2018 HME Business Handbook: Accreditation
How To Use Accreditation To Sharpen Your Competitive Edge
Accreditation represents much more than an obligatory paperwork requirement that comes up for renewal every three years.
For many providers, 2018 marks the year when they must renew their Medicare accreditation, but they shouldn’t look at it as a chore. Instead, it’s an opportunity to use the process as a means to sharpen their business strategies.
The last time a large bulk of providers were accredited was in 2015, so given accreditation’s three-year renewal cycle, 2018 has been a big year for renewals. Fortunately, there have been no significant policy changes that have radically changed accreditation. The quality standards to which providers must adhere haven’t changed.
In fundamental terms, Medicare accreditation has a singular purpose: it means an HME can bill DMEPOS claims. However, it goes beyond that. Accreditation represents much more than an obligatory paperwork requirement that comes up for renewal every three years. That’s the wrong way to approach the process. Obtaining accreditation demonstrates that a provider is following all the right procedures in terms of claims documentation, equipment handling, ensuring satisfaction, and doing the sorts of things that will help optimize patient outcomes.
That’s no small accomplishment, and 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.
THE GOLD STANDARD
Medicare accreditation is essential, not just from the standpoint of being able to bill DMEPOS claims, but because of what it means for other payers. While Medicare accreditation means an HME can bill DMEPOS claims, other payers use it as a gold standard. Even if a provider isn’t billing many Medicare claims, it still needs to maintain that accreditation to ensure it will pass muster with private payers and health plans.
Many plans beyond Medicare, such as Blue Crosses, managed care, Aetnas, Cignas, and other large payers and plans will not only contact the accreditor to verify the dates of accreditation for a particular HME provider business, but those payers will investigate the product lines for which that provider has been accredited.
When a provider obtains Medicare accreditation it is telling all of their referral partners that the provider meets or exceeds all the policy and procedure requirements that Medicare expects from a DMEPOS supplier. Medicare is confirming that the provider will serve its 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 considerable market differentiator to not only referral partners serving Medicare beneficiaries, but also referral partners with private payer insurance funding, as well as the patients themselves. Savvy providers will communicate this to their patients and referral partners to distinguish their businesses as a respected and knowledgeable provider that can be relied on to provide dependable and expert service. When communicated correctly, this message will resonate with clients and referral sources and instill a sense of confidence that they are working with the best in the business.
Medicare also helps your business ensure patient satisfaction, which is critical in establishing yourself as a trusted care partner. Medicare accreditation requires a provider to document patient satisfaction, which makes good business sense because it can give providers the kind of information they can use to improve their businesses. Implementing satisfaction surveys helps a provider business find out whether or not it is meeting the needs of its patient clients, and to pinpoint problems that to be fixed within the business so that mistakes are not repeated. Ultimately this feedback links back to care quality.
CMS looks to accrediting organizations to ensure that providers are using well-documented surveys as a means to assure patient satisfaction. That said, CMS does not outline how accrediting organizations should instruct their providers on surveying their patients. Your AO should provide guidelines that track patient satisfaction for a variety of criteria, such as timely equipment delivery; that the equipment was ready to use; proper patient instruction on equipment use; the patient has all the necessary contact information for reaching the provider; the provider is answering questions and helping patients after delivery; and that the patient is satisfied overall.
Ask any provider owner-operator to list his or her top business concern, and Medicare claims audits will make the top three. This is another area where Medicare accreditation can help. Essentially, the policies and procedures outlined in the standards ensure that providers collect the right claims documentation.
This reduces their audit exposure, and increase their ability to quickly follow up on audit contractor documentation requests. Starting by ensuring the correct documentation for claims, accreditation helps show the provider follows the latest LCDs and keeps 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.
Today’s HME businesses find themselves in the difficult position of having to balance care against cost. CMS continues to cut DMEPOS reimbursement, which means that providers must ensure they are living up to the requirements expected of them, but they must simultaneously reduce operational costs as much as possible in order to ensure that they can still run a profitable business. That’s not an easy balance to strike.
Fortunately, accreditation can help them in this regard. The accreditation process clearly outlines what providers need to be doing in every aspect of their business. From there, providers can start to map those policies and procedures to their workflows. This creates a baseline from which providers can begin to streamline those processes and find efficiencies where possible. In essence, it is a kind of plumb line from which providers can lay the foundation for their operational cost structure.
POINTS TO REMEMBER:
- Accreditation goes beyond a simple Medicare obligation; it’s a strategic asset for HME businesses.
- It’s a seal of approval, and all sorts of payers beyond Medicare look for a provider to be accredited.
- Accreditation raises your business’s reputation with referral partners, as well.
- It also helps your business ensure patient satisfaction, which is critical in establishing it as business as a trusted care partner.
- Accreditation also has operational benefits, such as improved efficiencies and cost models, and audit mitigation.
- It also helps your business ensure patient satisfaction, which is critical in establishing it as a trusted care partner.
Check out our the HME Business Accreditation Solutions Center at hme-business.com/microsites/accreditation to learn more about getting the most from your Medicare accreditation.
This article originally appeared in the June 2018 issue of HME Business.