Problem Solvers

Accreditation's Renewal Season

The time is approaching fast when HME providers need to renew their Medicare accreditation.

Spring is here, and so is Medicare accreditation renewal season. Over the next several months, the industry will see an increased number of providers starting to work on renewing their accreditation, which will be due in 2018 for many of them. So now is the time to launch the accreditation renewal process.

Why? Because accreditation renewal takes work, especially if you are adding new practices or acquiring other provider businesses. Moreover, there are only so many accrediting organizations serving the HME industry, which means it’s in an HME provider’s best interest to start working on the process sooner, rather than later.

“Next year, 2018, is going to be the next cycle, and we’ll double the amount of renewals that we will do this year,” says Sandra Canally, RN, president of deemed Medicare accrediting organization The Compliance Team. “When the last deadline came we had to pull some companies forward some backward in order to try to spread it out to make it a little easier.

“Even with that said, we’ve got more this year than last round,” she adds. “You’ll find that across the board with all the accreditors. If you look at their accreditation dates on their list of companies accredited you’ll see the bulk were in 2015, so that obviously means 2018 is going to be the biggest.

So, if providers are going to be visited by their accreditor during the second part of this year and into 2018, they want to start reviewing their policies, and making sure that the processes that they have in place match their policies. In many cases, providers will be in compliance with their AO’s standards, but their policy might not match what they are doing in terms of process simply due to oversight and other factors. “Renewal season” is an excellent opportunity to revisit that common mistake.

“Everybody should be reviewing their policies on an annual basis just to see if anything needs to be changed,” Canally note. “Especially if they’ve had new staff come on board older staff that’s been with them a long time maybe retire or whatever, they want to make sure that they are matching what they say they do.

“That goes hand in hand with product, because certainly with competitive bidding some folks have been more creative; they’ve chosen products that were not subject to bidding,” she continues. “Then they have to make sure that; their policies, their training, their staff were credential appropriately and this is a good time looking forward to that renewal with their accreditor to revisit. Making sure okay in their business plan are they planning on adding any new product category, so that when the accreditor comes they can be approved for those products because they’ve put those new things in place.”

And of course this goes double for when a provider has added a new category or practice, or if it acquired another business.

“They need to be show proof of accreditation for those product categories,” Canally says. “Remember sometimes people get it mixed up as to okay that they can still say it’s a non-bid item. They can still bill for items that maybe we didn’t accredit them for and they are thinking, ‘Oh wow I just got an order from Dr. Jones; I’ve been after him for a while for referrals. It finally came in the door and of course we said yes. We made sure we got the equipment, we filled the order.’ Then they go to bill it and it’s like oops it gets denied, because it’s not listed on the report that goes to CMS and the NSC showing the product that they are accredited for. It’s still is very much tied to billing capability.

So there are a lot of reasons for why providers need to get out in front of accreditation renewal Got it, and what about as far as the actual process of accreditation or accreditation renewal. Has any of that process changed?

“Nothing has changed from a CMS perspective outside of reporting code from the AO on the product category sheet,” Canally says. “They’ve summarized some things there, but in terms of the actual quality standards that all the AOs need to adhere to nothing has really changed. We continue but that doesn’t mean I mean obviously it’s still very relatable to the industry. Even if the industry has changed somewhat it’s still very much a good review of the processes and practices that they need to have in place with meeting those quality standards.

“The other thing I’d like to point out is a lot of folks think that okay they are dropping Medicare, they are getting out of the Medicare program that they no longer need the accreditation because they associate it with Medicare,” she says. “Actually that’s not true because most of the state Medicaid, most of the private insurers if you are in fact doing DME and we’ll just leave it to DME at this point they look for accreditation too. Often times what we have is the Blue Cross or an Aetna or one of the big guys, the big payers contact us ensuring that okay not only are they accredited and they want to know the dates and expiration but also relating to the product. Even the private insurers have more or less adapted that way of looking at the provider from a product category perspective.”

Approach Renewal as a Team

Because most providers want to be ensure their accreditation renewal goes as smoothly as possible, they should consider a team approach. Many providers might recall the significant amount time required in order to obtain their original accreditation. Fortunately renewing accreditation for existing lines is much simpler, quicker process, and they can apply their experience to ease the process in getting accreditation for new business lines.

And that’s important because in today’s environment, where providers are seeking to diversify revenues beyond Medicare, the policies and procedures that they put in place to adhere to accreditation become a true business advantage. They can use these standards to drive the kind of excellence that will make them attractive to new types of customers and referral partners. Let’s examine some key things you’ll want to do to ensure the renewal process goes smoothly:

The overarching principle in renewing accreditation is that it should be a company-wide undertaking. All members of the team must be involved in the process and take ownership in ensuring its success. Because the accreditation process is time-consuming and incorporates detailed work, everyone must be involved. Appoint a project manager and department leaders who can then work with team members to the task of implementing the standards throughout the organization. But before diving in, make certain the organization understands the imperative to pass renewal. For employees that have been around the process before, tell them about any changes. For new employees, review how the process will work; explain how it might be different from before; and specify how the process will impact each department and what will be required of team members in those departments.

As you renew your accreditation, you will need to have a mast plan in place. Chances are you might have done this in earlier instances of getting accredited, but your entire business should operate under an overarching outline of all the accreditation standards. These standards should apply to single process carried out by any department at any time. Having this master accreditation provides you with an easy way to review and ensure compliance at any time. Many accrediting organizations offer lists that can help you create one that can be tailored to your business, but it can serve as a good guide to create this business-wide outline. As you approach renewal, review your master plan and ensure that is covers all aspects of your business, old and new.

For any new employees who have not experienced accreditation, or if you are adding new lines of business that will require additional accreditation, or if your accreditation organization has expanded its standards for your existing accreditation, your team will need to be ready. They must be trained in new policies and procedures being put in place. This could even entail the addition of new credentials on your staff, so you will need to ensure your staff has the necessary certifications and licensure, and that those credentials are up to date and have sufficient CEUs. Moreover, if you are expanding geographically, then the staff at new locations will need to accredited, and that could entail unique requirements for those employees. For instance, different states have different requirements regarding required certification or licensure for providing different types of care of service.

CMS’s ramping up of claims audits, as well as pressures such as the face-to-face requirement mean that providers need to have their documentation ducks in a row. And, accrediting organizations will be monitoring this with a careful eye in order to ensure your business is safe from the threat of pre- and post-payment audits. The risk is simply too serious and the right documentation procedures must be in place. So, as a special part of your accreditation renewal, you must highlight the fact that all departments need to adhere to their required documentation procedures through the entire claims and care process — from having the right documentation from physicians on claims to patient signatures on delivery tickets.

Perhaps the culmination of the accreditation renewal process is the site survey. Like a pop quiz, you might not know when it is going to happen, but you can at least be prepared. If the accreditation standards outlined by your accrediting organization are indeed part of you business’s regular operating procedure and are second nature to every employee, then you should feel confident you’ll pass with flying colors.

This article originally appeared in the April 2017 issue of HME Business.


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