ATLANTA--CMS' accreditation deadline for first-round bidders came and went last week--this time with no extension--and no rush to the finish.
After release of its supplier quality standards in August 2006, CMS named 11 approved accrediting organizations late last year to enforce them. A merger in January between two of the organizations left 10 accreditors ready to deal with what many had expected to be an accreditation rush in the initial competitive bidding areas.
But the rush never came to pass. CMS' Sandra Bastinelli, charged with running the accreditation program, announced at an Oct. 11 meeting of the Program Advisory and Oversight Committee that a total 2,200 provider locations across the 10 CBAs had been accredited. About 100 more applications were pending before the Oct. 31 deadline, she said.
Providers participating in the Medicare bidding program had to be accredited by that date in order to be considered for contracts.
"Many providers have really struggled these past few months with the accreditation deadline," said consultant Mary Ellen Conway of Capital Healthcare Group, Bethesda, Md. "Their CBA was announced in April, they had to select an [accreditation] provider, send for standards and frantically try to complete the process by July 1 to be ready for an unannounced survey by the [original] accreditation deadline of Aug. 31."
Although CMS extended that deadline until Oct. 31, the extension "did little to change that original timeframe," Conway said.
"Many providers were unprepared for their first survey, whether it was completed in July or August, and while the deadline extension through the end of October gave them some breathing room to complete their requirements, that is still only six months in total," she said. "Accreditation preparation generally takes organizations four to six months before providers ... are ready for their unannounced survey, which then occurs over the next 60 to 90 days. This tight timeline was very difficult, and there are providers who did not complete their requirements in time."
Some providers simply decided not to become accredited, noting the expense put toward a business that might not be selected for one of Medicare's three-year contracts--and that might not survive. Indeed, CMS has said it expects there will be 50 percent fewer DMEPOS providers doing business with Medicare than currently exist after implementation of the bidding program.
"Why cough up the money if you know you're going to be killed off in the fight?" one oxygen provider told HomeCare Monday earlier this year, comparing competitive bidding to a "kamikaze flight."
"Who cares if you have a hole in your underwear [if] you're about to fly your plane into the ground? If I gain nothing from this other than more piles of paperwork, why would I spend the money?"
But Conway pointed out that even though CMS has yet to announce a deadline by which all providers must be accredited, HME companies--particularly those who will bid in the second round--should be prepared.
"We already know a few of the next 70 MSAs, and we learned in this round that a CBA can be a combination of several MSAs," Conway said. "New York, Chicago and Los Angeles were intentionally deferred from the first round, so we know that providers in those cities are at the top of the list. Others that were on the list of the 'Top 25' last year were Houston, Tampa, Washington, D.C., San Antonio, Virginia Beach, Atlanta, St. Louis, San Francisco, Detroit, Baltimore, Philadelphia and Boston. There is no reason why providers in these MSAs should not be underway right now.
"Don't wait for a deadline to be imposed," Conway advised providers. "Accreditation can be impossible to accomplish with very few deficiencies when you are rushing, and you will guarantee yourself an unannounced revisit if you are not prepared."
At the recent PAOC meeting, CMS' Bastinelli said a revised version of the quality standards, intended to clarify those released last year, has been sent to the approved accreditors for review. When the revised standards are ready for publication, she said, they will be posted on the CMS Web site and open for public comment.