Using DMEPOS Accreditation Strategically

Don't look at DMEPOS accreditation simply as a requirement. Rather, consider how you can leverage its value both in your internal procedures and in your healthcare marketplace.

If a DME pharmacy wants to bill Medicare for DME items beyond the pharmacy exemption’s limit, then obtaining DMEPOS accreditation is an absolute necessity, quite simply because the claims you submit won’t be processed without it. But if anything, obtaining accreditation is a strategic asset because it puts into place policies and procedures that ensure the DME pharmacy 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 such an incredibly important consideration 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 DMEPOS suppliers 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 pharmacies with the kind of information they can use to improve their businesses. Implementing satisfaction surveys will help a DME pharmacy 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 DME pharmacies are ensuring patient satisfaction, and using well-documented surveys as a means to do that.

CMS does not outline how AOs should instruct DMEPOS suppliers 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 supplies; that the equipment was ready for the patient to use and that the patient was given proper instruction on how to use it; that the patient has all the necessary contact information for reaching the DME pharmacy in case something goes wrong or because they might have a question; that the pharmacy 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 DME suppliers collect the right documentation so that they reduce their audit exposure and increase their ability to quickly follow up on audit contractor documentation requests. Starting with ensuring the correct documentation for claims, accreditation helps the DME pharmacy keep accurate and comprehensive documentation at order intake and all the way through to prove that the equipment was delivered, along with the model, serial and manufacturer numbers of the item delivered. Also, accreditation will help DME pharmacies 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, DME pharmacies can 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 can help, since the process clearly outlines what pharmacies need to be doing in every aspect of their DME business. From there, they can start to map those policies and procedures to their workflows, while simultaneously working to streamline those processes where possible. Moreover, accrediting organizations are cognizant of the fact that DMEPOS suppliers face difficult funding circumstances and keep those business constraints in mind.

DIFFERENTIATION

When a pharmacy obtains DMEPOS accreditation, it is telling all of its referral partners that it 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 partners serving patients with private payor insurance, and, of course, the patients themselves.

This article originally appeared in the DME Pharmacy December 2021 issue of HME Business.

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