Why Trial and Error Isn’t an Option in Medicare-Certified Facility Startups
Opening a new licensed healthcare facility—especially one pursuing Medicare certification—is not the time to learn as you go. The process is highly regulated, and even minor missteps can lead to serious delays, financial strain, or denial of certification. It is vital to have team members who understand the intricate steps and potential pitfalls is essential for avoiding costly errors and ensuring a smooth launch. In recent years, changes in the order of required submissions and shifts in the roles of key agencies have made the process more complex and less predictable. We’re often contacted after a facility has already submitted filings and is waiting—sometimes indefinitely—for the infamous CMS approval letter. In many of these cases, delays and complications could have been avoided with proper guidance from the start.
Five Issues That Can Cause Havoc in a New Facility:
- Waiting on Agency Timelines to Drive Your Process
Assuming that the published or communicated processing times from agencies are accurate and timely can be a major mistake. Instead of passively waiting, build a proactive timeline and stay ahead of requirements. - Failure to Follow Up Consistently
Following up is just as critical as submitting accurate application data. A well-prepared application can still fall through the cracks without persistent and timely follow-up with the relevant agencies. - Incomplete or Inaccurate Application Data
Seemingly small errors or omissions can result in major delays or denials. Every detail must be double-checked and aligned with regulatory expectations. - Misunderstanding State vs. Federal Requirements
State licensure and Medicare certification processes often overlap but are not the same. Confusing or conflating the two can stall your progress or result in failed inspections. - Underestimating Operational Readiness Requirements
Medicare surveys evaluate not just paperwork, but full operational readiness. If your facility, staff, or systems aren’t fully prepared, your application may be rejected or delayed with a deficient or failed survey.
If your team is already managing multiple priorities– or if opening a new facility isn’t something they’ve achieved recently—Advis can step in to bridge the gap. With decades of experience across multiple states, we bring the expertise needed to navigate complex filing and regulatory requirements. We will keep your project on track. Contact your Advis consultant or mhon@advis.com for more information.
Published May 23, 2025
