BALTIMORE, Md.--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 accrediting organizations in on its expectations as competitive bidding rolls out in 10 MSAs 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 when the program expands to an additional 80 MSAs. Of the remaining cities on that 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.
According to Michael Reinemer, vice president of policy and communications for the American Association for Homecare, the agency has begun "talking to congressional delegations for those MSAs where people need to get accredited to help prepare them."
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 could take from four to six months to complete. And some sources said getting site surveys done could 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.
Providers in the next 80 bid areas chosen 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.
The agency asked accreditors to report names of any new companies they accredit on an ongoing basis. Companies with current accreditation will be grandfathered in until their next expiration dates as long as CMS has approved a crosswalk between the accrediting organization's standards and the agency's mandatory supplier quality standards.
At a CMS Open Door forum on Dec. 20, an agency official said no "drop-dead date" for accreditation has been determined, but accreditors said based on the information they were given, 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."
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.