How to Get Accredited When Adding a New Line of Business
- By David Kopf
- Jul 01, 2010
Getting accredited for Medicare is an extremely important, but also lengthy process providers must endure if they want to continue filing claims. They must strive to ensure all the proper documentation and procedural steps are in place for the DME and services they offer, and then undergo site surveys — and possibly have to undergo them again if they are found to need in improvement in some aspects of their business before they can become accredited.
Then, the provider business must continue to work within its accreditation guidelines so that it will maintain its accreditation when it must renew its accreditation with its accrediting organization. (The schedule for this can depend on the accrediting organization.) Suffice it to say that accreditation is an ongoing process.
But what if a HME provider starts a new line of business, or acquires a new line of business after already being accredited? Does the provider need to apply for accreditation for that new business?
Look Before You Leap
To begin with, this is not an uncommon question accrediting organizations encounter. Providers are often adding new lines, and accrediting organizations have procedures in place to handle this. The key is to work up-front with the accrediting organization.
Essentially, when adding new product lines to its inventory, and when those items are billable to Medicare, the provider needs to inform their accrediting organization of that addition. Every accrediting organization has a product code checklist that outline which product categories and codes are covered by a provider’s current accreditation. The accrediting organization, in conjunction with the provider, will then determine if the new item(s) is covered by their current accreditation or if a new survey visit is in order.
This initial check is critical because if the provider isn’t accredited for that new line, it might not get reimbursed for the item. When submitting claims, there is a cross-referenced check to ensure that the provider is accredited for the items being billed. Accrediting organizations submit reports weekly to CMS, which includes all the product categories that a provider is accredited for, and if there is any discrepancy in billing, then there is risk of not getting paid.
So, before launching into a new business, each provider should be familiar with their accrediting organization’s process in managing the addition of products.
If adding a general DME item for which the provider is accredited, the item should fall within current processes: having a script, ensuring all the paperwork is in order, delivery is timely, presentation and education about the item is accurate and documented, and so on.
If adding items that are not within the scope of the provider’s current accreditation, then the provider will have to work with accrediting organization to become accredited for that line. Then the provider will have to work with the accrediting organization to put the proper standards, procedures and documentation in place and undergo a site survey to obtain accreditation.
In terms of cost, this depends on the accrediting organization. Some accrediting organizations will not charge to add a product line, but when adding standards and subsequently having a site visit survey, those general costs are incurred. Again, it comes down to up-front coordination and communication with the accrediting organization.
Purchasing Another Business
The question of whether or not a provider must get accredited when purchasing another provider business — even if that business was accredited for Medicare — is not as simple a situation as simply expanding into a new line.
In the very basic sense, accreditation stays with the location, just as a Medicare number does, but this rule doesn’t fit every situation. For instance buying a business and then integrating some of its assets into the company without maintaining the original location will almost definitely require reaccrediting, but if the provider were to buy a business and let it sit as is, then its Medicare accreditation might stand as is.
However, other factors come into place. For instance, if the purchasing provider wasn’t originally accredited for the products that the purchased HME offered, then again, the purchasing provider might need to obtain new accreditation. In the end, determining accreditation for a purchased business must be addressed on a casebycase business, so again, it is in the provider’s best interest to call it’s accrediting organization before diving in head-first.
Points to take away:
- Accreditation is an essential aspect of running a successful HME business — especially since CMS’s deadline for mandatory accreditation has long since past.
- That said, there are instances when a provider might need to revisit accreditation: two of these are when an HME adds a product line, or purchases a business.
- The best place to start is by contacting your accrediting organization as the issue of accrediting new lines is not uncommon.
- While the process of determining if a new line being added must get accredited is more straightforward, the issue of purchasing another HME almost needs to be judged on a case-by-case basis.
This article originally appeared in the July 2010 issue of HME Business.
David Kopf is the Publisher and Executive Editor of HME Business and DME Pharmacy magazines. Follow him on Twitter at @postacutenews.