accreditation, Seth Johnson, reimbursement,metropolitan statistical areas,competitive bidding, Medicare, DME suppliers

Accreditation’s Role in Reimbursement

MM: CMS recently announced a Sept. 30, 2009, deadline for providers to get accredited. What does that deadline mean, and what exceptions there are to that deadline?
Seth Johnson: All providers must be accredited by the end of September 2009.
Exceptions to that include those suppliers in competitive bidding areas (the first-round accreditation deadline was Oct. 31, 2007), and newly enrolled providers. New DMEPOS suppliers who are enrolled for the first time between Jan. 1 and March 1, 2008, must obtain and submit an approved accreditation to the National Supplier Clearinghouse (NSC) by Jan. 1, 2009; new DMEPOS suppliers submitting an enrollment application to the NSC on or after March 1, 2008 must be accredited prior to submitting the application. In addition, certain selected providers in Florida and California are subject to an anti-fraud demonstration project (with accreditation deadlines of 120 days after receipt of a letter requiring accreditation, per the NSC).
MM: From a funding perspective, why is it important to become accredited? What happens to dealers who choose not to become accredited?
Johnson: From a Medicare perspective, after the accreditation requirement is implemented, any non-accredited suppliers will have their Medicare numbers revoked, eliminating their ability to bill Medicare for any DME items provided to Medicare beneficiaries. If a supplier decides not to become accredited, they will essentially be walking away from any Medicare business.
MM: In addition to the inability to bill Medicare Part B, will DME suppliers be affected by lack of accreditation? Do you expect other payor sources to demand accreditation as well?
Johnson: Many other payors model themselves after the Medicare program, and many private insurance contracts already require accreditation.
MM: What advice do you have for providers who need to start the accreditation process? What resources are available to them, and when should they start the process?
Johnson: If a supplier has not already started to explore the different accrediting bodies and their programs, they should begin that process right away. Each entity has a Web site that details their accreditation programs, including the process and costs, which do vary according to the program. The Competitive Bidding Implementation Contractor (CBIC) Web site ( has a page outlining the Medicare-approved accrediting bodies.
MM: What are the overall goals of accreditation? How are those goals tied to competitive bidding and quality standards?
Johnson: A major goal of accreditation is to increase the standards that all Medicare providers must meet in order to participate in the program. The accreditors are in charge of making sure Medicare suppliers are in compliance with the new quality standards. The NSC will continue to be in charge of enforcing the supplier standards.
It is my understanding that one of CMS’ goals with accreditation is to help further reduce fraud and abuse in the industry, through increased standards and additional enforcement of the new standards via the accreditors. Also, once suppliers become accredited, they should realize additional operational efficiencies, and they should be on a more even playing field with their competition.
MM: How can providers turn this sizable task of getting accredited into a positive learning and business-building process? Do you have any advice for owners or managers as they discuss accreditation with their staffs?
Johnson: Accreditation will actually help a provider in two ways: It will help them develop processes and operational protocols, which in turn should lead to greater efficiency in their business. This also provides the opportunity to step back and take an objective look at their business, and ask, “Why do we do things this way? Is there a reason? Can this be done differently to achieve the same or better outcome?”

Seth Johnson is the vice president of government affairs for Pride Mobility Products & Quantum Rehab.

This article originally appeared in the February 2008 issue of Mobility Management.

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