2015 HME Handbook
How to Approach Accreditation When Expanding Your Business
When a provider expands into a new product category it must satisfy a variety of requirements, including accreditation.
As competitive bidding and consolidation impact the industry, there are many cases in which a provider will expand into a new product category. With that category come a variety of requirements: the provider will need to add product expertise, perhaps even new certifications to the staff, and maybe even hire entirely new team members. Also the provider will need to add billing for those items to its workflow and other back office functions. And, above all, that provider will need to get accredited in this new line of business — otherwise the provider won’t be able to bill Medicare.
And, while getting accreditation for a new category is extremely important, it is also an extremely detailed process. Providers going through accreditation for a new category 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.
And of course, the provider must continue to work within the accreditation guidelines so that it will maintain that accreditation and be able to easily renew with its accrediting organization. Suffice it to say that accreditation is an ongoing effort, but when first gaining accreditation, the provider must do a considerable amount of preparation and groundwork to ensure it can properly support the new category. How should the provider approach getting accredited for a new category?
Notify Your Accrediting Organization
Accrediting organizations regularly help providers prepare their businesses to properly support new categories, so your AO can serve as a solid resource. Your AO will have procedures in place to handle this, but the key is that you will want to work up-front with the accrediting organization.
So start by informing your accrediting organization that your are adding new products that are billable to Medicare to your product line-up. 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 will work with a provider to determine if the new products are covered by the provider’s current accreditation, or if a new survey visit is in order.
This initial check is critical because obviously if the provider isn’t accredited for that new line, it likely not get reimbursed for the item. When receiving claims, Medicare performs a cross-reference check to ensure that the provider submitting the claim is accredited for the items being billed.
And that list is regularly updated. 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.
Put the Right Policies and Procedures in Place
Obviously, if a provider is adding a DME item for which it provider is already accredited, not much work needs to be done. But if the provider is adding a new product category that falls outside the scope of the provider’s current accreditation, then the provider will have to work with accrediting organization to put into place all the policies and procedures required to ensure proper provisioning of those items.
The provider will have to work with the accrediting organization to put the proper standards, documentation and operations in place. It will have to ensure paperwork is in order, delivery is timely, patient set-up and education about the item is accurate, and that all the right resources are available.
Accreditation and Acquisitions
Mergers and acquisitions between providers are becoming increasingly common. The question of whether a provider should get accredited when purchasing another provider business — even if that business was accredited for Medicare — is not always simple.
In basic terms, accreditation stays with the location, just as a Medicare number does, but this rule doesn’t fit every situation. For instance if the provider were to buy a business and keep it at its existing location, then that Medicare accreditation would stand as is. However, if a provider buys a business and then integrates some of its assets into the company without maintaining the original location, then that will almost definitely require getting reaccredited in that category.
Ultimately, determining accreditation for a purchased business must be addressed on an individual basis, so again, the provider will want to work with its accrediting organization at the outset.
The cost of getting accrediting in new categories depends on the accrediting organization. Some accrediting organizations will charge to add a category, others won’t charge, but when adding standards and subsequently having a site visit survey, those general costs are incurred. Like at the outset of the process, the provider must communicate with the AO to ensure all the costs are understood.
Points to Take Away:
- There are many reasons why providers will add new categories.
- Adding new categories will likely mean getting new accreditation.
- Acquisitions can often require a provider to get new accreditation, but it depends on the circumstance of the acquisition.
- Providers should start by coordinating with their accrediting organization to find out what they need to do.
- Accrediting organizations have different cost models for adding new categories; make sure you understand what your AO will charge at the outset.
This article originally appeared in the June 2015 issue of HME Business.