Industry Accreditors: The Rush Is On

BALTIMORE, Md.–A mid-December meeting between CMS and the
industry’s 11 DMEPOS accreditors has sent those organizations–and
many unaccredited providers–scrambling.

CMS called the meeting to fill the accrediting organizations in
on its expectations as competitive bidding rolls out in 10 MSAs
this year. But at the all-day session, held Dec. 18, officials
handed out a list of 19 possible bidding areas where they said
providers should be accredited by spring.

“It’s clear CMS is focused on Miami,” said Tom Cesar, president
of the Accreditation Commission for Health Care. But beyond that
location, he added, “it’s really like Russian roulette. Who in the
world is going to get hit?”

Other cities on the list include: Charlotte, N.C.; Dallas;
Riverside, Calif.; Pittsburgh; Kansas City, Mo.- Kan.; Cincinnati;
San Juan, Puerto Rico; Cleveland; San Francisco; Atlanta; Houston;
Detroit; Seattle; Baltimore; Philadelphia; Phoenix; Boston; and
Tampa.

“My opinion is that CMS is going to focus on the areas that have
the highest rates of fraud and abuse,” said Mary Nicholas,
executive director of the Healthcare Quality Association on
Accreditation. Others at the closed session also said CMS
emphasized its intent to curb Medicare DME fraud.

CMS had earlier released a list of 25 potential bidding sites,
with three of the country’s largest MSAs–New York, Los Angeles and
Chicago–excluded until the second round of bidding in 2009 when
the program expands to an additional 80 MSAs. Of the remaining
cities on that list, four are not on the latest version: Orlando,
Fla.; San Antonio, Texas; Virginia Beach, Va.; and St. Louis. But
two cities not previously named–Seattle and Phoenix–do
appear.

According to Michael Reinemer, vice president of policy and
communications for the American Association for Homecare, the
agency has begun “talking to congressional delegations for those
MSAs where people need to get accredited to help prepare them.”

CMS estimated that 18,000 providers would be affected in the
bidding areas it names this year. “But even if we are generous and
say that half of those are already accredited,” Cesar said, “all of
[the accreditors] combined may not get the rest through in such a
short period of time.”

Several accreditors said that their new CMS-based programs could
take from four to six months to complete. And some sources said
getting site surveys done could present a problem with an
accreditation rush in the bidding areas. For companies with
multiple locations that must be accredited, CMS has said it will
allow “trending” information to be reported, with site surveys at
only a portion of the locations.

Providers in the next 80 bid areas chosen will have to be
accredited by spring 2008, CMS told the accreditors, and all
providers billing Medicare Part B will have to be accredited within
the next three years.

The agency asked accreditors to report names of any new
companies they accredit on an ongoing basis. Companies with current
accreditation will be grandfathered in until their next expiration
dates as long as CMS has approved a crosswalk between the
accrediting organization’s standards and the agency’s mandatory
supplier quality standards.

At a CMS Open Door forum on Dec. 20, an agency official said no
“drop-dead date” for accreditation has been determined, but
accreditors said based on the information they were given,
providers should begin the process immediately.

“Everybody has been telling providers for three years to get
ready … and now they have to face it,” said Cesar, noting that
CMS is “not talking about a grace period for anybody. It’s going to
be a really tough time for those companies within the 10 areas CMS
chooses.”

To view CMS’ supplier quality standards, visit www.cms.hhs.gov/CompetitiveAcqforDMEPOS/04_New_Quality_Standards.asp.

For a list of the 11 approved DMEPOS accrediting organizations,
visit www.cms.hhs.gov/CompetitiveAcqforDMEPOS.