HME Handbook: Accreditation
How to Get Accredited During a Purchase or Expansion
Adding new service categories means meeting new accreditation requirements.
These days, as providers explore and expand into new service categories, and engage in mergers and acquisitions on a more frequent basis, they need to keep a watchful eye on their accreditation. New service categories mean new requirements, and providers must ensure they will pass muster in order to maintain their Medicare accreditation.
Getting accreditation for a new category is not only extremely important, it is also an extremely detailed process. Providers must strive to ensure all the proper documentation and procedural steps are in place for the HME services they offer, and then undergo a site survey — and possibly have to undergo it again if there are areas of their business, care and documentation procedures they must improve before their accrediting organization (AO) will approve them to bill Medicare for the new category.
Since Medicare first began requiring accreditation in 2009, providers have come to learn that Medicare accreditation is an ongoing effort. They know they must engage in a considerable amount of preparation in order to ensure they can properly support the new category, and that once those policies and procedures are in place, they will need to continue adhering to them. That said let’s take a look at some of the key considerations providers must address when adding accreditation to new categories:
Work with Your AO
Adding accreditation for a new line of business is something accrediting organizations regularly help providers with. Your AO will serve as a solid resource for helping you prepare your businesses to properly support a new HME category. The important thing is to make this your first priority; you want to front-load your AO’s involvement in your expansion.
Start by informing your accrediting organization that you are adding new products that are billable to Medicare to your product line-up. Every accrediting organization has a product code checklist that outlines which product categories and codes are covered by a provider’s current accreditation. The accrediting organization will work with a provider to determine if the new products are covered by the provider’s current accreditation, or if a new survey visit is in order.
Understand Accreditation and Acquisitions
For providers that are growing through acquisition, the question of whether it should get accredited when purchasing another provider business — even if that business was accredited for Medicare — is not always simple. But it’s an important one that providers must address given that mergers and acquisitions between providers are becoming increasingly common.
Essentially, accreditation stays with the location, just as the Medicare number does, but this rule doesn’t fit every situation. For instance, if a provider were to buy a business and keep it at its existing location, then that Medicare accreditation would stand as is. However, if a provider buys a business and then integrates some of its assets into the company without maintaining the original location, then that will almost definitely require getting reaccredited in that category.
Ultimately, determining accreditation for a purchased business must be addressed on an individual basis, so again, the provider will want to work with its accrediting organization at the outset. This initial check with the AO is critical because obviously if the provider isn’t accredited for that new line, it likely not get reimbursed for the item. When receiving claims, Medicare performs a cross-reference check with a list that is regularly updated via reports from the AOs to ensure that the providers submitting claims are accredited.
Delegate the Process
Accreditation is detailed work, and for management or ownership to take it on would paralyze the business from a strategic perspective. Instead, delegate and create an accreditation team. Select some meticulous, dedicated members of the team can take ownership in ensuring its success. 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.
Get the Proper Training or Certification
If you are bringing on new or additional accreditation, your staff will not only need to be trained in the new policies and procedures being put in place, but will likely need to take on new expertise related to the new category. Moreover, this will likely be a requirement of the new accreditation. This could even include new credentials. Ensure your staff has the necessary certifications and licensure, and that those credentials are up to date and have sufficient CEUs.
Prep for the Site Survey — Sooner, Rather Than Later
Since you know the site survey is coming, you need to start working on ensuring you have the all the policies and procedures in place well before the actual survey. Bearing that in mind, your team should ensure that the accreditation standards outlined by your accrediting organization are now your business’s standard operating procedure and second nature to every team member.
Moreover, while you might not know the exact date of your site survey, ensure you always have some pinch hitters in place. Try to arrange your staffing so that you always have some accreditation team leaders working. In fact, as a general rule of thumb, your business should always be functioning as though a site survey was just around the corner.
Points to Remember:
- Providers know all about the process of accreditation, but as experienced as they are, they must learn new policies and procedures when adding a new line or buying another provider.
- Purchases of other HMEs might or might not require adding new accreditation, and it’s important providers understand when it is needed.
- Assign a team and team leader to tackle the accreditation process.
- The new categories might require specific education or certification, and the accreditation process will reflect that.
- Set up your business so that it is always ready for a site survey.
For the latest news, articles, columns and features on accreditation, check out or accreditation solutions center.
This article originally appeared in the June 2017 issue of HME Business.