Accreditation Powwow Set for Today

BALTIMORE–CMS will meet today with its newly approved DMEPOS
accreditors to relay additional information about what the agency
expects from those organizations–and Medicare Part B
suppliers.

Shortly before Thanksgiving, CMS announced that 11 accrediting
bodies had been granted “deeming authority” to apply its new
quality standards, mandated by the Medicare Modernization Act for
providers who will participate in competitive bidding next year.
(See HomeCare Monday, Dec. 4.) However, no
further information about what the agency expects as far as
deadlines for accreditation, or about what the new standards mean
for providers that are already accredited, has been released.

The “biggest” questions he would like answers to, according to
Tom Cesar, president of the Accreditation Commission for Health
Care, are:

–When are the metropolitan statistical areas where bidding will
begin going to be announced?
–What about grandfathering? What are the rules for DME companies
that are already accredited?
–When will the new standards actually be applicable to providers?
What date?
–Is there a particular structure for provider networks with
guidelines or rules for accreditation and competitive bidding?

About these questions and others, said Cesar, “We have concerned
customers.”

Added Sandra Canally, president of The Compliance Team, “CMS
needs to communicate the identity of the first 10 MSAs to both the
accrediting bodies as well as the rest of the industry ASAP so that
we can all move forward with our individual contingency plans.
Without that information,” she continued, “it makes no sense for us
to ramp up our operations in areas that will not be affected by the
initial roll-out of the MMA competitive bidding process.”

In a CMS Open Door Forum last month, a CMS official said the
names of the 10 cities where bidding will begin won’t be released
until the final rule on competitive bidding is issued. While
insiders believe the rule could come down before Christmas, the
bidding locations are expected to follow at a later date.

But also at the Open Door session, the agency official noted
that providers who want to participate in the 2007 bid should be
accredited by early in the year. That’s troubling to accreditors,
who said they are hoping to get clarification today on when the
actual accreditation deadlines will be.

The previous rule of thumb for completing the accreditation
process through the industry’s established accreditors was
estimated at a year or more. However, both ACHC’s Cesar and Mary
Nicholas, executive director of Healthcare Quality Association on
Accreditation, said their new CMS-based programs would take
approximately six months to complete. Canally said providers may be
able to complete The Compliance Team’s program in four months.

That could still leave some providers in a jam with estimates of
thousands of HME companies/locations currently unaccredited.
According to HomeCare magazine, the percentage of
providers accredited in 2005 has jumped substantially, from 43
percent to 52 percent in 2006. But experts say the capacity may not
exist to get the remaining affected providers through the process
in time.

The advice to unaccredited providers from industry consultant
Mary Ellen Conway, president of Capital Healthcare Group, Bethesda,
Md.: “Just don’t wait.” Although CMS is behind in its timeline for
the competitive bidding ramp up, Conway said, some companies could
be left at the gate unless CMS grants a grace period for those who
are only part-way along in the process.

CMS has asked accreditors to give preference to providers in the
bidding areas that are chosen, and the agency also said it will
allow accreditors to consider previous accreditation, Medicare
certification and licensure that would indicate its quality
standards are being met.

But specifics about exactly how this will work are lacking,
Conway said. “What is CMS going to require to ensure that companies
who have previously gone through the process meet the new
standards?” she questioned. “Do they just want a questionnaire from
the individual provider or will it be something more formal? The
accreditors need to understand what this means on their end.”

And there are numerous additional details that must be
ascertained about the quality standards themselves.

Nicholas, for example, said she is looking for more information
on the Appendix B rehab standards. “One of the most frequently
asked questions we’ve received from providers is if their manual
wheelchair business falls under the section requiring the
technically trained staff. I would like to gain further
clarification on that issue.”

Plus, she continued, “HQAA needs to hear the expectations for
the numerous reporting processes that CMS requires. When do they
want reports of the accredited providers? Will it only matter when
the MSAs are identified, or can Medicare provider numbers/NPI
numbers be sent now?”

Nicholas said she is hoping today’s meeting will address her
questions and those of other accreditors. “Providers want to know
if they are going to receive reimbursement–that is really the
bottom line,” she said.

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.