As with the establishment of any business, medical or otherwise, a large number of factors enter into that determination. Establishment of an operational facility can be as quick as 3 months or as long as a year. An initial determination of possible state requirement of a Certificate of Need (CON) may render the decision to establish a facility in those states requiring such as not worth pursuing resultant of the time and expense involved. Conversion of an existent facility into a CORF may require build out or spatial re-orientation. The facility must comply with all federal, state, and local building, fire, and safety codes. An in-house fire alarm system (meeting local fire codes) as well as adequate fire extinguishing and emergency lighting must be in place. Medicare program application paperwork must be requested from the State Health Department who is empowered to survey and oversee the facility on behalf of Medicare. Establishment of a billing relationship with the Medicare appointed FI (Fiscal Intermediary) requires minimal paperwork. The FI is responsible for billing review, oversight, and payment disbursement.

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