The 2013 HME Handbook: Accreditation
Acting Fast
How to simplify accreditation for new category additions.
CMS requires all DMEPOS suppliers to disclose all products and services, including the addition of new product lines for which they are seeking accreditation. According to Supplier Standard No. 25, if a new product line is added after enrollment, the DMEPOS supplier will be responsible for notifying the accrediting body of the new product so that the DMEPOS supplier can be re-surveyed and accredited for the new products being added.
This standard is particularly timely with many providers looking to add new product categories because of competitive bidding. And other providers might be seeking accreditation in order to appeal to private payors, as well. Because there is a direct link between the ability to bill and what they’re accredited for, most providers want to be accredited as quickly as possible. Many providers remember the copious amount time needed from getting their original accreditation, but fortunately the next time is a much simpler, quicker process.
It all starts with a phone call to the accrediting organization. Typically, the organization will inquire about the provider’s timeline, i.e. when do they want to start billing for the new product?
The process can vary depending on the product category. A provider may need to just submit written policies as it relates to how they handle the new product, they may need specific training and then need to show the accrediting organization proof of training. For the more complex items, the accrediting organization may go out and do an additional visit to make sure the provider is instructing the patient appropriately, following the new procedures and that they do in fact know all of the manufacturer guidelines as it relates to the new item.
Following along with the provider’s timeline helps the accrediting body to guide the provider and say something like, “in the next 30 days you need to do this, this and this on your end in order for us to then review.” If a survey is required, it’s not going to be announced beforehand, but should go much quicker because it’s just focused on the new product additions. For what is referred to as an “office review,” the provider simply needs to send in their paperwork, which can be turned around very quickly by the provider’s accrediting organization.
In some cases, providers look toward accreditation because they are opening up a new location. Supplier Standard No. 23 states all DMEPOS suppliers must notify their accreditation organization when a new DMEPOS location is opened. The accreditation organization may accredit the new supplier location for three months after it is operational without requiring a new site visit.
And along the same lines is No. 24, which states all DMEPOS supplier locations, whether owned or subcontracted, must meet the DMEPOS quality standards and be separately accredited in order to bill Medicare. An accredited supplier may be denied enrollment or their enrollment may be revoked, if CMS determines that they are not in compliance with the DMEPOS quality standards.
Adam Breeze, one of the owners of Byrd Watson Drug in Southern Illinois, needed accreditation for the opening of a new location.
“We are in a rural area. Cash sales are limited and so we needed to get accredited so that we could bill Medicare right away,” he says. “Very few people would come in and say ‘Oh, you don’t bill Medicare. I’ll just pay for it.’ Nobody ever says that in our area. They say ‘Oh well, I’ll just go somewhere else.’”
Since Breeze and his co-owners had been through the process before, he says it was much smoother going through it again.
“We’ve been accredited since 2007, so they had been to our location many times, and we know them pretty well. We have received high marks every year, and if we did something incorrectly, we’ve corrected it,” he explains. “They were able to come down and do a very quick survey, which is not typical. Typically, I assume it takes a long time to do that. It felt like a long time the first time we did all this.”
Breeze’s advice to providers is as soon as they know that they would like to add a category or open a new location is to talk to their accrediting organization immediately, so they can start looking into the subject matter to see if it even applies to them and they’d be able to bill for it in the future.
“We got on the phone with them and they handled it and called us back,” he says. “It wasn’t a lot of work on our part.”
Points to take away:
- Subcontracting will likely be a viable revenue source with Round Two.
- The two types of subcontractor are: one with a billing number and, therefore, is fully accredited in order to maintain that number, and, a provider that does piecemeal work and does not have a billing number.
- The most important way to get through accreditation quickly is to be prepared.
- Choose an internal accreditation champion or project team to help move the process through your company.
- If a provider is servicing patients in an area not previously served, then state licensure is of utmost importance.
Learn More:
- CMS’s supplier standards can be found at www.cms.gov
- Also available in that same section of the CMS site are details on Medicare’s accreditation requirements on the left-hand navigation tab under “DMEPOS Accreditation.”
- A compendium of accreditation news, articles, columns and features can be found on our site at hme-business.com.
This article originally appeared in the June 2013 issue of HME Business.