2016 HME Handbook

How to Use Accreditation to Sharpen Your HME Business Strategy

Many providers see DMEPOS accreditation as an obligation, but the process has considerable strategic value.

Accreditation StrategyIf you want to bill Medicare for home medical equipment, then obtaining DMEPOS accreditation is an absolute necessity, quite simply because the claims you submit won’t be processed without it. The problem with that is that for many providers, they see accreditation as an obligation, something that gets put on a checklist and ticked off every three years or so when their accreditation comes up for renewal.

But that’s the wrong way to approach accreditation. If anything, obtaining accreditation is a strategic asset because it puts into place policies and procedure that ensure the provider is doing everything it needs to do in order to ensure it is dotting its “I”s and crossing its “T”s when it comes to working with referral sources and providing service to Medicare beneficiaries.

And that’s especially important these days, when documentation is becoming such an incredibly important considering when working with physicians and other healthcare entities. You want to ensure that you are obtaining all the required documentation so that you have a clean claim and that you will be able to quickly and comprehensively respond in the case of an audit, and your referrals want to ensure that the claim will go through without a hitch.

But documentation is only one element of why accreditation offers considerable strategic value. It also demonstrates that you are following all the right procedures in terms of equipment handling, ensuring satisfaction, and doing the sorts of things that will help optimize patient outcomes. Let’s examine some key aspects of accreditation’s strategic value:

Patient Satisfaction. A key element of maintaining Medicare accreditation is to document patient satisfaction. In fact, if providers neglect to track satisfaction, it can cost them points on their accreditation score. And while there might be a requirement to do so, documenting patient satisfaction, simply makes good business sense, because it can provide them with the kind of information they can use to improve their businesses. Implementing satisfaction surveys will help a provider business find out if it is meeting the needs of its patient clients, and if not it can use that data to determine what needs to be fixed within the business so that mistakes are not repeated.

That’s important because ultimately the feedback is related to care quality. For instance, an improperly set-up wheelchair or an oxygen patient not understanding how to use his or her equipment can negatively impact that patient’s care. That’s why CMS looks to accrediting organizations to ensure that providers are ensuring patient satisfaction, and using well-documented surveys as a means to do that.

CMS does not outline how AOs should instruct their providers on surveying their patients, So your AO will likely provide guidelines that track patient satisfaction for a variety of criteria related to the provisioning of DME. Those factors can include timely delivery of equipment and supplies; that the equipment was ready for the patient to use and that the patient was provider proper instruction on how to use it; that the patient has all the necessary contact information for reaching the provider in case something goes wrong or because they might have a question; that the provider is answering questions and helping patients after the DME has been provisioned; and that the patient is satisfied.

Audits. When it comes to implementing solid documentation policies and procedures, Medicare accreditation can help considerably in making sure that providers collect the right documentation, so that they reduce their audit exposure, and increase their ability to quickly follow up on audit contractor documentation requests. Beginning at ensuring the correct documentation for claims, accreditation helps ensure the provider keeps accurate and comprehensive documentation at order intake and all the way through to proof that the equipment was delivered, along with the model, serial and manufacturer numbers of the item delivered. Also accreditation will help providers follow the local coverage determination for the items billed, which can mean additional documentation requirements, such as a face-to-face visit, depending on what DME is billed.

Efficiency. At a time when policies such as competitive bidding are radically reducing Medicare reimbursement, providers find themselves at a painful crossroads: they must ensure that they are living up to the requirements expected of them, but they must also reduce operational costs as much as possible in order to ensure that they can still run a profitable business. This is where accreditation helps, because the process clearly outlines what providers need to be doing in every aspect of their business. From there, providers can start to map those policies and procedures to their workflows, while at the same time, working to streamline those processes where possible. Moreover, accrediting organizations are cognizant of the fact that providers are facing difficult funding circumstances and their services keep providers business constraints in mind.

Business differentiation. When a provider obtains Medicare accreditation it is telling all of their referral partners that the provider meets or exceeds all the policy and procedure requirements that Medicare expects from a DMEPOS supplier in order to serve Medicare beneficiaries with the kind of care, consideration and product expertise that will help ensure that patient derives the expected benefits from their equipment. That is a huge business differentiator to not only referral partners serving Medicare beneficiaries, but also referral partners with private payor insurance funding, and the patients themselves.

Savvy providers will realize that they have received a “stamp of approval” that they should be communicating to their patients and partners in order to distinguish their businesses as a respected and knowledgeable provider that can be relied on to provide dependable and expert service. When communicated correctly, this message will resonate with clients and referral sources and instill a sense of confidence that they are working with the best in the business. True, obtaining accreditation is a necessity in the Medicare world, but it’s an investment in the business overall, so don’t be afraid to flaunt such an important accomplishment.

Points to Remember

  • Accreditation is required by Medicare in order to accept DMEPOS claims, so HME providers need to obtain it if they wish to bill Medicare.
  • However, while accreditation is a requirement, it also represents a strategic business edge.
  • Accreditation requires providers to survey and ensure patient satisfaction which will help cement long-term relationships.
  • Accreditation requires providers have the right documentation procedures, which consequently reduces their audit exposure.
  • Accreditation helps providers strike a good balance between care and cost efficiency.
  • Smart providers will communicate these advantages to not only Medicare referrals and patients, but their private payor counterparts, as well.

Learn more:

This article originally appeared in the June 2016 issue of HME Business.

About the Author

David Kopf is the Publisher and Executive Editor of HME Business and DME Pharmacy magazines. Follow him on Twitter at @postacutenews.


Add your Comment

Your Name:(optional)
Your Email:(optional)
Your Location:(optional)
Please type the letters/numbers you see above.
HME Business Podcast