Docs Send ‘Hugs and Kisses’ for Accreditation Exemption

BALTIMORE–“Hugs and kisses.” That is what a
number of physicians and others sent CMS last week during a Sept. 3
Special Open Door Forum on exemptions to the accreditation
requirement for DMEPOS providers.

“Consider yourself hugged and kissed,” one doctor
told the agency’s Sandra Bastinelli, as he celebrated the
announcement that he would no longer be required to become
accredited. The phrase quickly became the impromptu theme of the
call.

Bastinelli, division director of medical review and education in
CMS’ Program Integrity Group, explained that physicians and certain
other health care professionals are exempt from accreditation under
the Medicare Improvements for Patients and Providers Act, the law
that delays competitive bidding. The exemptions include physical
and occupational therapists, qualified speech-language pathologists
and practitioners, physician assistants, certified registered nurse
anesthetists and clinical social workers, among others.

“[MIPPA] states that eligible professionals and other
persons are exempt from meeting the Sept. 30, 2009, accreditation
deadline unless CMS determines that the quality standards are
specifically designed to apply to such professionals and other
persons,” Bastinelli said. She added that “CMS will
work in collaboration with the medical and professional groups to
develop any specific quality standards in the future.”

In July, the American Medical Association and other medical
organizations wrote HHS Secretary Michael Leavitt asking for an
official exemption. The AMA pointed out that, in spite of the new
law’s provision, CMS continued to apply the accreditation
requirement to some physicians who supply DMEPOS to their
patients.

Orthotists and prosthetists are also exempt, Bastinelli said, at
least for now. She noted CMS plans to publish a notice of proposed
rulemaking in 2009 that will address quality standards for orthotic
and prosthetic providers. “In 2009, CMS will be issuing
further qualifications or standards for orthotic and prosthetic
suppliers that these suppliers will need to meet in order to bill
for those supplies,” she said.

Bastinelli did not reveal what the NPRM would include, but said
CMS would work with those professional groups regarding their
services. “You will have the opportunity to comment on the
proposed rule,” Bastinelli said, urging one caller to submit
comments on who is qualified to fit a brace once the NPRM is
published.

While many teleconference callers said the exemptions were great
news, Bastinelli reminded others–including home medical equipment
providers–of CMS’ mandatory accreditation deadline Sept. 30,
2009.

One caller asked if her home health agency was exempt.
Bastinelli drove home the point: “If you tried to go into
business as a DMEPOS supplier, separate and distinct from your home
health agency, yes, you would need to be accredited, and no, you
would not be exempt.”

Bastinelli also reminded listeners that as of March 1, 2008, new
HME providers must be accredited before submitting their enrollment
applications to the National Supplier Clearinghouse.

She suggested that all providers who plan to apply for
accreditation should register by Jan. 31, 2009, in order to make
sure they get through the process by the Sept. 30 deadline.
Otherwise, even though accreditors might accept their applications
after that date, “there is no guarantee they will be
accredited in time,” she said.

One now-exempt caller, whose company had already submitted the
money to an accrediting body to begin the process, wondered how the
company would go about getting its money back. Responding to that
comment and others from exempt callers who had begun accreditation,
Bastinelli suggested they should discuss whether to continue the
process with their accreditor. “It’s up to you,” she
said.

Several callers who fall under the new exemptions stated they
had been denied NSC numbers because they were not accredited and
asked if they should reapply.

A CMS official responded, “Resubmit the enrollment
application. The NSC has been given written guidance on this so
there shouldn’t be a problem.”

And in response to a question about exemptions for health
clinics, CMS issued the following written statement: “DME is
not covered within the Medicare Federally Qualified Health Clinic
benefit. All FQHCs would need to have a DMEPOS supplier number in
order to bill for those separately, and go through the same process
as any other DME supplier. Thus, all FQHCs billing for the products
covered under the DME quality standards would be subject to the
accreditation deadline of Sept. 30, 2009, in order to continue to
bill for these supplies.”

Bastinelli said CMS would post a fact sheet and a list of
frequently asked questions on the exemptions by today at www.cms.hhs.gov/medicareprovidersupenroll.

A replay of the teleconference will be available Sept. 10 at
www.cms.hhs.gov/OpenDoorForums/05_ODF_SpecialODF.asp.