This article is sponsored by The Compliance Team. In this Voices interview, HME Business sits down with Sandy Canally, Founder and CEO of The Compliance Team, to talk about how DMEPOS Retailer Certification for non-Medicare providers creates an environment of quality, trust and value for HME customers. She breaks down the key differences between DMEPOS retailers and suppliers, as well as DMEPOS accreditation versus retailer certification. She also outlines the benefits of accreditation and certification as it relates to Medicare billing in the home medical equipment space.
HME Business: Share a little bit of background about The Compliance Team for anyone who may not be familiar with your organization.
Sandra C. Canally: The Compliance Team is a CMS-approved, nationally recognized accreditation organization. When DMEPOS was required to obtain accreditation, we were one of the Medicare-approved agencies tasked with that mission. We’ve been in business for 30 years—currently celebrating that milestone—and just returned from a fantastic conference filled with celebration and training. Here’s to many more years ahead.
How has The Compliance Team evolved since you founded it 30 years ago?
First of all, I’m a nurse by training and have held various positions related to compliance, regulation, home health and DME. I was introduced to accreditation early on, and as I advanced in my career, it became clear that the accreditation process needed improvement. It was challenging, costly, and didn’t focus on what mattered most to patients—safety, honesty and caring. Overall, it didn’t offer a positive experience for providers, which often led to them approaching it reluctantly.
As I mentioned before, The Compliance Team is CMS-approved under the Medicare Modernization Act. We were actually one of four accreditors actively accrediting DMEPOS providers before this act even required it, all in the spirit of helping businesses improve. Our focus was on enhancing day-to-day practices and improving the customer experience so that clients could trust their providers more fully.
The accreditation deadline brought in thousands of providers at the last minute, then Competitive Bidding reshaped the landscape, leaving a core of strong business leaders committed to serving their communities through DMEPOS, pharmacy and other services. Compliance standards ensure that work is done the right way, and at The Compliance Team, we continue to diversify and adapt to market needs. When someone calls with a unique business model, asking if we can accredit it, the answer is typically yes, because I see myself as a social entrepreneur, committed to serving the greater good by improving the businesses that serve patients.
We’re sensitive to the unique niches that often go unaddressed by our competitors, and we pride ourselves on adapting swiftly to new regulations and changing demands. The pandemic, for instance, brought lasting changes to the way business is done in our industry. Those who stay in business recognize the need to evolve continuously.
At The Compliance Team, one of our core strengths has been diversifying early on, which has been key to our success. I tell providers the same thing: if your revenue streams are limited in one area, it’s vital to seek other opportunities and continuously reinvent your business.
In addition to The Compliance Team’s recent 30th anniversary, what have been some of your greatest highlights of 2024?
Every time we submit a reapplication to CMS for deeming authority, we go through this process on both the rural health clinic and home infusion therapy sides. This past year, we completed that extensive reapplication and are now re-deemed for both services. Just to give you an idea of what that involves, it’s typically a year-long process. We submit all our policies and detail how our processes work, and Medicare validates our approach by shadowing us at a provider location and repeatedly approving our standards.
When people hear that we’re CMS-approved, they should understand that it’s a significant undertaking. On the DMEPOS side, the process isn’t quite the same, as it falls under a different CMS umbrella, but on the Part A side, it’s a rigorous, yearlong vetting process.
Let’s get into our topic of DMEPOS retailers. What is the difference between a DMEPOS retailer and a supplier?
When I think of the term “supplier,” I’m specifically referring to DMEPOS providers who are required to get accredited. These are providers who need accreditation because they want to bill Medicare, obtain a PTAN number, or meet Medicaid or private insurance requirements. Most insurers have followed Medicare’s lead, requiring credentialing to be part of their network, typically starting with, “You must be accredited by an approved agency.” So, whether you call them billing suppliers or providers, that’s generally the standard.
Now, when I say “retailer,” I’m referring to those who operate on a cash basis, without billing insurance. These could be brick-and-mortar businesses, online retailers or even mobile app-based operations. Some providers with PTAN numbers operate in both spaces—they may have a cash-only division that doesn’t accept insurance, even separating it into a different suite or on a distinct part of their website. There are a variety of models out there, and we can’t overlook that some providers can indeed operate as both, offering cash-based retail options in one division and conducting Medicare business in another.
What’s the difference between DMEPOS accreditation and DMEPOS Retailer Certification?
When we talk about accreditation, whether it’s through Medicare for DMEPOS or any other avenue, we’re evaluating the entire organization. This includes HR, administration, business practices, equipment management, patient care, OSHA compliance—everything. Accreditation assesses the full scope of their operations.
Certification, on the other hand, is focused specifically on standards related to a particular service. For example, if a provider is cash-based and only offers mobility products, certification would concentrate on how they deliver that specific service, rather than reviewing the entire business structure.
If a DMEPOS is not billing Medicare, why take that extra step to get accredited? What are the benefits?
It’s all about enhancing your business by having a third-party verify that you meet established standards. This quality validation signals to the community that you’re a trusted business owner and a reliable provider of medical equipment. In other words, it’s a key differentiator. Once a provider is accredited or certified by The Compliance Team they are designated an Exemplary Provider®, whichresonates more clearly to their customers than accreditation or certification. This is our brand across all certified and accredited programs.
Isn’t that just me leaving money on the table? Why wouldn’t organizations be doing that?
First, there are business models that don’t involve billing Medicare. Is that leaving money on the table? It depends on your goals and the patient population you want to reach. When you bypass insurance, you’re offering convenience to patients or families who just want a manual wheelchair, a cane, a walker or similar items. For example, after a hospital discharge, it’s easy to go online and order something like that.
The downside, though, without any accreditation or certification, is that patients, caregivers, or family members won’t receive the instructions or quality assurance that come with a provider held to specific standards. People who have been in health care often expect some form of third-party evaluation—like a “Good Housekeeping” Seal of Approval—that speaks to them and assures them they made a wise choice. Without it, they’re left guessing about how this provider truly operates.
We now have Google reviews and other measurement tools that gauge customer experience, but our organization has taken it further. The Compliance Team is the only accreditor with its own portal for tracking patient satisfaction, backed by millions of data points dating back to 1999 for DMEPOS and Pharmacy. People want evidence of quality and assurances about what they’re buying.
What does the future hold for The Compliance Team and its clients?
Coming off our 30th anniversary celebration, I’m more energized than ever. It’s nice to take a look at what we’ve accomplished over 30 years but our focus is always what’s ahead. What do the market trends tell us.
One example of this forward momentum is our newly launched E-Commerce Protection Accreditation (e-CP)for providers conducting business online or through mobile apps. This accreditation safeguards everyone involved: the consumer, the DMEPOS provider or pharmacy, and the payment processor, by implementing strong controls for security and privacy. There’s been significant interest because so many business models now rely on online transactions, even alongside traditional brick-and-mortar setups. In a time when health care has seen increased cyber threats, the need for security, privacy and assured protection is more critical than ever for doing business.
Finish this sentence: “In the DMEPOS space, the next 12 months will be defined by…”
I think politics come into play within the next 12 months. Another area I believe is relevant is that CMS is looking at improved oversight of accreditors regarding how we deliver services to providers and how that’s organized. There may be some aspects we’ll need to adjust in our approach because of CMS’s renewed oversight with DMEPOS. Ultimately, it’s always about the mission: improving the delivery of care and preventing fraud and abuse.
Editor’s note: This article has been edited for length and clarity.
Celebrating 30 years in business, The Compliance Team is a CMS-approved, nationally recognized accreditation organization offering a full suite of Pharmacy/DMEPOS Accreditation and Certification programs. For more information, visit www.thecomplianceteam.org or call 215.654.9110.
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact [email protected].