high turnover. Clinicians may look for other opportunities rather than waiting for your agency to ramp up referrals.
Many of the first referrals your agency receives will likely be the more complex or difficult cases. This is because referral sources typically have a shortlist of trusted agencies they work with regularly. As a new agency, you often only get an opportunity in three situations:
- when you have a personal relationship with the referrer
- when another agency has dropped the ball and they’re looking for a replacement
- when no other agency is willing to accept the patient.
These early referrals are often in hard to staff areas, and/or patients requiring specialized clinicians with experience in wound care, chronic disease management, or palliative care.
If you haven’t secured a well-rounded clinical team, you may struggle to accept these early referrals. This will damage your agency’s reputation before you even begin operations.
Since home-based care requires flexible staffing, having a strong clinical team in place before your provider number arrives ensures you can hit the ground running.
How To Hire a Strong Clinical Team for Your Home Health or Hospice Agency Before You Get Your Provider Number
The ideal scenario is to employ a strong team of direct-hire clinicians. Direct employees:
- provide stability,
- integrate into your agency’s culture & operations,
- and help maintain consistent quality of care.
Here’s how to build your talent pool:
- Advertise on traditional hiring sites: Like indeed, linked in and zip recruiter. Just be careful. Good clinicians are hard to find and not usually looking for work this way. Traditional hiring sites will usually bring newer clinicians that don’t already have a network, or people looking to start fresh in a new sub-industry.
- Network aggressively: Attend industry events, engage with local nursing and therapy associations, and participate in home health and hospice networking groups. The more connections you make, the easier it will be to fill gaps in your coverage.
- Ask for recommendations: Your best hires may come through word of mouth. Ask trusted colleagues, existing clinicians, and others in the industry for recommendations.
- Keep a roster, even if clinicians don’t commit immediately: Some clinicians may be hesitant to sign up before you have active referrals. However, having a list of potential hires (with their availability and service areas) will make it easier to onboard them when you’re ready.
- Balance specialties – You need more than just nurses. A well-rounded team includes physical therapists, occupational therapists, speech therapists, social workers, chaplains (hospice only) and aides.
Pro Tip: The stronger your clinical team, the smoother your agency's launch will be.
However, hiring direct staff for every area you serve can be difficult. This is especially true when your agency is just starting out. Some clinicians may hesitate to sign on with a new agency until they see a steady stream of referrals.
This is where staffing agencies can help.
Should Your Home Health or Hospice Agency Work with Staffing Companies?
Many home health and hospice providers contract with staffing companies to supplement coverage. These companies have a roster of therapists, social workers, and sometimes even nurses to fill in gaps when you don’t have direct hires available.
However, it’s important to remember that staffing agency clinicians must still meet your organization’s training, competency, and compliance standards. They require proper orientation to your policies and procedures, just like direct hires.
If you’re concerned about staffing companies and want to go above and beyond, there’s more you can do to find direct hires.
2. Why Is It Important to Build Relationships with Referral Sources Before You Get Your Provider Number?
Marketing during this waiting period can be tricky. You can’t bill Medicare for services yet, and your patient census is still very small or non-existent. However, you can still use this time to establish relationships with
- hospitals,
- physicians,
- and other potential referral sources.
Focus on building trust rather than pushing for immediate patient referrals. Introduce your agency, explain your services, and let them know when you expect to start accepting patients. To read more about how to increase your reach and referrals, read our article on How to Attract Referral Sources .
Referrals often come with challenges, especially when you're new. Again, initial referrals will likely be complex cases or patients in remote areas. These complex cases don’t just affect staffing.
Being prepared and able to accept these cases will give you a competitive edge. Establishing early connections with referral sources ensures that when you're ready to accept patients, they already know who you are and what you offer.
3. Why It’s Essential To Coordinate with Your Leadership & Office Staff Before Receiving Your Provider Number
As you prepare for operations to ramp up, you need to evaluate the availability of your leadership team. Your Administrator and Director of Patient Care Services (DPCS) may currently be working limited hours. Now is the time to discuss increasing their availability. If they are unable to commit to the hours required, consider replacing them before you receive your provider number. Or at least start looking. It’s much less of a headache to jump this hurdle before you have an influx of patients and become entangled in daily operations.
Additionally, you should start looking for office staff if you haven’t already. Even if you don’t officially hire someone yet, identifying the right candidate and starting informal training will make the transition smoother. A well-trained office team will ensure that referrals, billing, and patient care coordination run efficiently from day one.
Why It Matters to Strengthen Financial & Operational Systems Before Getting Your Provider Number
Financial preparedness is crucial. Payroll delays are one of the fastest ways to lose staff. So having a financial system in place from the get-go is non-negotiable. Many agencies choose accounting software like QuickBooks to manage payroll and expenses efficiently. It can take 30 to 60 days to receive payments after admission. So, you need a clear plan to cover payroll in the meantime.
Additionally, you’ll need a billing connection provider like Ability or Waystar to process claims efficiently. Further, having a biller in place early ensures that you’re going to receive your reimbursements on time, pay staff on time, and in turn keep your clinicians happy.
Once you receive your Tie In Notice from Medicare, you’ll have several steps, like applying for billing access, before you can bill your first claim. You can read more about the importance of different kinds of vendors below. Researching and securing these systems now will prevent unnecessary headaches and delays when patient care begins.
Beyond finances, this is also the right time to evaluate your Electronic Medical Records (EMR) system. If you’ve been using a temporary or unsatisfactory software solution, now is the moment to switch to a system that better fits your needs.
Should Your Agency Accept Medicare Patients Before You Have Your Provider Number?
This is a question we hear often—and the answer isn’t straightforward. Technically, you can start seeing Medicare patients before your provider number is active, but you won’t be able to bill for services until it's assigned. Some agencies choose to self-finance care during this period to start building their census.
But this strategy carries serious risk. Without your provider number, you won’t know if a patient has already been admitted by another agency until you try to bill. Other agencies also won’t be able to see that you’ve admitted the patient, and might admit them at the same time. If there’s overlapping billing, Medicare will reject your claim or pro-rate it significantly. That means you may have already delivered an entire episode of care, and likely will never be fully reimbursed.
Pro Tip: If you do decide to take patients while waiting for your provider number, there are a couple of things you can do to reduce the chances of other agencies “stealing” them.
All of the below items are best-practices that should be routine, but are especially important to keep in mind if you’re accepting patients before getting your provider number.
1. Identify all non-clinical individuals involved in the patient’s care. This includes family members, friends, or any informal caregivers. It’s important to build a relationship with whoever is helping the patient outside of home health services.
Doing so ensures open communication, helps coordinate care more effectively, and confirms that another agency isn’t also providing services without your knowledge.
2. Ensure patients and caregivers are able to identify clinicians from your company. Many patients and families associate care with the clinicians providing it. It’s important they know your branding. This can be your company name, colors, what your admission package looks like, your staff badges, etc.
With this, they will be able to tell whether or not a clinician from another agency shows up. In the case a clinician from another agency does show up, your patient and their caregiver should know to inform you.
3. If your referral is from a specialist or hospitalist, start coordinating care with the primary physician. By establishing communication with the primary care provider, you gain a better understanding of the patient’s condition and if any other referrals have been sent for that patient.
If you choose to accept patients during this waiting period, make sure you fully understand the risks and have safeguards in place. For many agencies, it’s a high-stakes gamble.
Why You Need to Secure Vendor Contracts Before Getting Your Provider Number
Finding the right vendors for your agency is absolutely critical to keeping operations running smoothly. Essential vendors to consider include:
- Billing providers
- Pharmacies
- Medical equipment suppliers
- Transportation services
If you're in a rural area with limited vendor options, you can look outside of your state for help. Major home health hubs like...
- California,
- Texas,
- or Florida
...can help you identify national vendors with strong industry networks. The more vendor options you have lined up, the more flexibility you'll have if issues arise. Establishing relationships with backup vendors is also a good strategy to avoid disruptions. At the very least, you’ll have another person to ask if something feels off.
Why Establishing a Strong Compliance Program Before Getting Your Provider Number Can Make or Break Your Agency
So you’ve done all of the above. You’ve secured staff, referral sources, financial systems, and vendors. Your agency opens, and after a few months you’re receiving a consistent flow of referrals.
But then it gets busier, and busier, and busier. Your agency is thriving, and you couldn’t be happier (or any busier). But be careful. As your agency grows, compliance can take a backseat to quality patient care.
Before you know it, your triennial survey is in less than a year and you’re scrambling to prepare. All the hard work you did to get your agency up and running could crumble if a conditional deficiency is found at your next survey.
So what’s the best way to stay on top of Medicare regulations while juggling vendors, staff, and of course, patients? Of course, we’re a bit biased, but we recommend implementing a strong compliance framework before you get lost in the sauce.
With a clear process in place, you’ll maintain compliance over the days, months, and years leading up to your next survey. Maintained compliance means no more scrambling before survey, less survey-stress, and more peace of mind. At The Home Health Consultant, we refer to this as survey-readiness. To learn more about our approach to compliance and how survey-readiness can transform your agency, check out our article below.
Whether you handle compliance in-house or work with a consulting service, having a structured plan ensures that regulatory requirements don’t become an afterthought.
How to Prepare to Open Your Home Health or Hospice Agency with Confidence
The period between passing your accreditation survey and receiving your provider number is an opportunity. It’s your chance to lay the groundwork for success. Agencies that use this time wisely are better prepared to handle referrals, staffing, and compliance without unnecessary setbacks.
By focusing on:
- staffing,
- networking,
- financial planning,
- vendor relationships,
- and compliance
…your agency can ensure a smooth transition into full operations. If you want to build a strong, structured compliance program from day one, The Home Health Consultant is here to help. Contact us today to get started.
Not quite ready to reach out? No problem. Discover how our program works to make sure you stay compliant all the time, not just before a survey.
*This article was written in consultation with Mariam Treystman.
*Disclaimer: The content provided in this article is not intended to be, nor should it be construed as, legal, financial, or professional advice. No consultant-client relationship is established by engaging with this content. You should seek the advice of a qualified attorney, financial advisor, or other professional regarding any legal or business matters. The consultant assumes no liability for any actions taken based on the information provided.
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