HME Business Handbook: Accreditation

How to Leverage Specialized Accreditation Services

Medicare accreditation has become such a gold standard for HME care that specialized programs have emerged. What are they and how do providers take advantage of them?

There’s been an evolving in attitude when it comes to Medicare accreditation. When the requirement was first announced, accreditation initially seemed like another CMS hoop through which providers had to jump, but providers quickly realized that line of thinking was off the mark. Accreditation, they quickly realized, represented a strategic advantage.

Obtaining accreditation demonstrates that a provider is following all the right policies and procedures in terms of claims documentation, equipment handling, ensuring satisfaction, and implementing practices that will help improve patient outcomes. Medicare accreditation tells referral partners a provider will serve their patients with the kind of expertise that ensures patients derive the expected benefits from their equipment.

Moreover, it compounds a provider’s reputation with referral partners and satisfaction from patients. HME providers are a partner in patient care and optimizing outcomes, and having an accrediting organization confirm that a provider meets Medicare’s standards in that regard gives that provider a competitive edge.

Ultimately, Medicare accreditation has morphed into a bit of a Gold Standard. Now even private payer insurers and health plans seek out HME providers that have Medicare accreditation. Bearing that in mind, accrediting organizations are working to increase Medicare accreditation’s market cachet.

SPECIALIZED ACCREDITATION

Accrediting organizations are starting to offer specialized accreditation designations to further help HME providers demonstrate to referral partners and patients that they are an expert in their community when it comes to medical equipment and that they possess deep product knowledge as it pertains to their care.

These specialized accreditation distinctions take the Medicare accreditation for a specific category and “turn it up to eleven.” The standards for these programs are robust and put providers through their paces, but once a specialized accreditation is achieved, the recipient can use it to say it is the best of the best. If accreditation is a Gold Standard, then specialized accreditation would be the Platinum Standard.

One such accrediting organization is The Compliance Team (TCT), which introduced a special accreditation program called Patient-Centered Medical Home into the pharmacy arena that helped pharmacists communicate to prescribers that they offered additional service levels and would help act as a nexus in their community for medication care management.

Based on the success of that program, TCT launched Patient-Centered Respiratory Home, a specialized accreditation program designed for respiratory providers. Patient-Centered Respiratory Home is the first accreditation program designed to help advanced respiratory care providers perform at the top of their license to better serve patients. The program operates at higher quality thresholds and uses concise measures to help providers holding the distinction prove that they function to a higher standard and can further differentiate the respiratory services and quality standards they offer to referral partners’ patients.

To complement specialized accreditation programs for HME businesses billing Medicare, there are also special certification programs for members of their team. Providers can work with accrediting organizations to find specialized certifications that further demonstrate their expertise to their local market.

For example, the Board of Certification/Accreditation offers a Certified Durable Medical Equipment (CDME) Specialist certification to help providers show their staff to communicate their proficiency in providing home medical equipment.

GETTING STARTED

The first place to start when considering specialized accreditation or staff certification is to contact your accrediting organization and start learning about what they have available. That said, also review what other accrediting organizations are offering to see if there isn’t something that might serve your business better.

Once you land a program that you think is right for your business, you want to take the right steps toward implementation. Given that accreditation is a time-consuming process that involves considerable detail work, HME Business has always suggested implementing a team approach. Form a team of key staffers who will approach accreditation renewal with the level of intensity your company probably did when first applying.

Once you’ve identified the right people, make sure that not only those staffers, but the entire business understands that the company will be renewing accreditation. Outline why your business is doing this; what any changes will be; review how the process will work; explain how it might be different from before; and specify how the process will impact each department.

ACCREDITATION IS AN IMPERATIVE

Remember, this discussion isn’t happening in a bubble — accreditation is still a requirement for participating in Medicare’s DMEPOS program and billing Medicare, and there are important deadlines looming when it comes to Medicare accreditation. Just recently, the Competitive Bidding Implementation Contractor (CBIC) urged providers that, as part of their preparations for Round 2021 of competitive bidding, they must get accreditation for each location on their bid from CMS-approved accrediting organization for the lead and non-lead items in a product category by the close of the bid window, which is open from July 16 to Sept. 18 (the registration window opens June 10).

Also, per CMS’s final ESRD/DMEPOS rule issued in November 2018, competitive bidding went dormant for a period lasting 18 to 24 months, which started back on Jan. 1. Per the Final Rule, any Medicare accredited DMEPOS provider can offer items for which they didn’t have a contract. For providers that were unable to successfully bid a contract for a competitive bidding area or a product category they might have previously served, this could represent a tremendous opportunity. That said, they might have let their Medicare accreditation for a particular category lapse and would need to get accredited again.

So, now is the time to not only review accreditation as they pertain to your market objectives, but to consider whether or not specialized accreditation programs or staff certifications might not be the best way to get on top of these market challenges and opportunities.

POINTS TO REMEMBER:

  • Accreditation has evolved into a strategic asset for HME businesses that raises your business’s reputation with referral partners, as well as patients.
  • To that end, accrediting organizations have created specialized accreditation programs and staff certifications to help providers further sharpen accreditation’s competitive edge.
  • To get started, you want to work with your accrediting organization to survey the programs it has available.
  • Then you want to form a company-wide team that can implement the specialized accreditation.
  • There are market forces making the need to consider specialized accreditation an imperative.

LEARN MORE:

Check out the HME Business Accreditation Solutions Center to learn more about getting the most from your Medicare accreditation.

This article originally appeared in the June 2019 issue of HME Business.

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