Pass the Decoder Ring

You would think the accreditation requirements would be straightforward and easy to understand, but if the question-and-answer sessions during CMS’ teleconferences are any indication, it appears they are not.

In April, CMS held the second and third in its series of “Accreditation 101” educational teleconferences. These are meant to be instructional sessions offered to help Part B providers better understand the accreditation deadlines and requirements.

The content of the calls is the same each time. A CMS staff member reads portions of the statute and a script that, for those who are new to the process, can be very overwhelming. Then a Q&A segment begins. That’s when we learn the most about both the audience and the speakers.

In one of these sessions, the script was presented by a CMS staff member who introduced herself, but then did not introduce any of the other speakers. Once the questions began, CMS’ Sandra Bastinelli answered a question and identified herself to the caller, but at one point a male responded to several questions — and we never heard who he was!

Caller after caller continued to ask the most basic questions, such as “Does this include me?” and “Am I exempt?” and “What is competitive bidding?” Rather than answering many questions directly, the CMS panel referred callers to published articles and documents and stated they were not experts in competitive bidding — even though accreditation is a requirement for that program. Again, not very helpful to the “newbies” in the audience.

Perhaps the most alarming exchange, however, came at the end of the April 17 call when a pharmacy provider brought up the May 14 accreditation application deadline. CMS had reminded the audience that was the date by which providers who wanted to participate in round two of competitive bidding would need to apply with a CMS-approved accredit or.

This provider pointed out that CMS referred to the next 70 metropolitan statistical areas that have been identified for round two. In reality, competitive bidding areas can consist of multiple MS’s. The question was, how could a provider meet this deadline since CMS had not announced the zip codes that define the CBAs?

CMS’ Bastinelli — who had stated that the round two zip codes would be announced this month — told the caller everyone knew what the MS’s were, that waiting was no excuse and that he was not staying on the subject.

At that she terminated the call, even though the provider pointed out that knowing the zip codes was directly related to accreditation and the May 14 application deadline for round two bidders.

Reviewing this exchange is meant to be a learning experience, because we continue to learn so much from it.

The main thing we’re finding from CMS’ accreditation calls is that there are still many Part B DMEPOS providers who don’t understand what’s happening. We also realize there are still dozens of issues to be resolved, even the most basic.

Whether CMS wants to address problems in a public forum or not, we need to continue to participate in these opportunities to get clarification. We need to push until CMS understands that when information is incomplete, CMS must fix the problem(s) before we can move forward.

We need to hop on the phone, fax and email and contact our legislators to point out these critical flaws over and over again. When the CMS staff tells members of Congress that everything is running smoothly and that things are on track, our elected officials are unaware of the logistical problems and incomplete information that those in this industry deal with on a daily basis.

Unless we point this out every time it occurs, we have no one to blame but ourselves if we let this kind of exchange occur without the proper follow-through on our part.

At this point, it seems, we need to get out the dictionary, pass the decoder ring and circulate the super-secret password to all so that everyone will know how to participate and follow the rules … that is, once we figure them out!

Mary Ellen Conway, RN, BSN, is president of Capital Health care Group, LLC, Bethesda, Mad., which provides health care management expertise in accreditation preparation and survey follow-up, operations assistance, design of quality improvement programs and outcome measures. She can be contacted by phone at 301/896-0193 or through www.capitalhealthcaregroup.com.