
What Does It Mean to be Medicare Certified?
According to the nonprofit KFF, there were 6,200 Medicare certified hospitals in the United States as of 2021. KFF also notes that there were 10,441 federally qualified health centers that were Medicare certified in 2021.
It's important to make sure any services and treatments you receive are from a Medicare certified provider.
What is Medicare certification?
When a provider is Medicare certified, it means they agree to offer services at a quality level approved by Medicare. Medicare only pays for services and treatments that are provided by hospitals that voluntarily seek certification and receive approval from the Centers for Medicare & Medicaid Services (CMS).
The Department of Health contracts with CMS to evaluate facilities' compliance with federal regulations. They use periodic on-site surveys for these evaluations.
How do providers become Medicare certified?
Each state may have a slightly different certification process. But the process always ends with the CMS, where a provider receives approval.
State Survey Agencies
Each process will include an initial assessment by a State Survey Agency. These are the agencies that perform periodic surveys of Medicare certified providers.
The State Survey Agencies act on behalf of the CMS to perform these assessments under the agreements in Section 1864 of the Social Security Act (the Act). The state agencies do not have Medicare determination-making functions. These authorities are delegated to CMS regional offices.
Process
The acts that the State Survey Agencies perform for the CMS are referred to as 'the certification process.'
This process includes:
Identifying potential participants: The law guarantees Medicare beneficiaries that payment will only be made for health services provided by or furnished in entities that meet the requirements of the Act.
Conducting fact-finding surveys and investigations: This may be referred to as 'the survey process.' It includes verifying how well the providers are complying with the conditions of participation (CoPs).
Certifying and recertifying: Certifications are sent periodically to state or federal agencies regarding whether providers are qualified to participate in programs like Medicare.
Explaining requirements: State agencies have the responsibility to advise providers and potential providers about applicable Federal regulations that enable them to participate in programs, such as Medicare. These agencies also advise the providers on maintaining the standard of healthcare consistent with the CoPs and conditions for coverage (CfCs).
How do I find a Medicare certified provider?
It's important to receive treatment from a Medicare certified provider. This is the only way Medicare will cover the services you receive.
You can find the following types of providers near you using the Medicare search tool:
hospitals
doctors and clinicians
nursing homes and rehab services
hospice care
inpatient rehabilitation facilities
home health services
long-term care hospitals
dialysis facilities
medical equipment and suppliers
If you have Medicare Advantage, your insurer will typically have a list of in-network providers you can use.
Summary
A Medicare certified provider agrees to provide services that are of the quality approved by Medicare. Medicare will only cover services and treatments from certified providers.
You can find providers near you using the Medicare search tool. Or if you have Medicare Advantage, your insurer can provide you with a list of in-network providers.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.

Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Yahoo
3 hours ago
- Yahoo
‘Pause': Kaiser stops gender-affirming surgeries for patients under 19
( — Kaiser Permanente has announced it will be pausing gender-affirming surgeries for patients who are under the age of 19. Kaiser became the latest health care provider to change its gender-affirming care policy starting August 29, in response to efforts by the Trump administration to restrict access. 'After significant deliberation and consultation with internal and external experts, including our physicians, we've made the difficult decision to pause surgical treatment for patients under the age of 19 in our hospitals and surgical centers,' a Kaiser spokesperson told 'All other gender-affirming care treatment remains available.' Kaiser says there has been a huge focus by the federal government on gender-affirming care, especially for those who are under the age of 19. Ring app users report unauthorized access to their accounts 'We continue to meet with regulators as well as our clinicians, patients, their families, and the community with the goal of identifying a responsible path forward,' Kaiser officials said. According to the hospital, this includes an executive order that instructs federal agencies to take actions to reduce access and restrict funding for gender-affirming care, and hospital inquiries by the Centers for Medicare & Medicaid Services, and changes to coverage and border federal agencies review, which includes the Federal Trade Commission. A recent subpoena has also been issued by the U.S. Department of Justice to doctors and clinics that provided care to minors. 'We recognize that this is an extremely challenging and stressful time for our patients seeking care, as well as for our clinicians whose mission is to care for them,' Kaiser said. 'We will work closely with each patient to support their care journey.' State Senator Scott Wiener (D-San Francisco) stated this is 'straight up denial of care' to those who are under the care of a physician and parents who have permitted the treatments. 'Trump has declared war on trans people and trans kids and their families in particular,' Wiener said. 'Now is the time to have these kids' and these families' backs, not to fold under pressure from the most homophobic and transphobic Administration in modern history — an Administration that won't stop until LGBTQ people are entirely erased from public life.' reached out to some Republican senators and congressmen, but did not hear back in time for this article. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.


CBS News
7 hours ago
- CBS News
140,000 Minnesotans could lose health care coverage over federal Medicaid cuts, analysis shows
A new state analysis found that up to 140,000 Minnesotans could lose health care coverage due to federal Medicaid spending cuts. The Minnesota Department of Human Services said Monday that Minnesota will also lose nearly $1.5 billion in federal funds over the first four years of implementation of President Trump's so-called "big, beautiful bill." According to state officials, people not on Medicaid could see higher health care costs, too. "The loss in coverage within Medicaid will contribute to more uncompensated care for providers and raise costs more broadly in the system for people who are privately insured," John Connolly, deputy commissioner of the Department of Human Services, said. "Because providers will feel that stress and not have a source of payment for people who lose Medicaid coverage and need to cover their costs broadly, and so that means more out-of-pocket costs, potentially, for consumers." Even though Mr. Trump signed the bill into law earlier this month, many of the Medicaid provisions will kick in over the next few years.


Bloomberg
10 hours ago
- Bloomberg
Trump Administration Continues Cushioning Medicare Drug Premiums
Republicans lambasted Democrats last year for subsidizing monthly payments that seniors pay for prescription drug insurance, but the Trump administration is continuing the policy, it told insurers Monday. The Biden administration overhauled the way Medicare, the US program for the elderly and disabled, pays for prescription drugs. Democrats capped the amount of money seniors would have to spend on drugs they pick up at the pharmacy and allowed the program to negotiate what it would pay for some high-cost medications.