Accreditation Rush: It’s Like Russian Roulette

Baltimore

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 newly “deemed” accrediting bodies in on its expectations as competitive bidding rolls out in 10 MSAs later 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. Then, the program will expand to another 80 metro areas.

Of the remaining cities on the previous 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.

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, built around the agency’s supplier quality standards, could take from four to six months to complete. Getting site surveys done could also 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.

Because of the short time frame, CMS has asked the accrediting bodies to give preference to providers in the competitive bidding areas that are chosen for 2007.

Providers in the next 80 bid areas 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.

Even that time frame could leave some providers in a jam, accreditors said.

According to a recent HomeCare magazine survey, the percentage of providers accredited in 2005 has jumped substantially, from 43 percent to 52 percent in 2006.

But past the first MSAs that are chosen for bidding, accreditors estimate that “thousands and thousands” of HMEs nationwide will need to go through the process.

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

At a CMS Open Door Forum on Dec. 20, an agency official said no “drop-dead date” for accreditation had been determined, but accreditors said based on the information they were given, unaccredited 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.”

For a list of the 11 “deemed” DMEPOS accrediting organizations approved by CMS, see page 8.