Sneak Preview: A Quick-Start Accreditation Primer
The accreditation deadline of Aug. 31 looms for providers in national competitive bidding's first 10 rollout areas. If you're in that group, you're by now wrapping up the accreditation process and perhaps awaiting your on-site survey.
That leaves the rest of the country. And, while your accreditation window has yet to be set, it's certainly racing your way, 2009 at the very latest, and perhaps sooner.
If you've watched with less than complete attention as your fellow DMEs work to hit their late summer deadline, now is a good time to get focused on your own preparations.
Wondering where to start?
Home Health Products' July issue is a good choice. It features concise, step-by-step guides to most aspects of DMEs' business, from ramping up your sleep business to helping your clients choose the right support surfaces. The issue will land on your desk in a couple of weeks, but we offer here a sneak preview - our accreditation How To for people new to the business and others who are just beginning to work toward accreditation now that the first wave is nearly over.
If you live in one of the first 10 accreditation roll-out cities, this isn't for you. Your Aug. 31 deadline is just days away, and you're probably all set on the accreditation front.
You are, aren't you?
But if you've dodged the initial CMS bullet and live elsewhere, you still have some time - no one knows how much, of course - to absorb the gritty details. So, to help you get started, here, in a convenient, economy-size package, are the essentials that you need to head down the path to accreditation.
What it is: Accreditation is one part of an effort by the Centers for Medicare and Medicaid Services (CMS) to implement reforms passed by Congress in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), which aim to rein-in the rate of Medicare spending growth and weed out fraud and abuse. Taking advantage of the industry's historical lack of rigorous regulation and word on the street that Medicare would "reimburse for anything," unscrupulous players were attracted to what they thought would be quick bucks. Instead, they attracted onerous regulatory attention that is punishing the vast majority of the DME providers who work hard and with integrity to serve patients in their communities.
To be accredited and eligible for Medicare Part B reimbursement, you must convince an approved accreditating body (see below) that they satisfy CMS' quality and consumer-service standards for DMEs. The entire quality-standards document is here: www.cms.hhs.gov/CompetitiveAcqforDMEPOS/downloads/CMS_DMEPOS_Quality_Standards_081406.pdf.
How to get accredited: The first step is to choose an accreditor. A list of CMS-approved accreditors is here: www.cms.hhs.gov/competitiveacqfordmepos/downloads/DMEPOS_Accreditation_Organizations.pdf.
Each accreditor has its own customized processes, but there are several steps that are common to all. Your accreditor will ask you to initiate an assessment of your business by comparing your practices to CMS' quality standards. If what you do in financial record keeping or inventory tracking, for example, diverges from what CMS says you should do, you'll have to make changes.
Accreditors differ in how much up-front help they give you to get ready for completing your accreditation application and preparing for the onsite survey that comes later. Because of this and the complexity of compliance, to say nothing of the high cost of failure, some DMEs choose to retain accreditation consultants who specialize in aligning DMEs' businesses with CMS' quality standards.
The actual application comes next. In it, you present an in-depth picture of your business and provide documentation that you are quality-standards compliant. Accreditors can ask for changes or for more information. Once your application is accepted, the accreditor will assign you a window of time during which their team will drop in for an unannounced visit called an on-site survey. No, they won't call and let you know they reached their hotel safely, thank you. They'll just show up and look at everything and talk with everyone, including clients. So long as what they see and hear tracks with the standards and your portrayal of your business practices in your application, you can relax.
Why everyone (well, almost everyone) is worried: Actually, most DMEs aren't too worried about accreditation. If you're doing business the way you should be doing it, accreditation will simply mean documenting your good practices. Mostly. A time-consuming hassle, perhaps. But, by and large, providers know that most health-care professionals must have some kind of certification attesting that they know what they're doing.
It's competitive bidding that's keeping DMEs up nights. The connection between accreditation and competitive bidding, of course, is that you've got to get the former before you can take part in the latter. You've almost certain heard or read about the industry's anxieties: many suppliers, especially the smaller ones, worry that they won't be able to afford to submit bids low enough to have a chance of winning; they'll be unable to continue as Medicare providers, and their businesses' viability will be threatened. The market could become dominated by a comparatively small number of providers, and client service could suffer. At least that's the fear. Now, only time, and whether Congress or the courts intervene, will tell.
This article originally appeared in the June 2007 issue of HME Business.