Providers are now largely
accustomed to obtaining
Medicare accreditation, whether
it’s through general or specialized
programs designed for specific product
categories. But it’s now becoming
clear that private payers are taking
accreditation just as seriously, making
the achievement even more important
to a provider’s overall market strategy.
The accreditation process
requires passing the inspection
of an accrediting organization,
which examines a provider’s
policies regarding equipment
handling, claims documentation
and patient satisfaction as well
as the implementation of those
procedures. Once a provider earns
accreditation, referral partners and
payers have outside confirmation
that the organization is laser-focused
on meeting industry standards and
improving patient outcomes.
Many private pay insurance
companies have come to expect
accreditation from providers, making
it imperative to obtain the recognition
even if the HME/DME business
does not frequently bill Medicare for
DMEPOS claims. Over the past few
years, private payers have gone a
step further and started to concern
themselves with the specific categories
that providers are accredited in,
whether that’s oxygen concentrators,
manual wheelchairs or another sector.
The increased scrutiny on
accreditation opens opportunities for
HMEs to stand out from the crowd.
PRIVATE PAYERS’ SHIFT
Over the course of the several
decades after the Medicare accreditation
requirement was introduced,
private payers largely went along
with the requirement but were not
as interested in zeroing in on what
HME providers were accredited for.
That element of the equation has
changed in recent years, as more
accrediting organizations have
introduced specialized programs
that allow providers to showcase
their expertise in specific product
categories, including respiratory
health, pharmacy, home infusion and
sleep therapy.
With the growth in popularity of
those programs, it’s no shock that
private payers have caught on and
will be more likely to reward providers
that have taken the time and energy
to specialize in the most important
areas of their business. This mindset
acknowledges that there are major
differences in setting up a home infusion
program and providing a patient
with a manual wheelchair.
The trend may take on increased
importance as insurance companies
look for providers that have infection
control and emergency policies
in place to handle a second or third
wave of the COVID-19 pandemic.
If an HME provider can show that
their personnel have been trained to
handle emergencies and can effectively
manage risks to both staff and
customers, that provider will have
a major leg up on the competition
regardless of product category.
What else are private payers
looking for that they may not have in
the past? Private insurers are particularly
concerned with quality improvement
plans and patient experience
policies. While these may come
off as buzzwords within the HME
industry, their impact is quite real.
Providers that highlight their working
quality improvement plans and show
they are continuously looking at areas
of their company to enhance will have
a much easier time convincing private
payers of their concern for compliance.
Plus, these providers will be better
prepared to handle whatever emergency
or unforeseen circumstances
come down the pipe – a characteristic
that will carry even more weight as the
healthcare system weathers the storm
of COVID-19.
CHOOSING THE RIGHT ACCREDITOR
To navigate the at-times rough
waters of accreditation, providers
must first seek out an accrediting
organization that fits their needs. For
a successful experience, providers
should not choose accreditors that
appear to give a quick stamp of
approval but instead find organizations
that will prepare the business
for the long haul.
Leaders should ask if the accreditor
offers additional educational
elements or has shown the willingness
to continuously update their
providers on changes in the medical
equipment landscape. Providers
should reach out to their networks
in the industry and ask about their
experiences with the accrediting
organizations, particularly if they
also work in similar product and care
categories.
From there, providers can decide
if pursuing specialized accreditation
makes sense for the long-term
growth and reputation of their
businesses. If so, they must choose
an accreditor that offers a program
in that sector and can guide them
through the compliance and inspection
process. The organization
should provide the all-inclusive cost
of the program so that providers
know how much time, money and
effort will be spent on the process.
It’s also important that providers
consider if the requirements of the
accreditor fit their business size, particularly
if their programs were designed
for larger companies. Quality standards
are the same for every business,
but a 10-location provider could be
burdened by the process if they are
treated like a 100-location provider.
THE SPECIALIZED ROUTE
Once a provider has committed
to the time and effort required to
obtain specialized accreditation,
they can start to reap the benefits
of that investment. In particular,
private payers have been impressed
by programs like The Compliance
Team’s Patient-Centered Respiratory
Home, a program designed to help
advanced respiratory care providers
perform at the top of their license
and better serve patients.
Advanced pharmacy accreditation
programs have also seen their value
grow, as providers show that the high
quality of their business could help
the payer’s bottom line. If a provider
can keep patients satisified, compliant
with their therapy regimens, and
prevent emergency room visits or
readmissions, insurers will no longer
have to pay for the patient to have
costly hospital care on a regular basis.
Rather than making these cost-savings
and patient satisfaction arguments
in a silo, accreditation brings
outside validation to the provider’s
claims when seeking contracts
with private payers, skilled nursing
facilities and ACOs. To get these
valuable contracts, providers have to
be willing to go the extra mile, and
specialized accreditation is increasingly
part of that calculation.
POINTS TO REMEMBER
- After years of largely accepting the accreditation
requirement, private payers have begun to
scrutinize what product categories providers
are accredited for when making decisions about
valuable contracts. - As the HME industry weathers the storm of the
COVID-19 pandemic, demonstrating compliance
and emergency preparedness policies to private
payers will become more crucial in standing out
in the marketplace. - Accrediting organizations have created
programs specifically targeted at proving expertise
in product categories such as oxygen, home
infusion, pharmacy and more. - Choosing an accreditor for specialized accreditation
or a robust general accreditation program
comes down to the best fit as well as the educational
content and industry updates that an
accreditor can provide.
LEARN MORE
To learn more about how to get the most of your
accreditation for Medicare and private payers,
check out the HME Business Accreditation
Solutions Center.