Ongoing Accrediting, Bond Issues Frustrate Providers

ATLANTA — Days after the CMS Sept. 30 deadline for mandatory DMEPOS accreditation, HME providers were still in an uproar, seeking an explanation as to why some pharmacies apparently did not have to undergo onsite surveys to become accredited.

Many providers are reportedly also agitated about whether or not Medicare has correctly recorded their surety bond status; CMS required all DMEPOS providers to have surety bonds for each location by Oct. 2 or forfeit their right to bill Medicare. But it is the apparent waiver of site surveys for one accreditor’s clients that has providers most riled up.

“I have been deluged with companies calling me to complain how angry they are that anyone was allowed to go through a paper process,” said Mary Ellen Conway, president of Capital Healthcare Group in Bethesda, Md. “People are furious. Dozens and dozens of companies have called me to say their peers did not have to have onsite surveys [to win accreditation].”

Accrediting standards require unannounced, onsite visits before accreditation can be granted; however, providers, consultants and some accrediting bodies themselves have been outraged over rumors that one accreditor has allegedly been accrediting providers without doing the surveys, thus short-circuiting the process for its clients.

Glen M. Stocking, R.Ph., vice president of pharmacies for Rosauer’s in Spokane, Wash., said he was surprised to learn of at least one pharmacy that was accredited without the onsite survey. Stocking, whose 15 pharmacies were accredited — after site visits — in April by the Healthcare Quality Association on Accreditation, said he talked to a fellow pharmacist at a recent community event.

“He said he was thrilled to have his accreditation, and I said, ‘Did you have a nice surveyor?’ He said, ‘We haven’t had our survey yet. They were so backed up they didn’t do it,’” Stocking recounted, adding that the pharmacist told him the accrediting body would do the site visit later.

CMS, which did not return phone calls on Friday, has denied any knowledge that a waiver of onsite surveys was given to any accrediting body, but still the frustration has persisted. It has been fueled at least in part by the fact that numbers of providers — some of whom started the process in January — were unable to secure accreditation because their accrediting organizations could not get to their required onsite surveys in time.

That resulted in a deluge of calls to the National Supplier Clearinghouse prior to the Sept. 30 deadline as providers sought to withdraw their Medicare billing numbers voluntarily. Under CMS rules, unaccredited providers that did not voluntarily terminate their Medicare enrollment before the deadline risked termination by the NSC and a one-year reenrollment bar. Those who voluntarily withdrew their numbers can apply for reenrollment once they are accredited, the agency has said.

CMS has not yet released any information on how many providers have been accredited, how many voluntarily withdrew or how many have been dropped by the Medicare program. As of late August, nearly 30,000 providers remained unaccredited, according to the NSC.

However, at least one accrediting body, the Accreditation Commission for Health Care, said it was able to process all DMEPOS surveys for providers who had applied by CMS’ advised soft application deadline.

“[ACHC] has completed all accreditation surveys for DMEPOS providers who applied with ACHC before Jan. 31, 2009, as well as several providers who applied after the January deadline,” according to a press release. “The surveys were completed before the CMS mandatory accreditation deadline of Sept. 30, 2009.”

Extension for Pharmacies?

Apparently, not all providers who remained unaccredited by the deadline have been barred from billing Medicare. Kevin Schweers, vice president, public affairs, for the National Community Pharmacists Association, said his organization has been working with Medicare to aid unaccredited pharmacists as it awaits further congressional action on whether or not to extend the deadline for pharmacies.

On Wednesday in a unanimous voice vote, the House of Representatives passed a bill that extended the accreditation deadline for pharmacies to Dec. 31, 2009. The bill was introduced on Tuesday by Reps. Zack Spence, D-Ohio, and Lee Terry, R-Neb.; as of Friday, a companion Senate bill was still waiting for action.

“The Senate has not approved the delay yet, but we are still hopeful that they will early next week,” Schweers said on Friday. “Until then, we’re providing our members with technical advice and guidance, based on our conversations with Medicare officials, in order to help as many of them as possible to continue supplying durable medical equipment to their patients.”

When asked for clarification, Schweers said that in some cases, pharmacists could continue billing Medicare. “It depends on the pharmacy, their present standing with Medicare and where they are in the paperwork process,” he said. “So our technical experts are working with our members on their specific cases.”

Pharmacists are hoping for the extension in order to give legislators time to consider two bills that would exempt small pharmacies that provide diabetic testing strips from the accreditation requirement. The House is already mulling H.R. 3200 (its health care reform bill), and on Thursday, Sen. Byron Dorgan, D-N.D., introduced a similar bill, S. 1746.

Regarding the extension, commented Conway, “It’s unfortunate it is only for pharmacies but not for all DME [providers]. And we are going to have to figure out how this is interpreted? How do they define a small pharmacy? We need a lot more information. There needs to be more clarification about who this applies to because it doesn’t apply to everybody.”

Surety Bond Hitch

Even as the accreditation questions continued, HME providers were also grappling with the surety bond issue. As of Oct. 2, they were required to hold a $50,000 surety bond per location in order to continue billing Medicare.

However, some industry stakeholders feared that an overlooked requirement could cause even some providers who had obtained surety bonds to lose their billing privileges.

“Many DME providers will lose their billing privileges … not because they failed to get their mandatory $50,000 surety bond, but because they never sent the required portions of the Medicare application along with it,” said Rob Brant, president of the Accredited Medical Equipment Providers of America, in the organization’s newsletter last week.

Brant said providers were required to send sections of the CMS 855-S application along with the surety bond to the NSC. However, some simply sent a cover letter with their bonds.

Providers had been encouraged by consultants and others to check with the NSC to ensure their Medicare status had been updated, but Brant noted that “for the past two weeks, providers with surety bonds in hand have been unable to break through the busy signals at the NSC.

“I expect a lot of appeals will be submitted to the NSC regarding this issue,” he said.

For a full report on an investigation of DMEPOS accreditation by the Center for Regulatory Effectiveness, see Accreditation Deadline Brings Action, Anxiety, Oct. 1.