Accreditation 101

It's Not Too Early (or Too Late) to Make It Work for You

All right, class —true or false: You only need to worry about accreditation if you intend to participate in national competitive bidding (NCB).

False. But if you were tripped up, don't feel bad. This is one of the more stubborn misconceptions about upcoming accreditation requirements (for the record, if you bill Medicare, you will need to be accredited, even if you do not participate in competitive bidding).

And if you intend to work with Medicare but haven't yet started the accreditation process, you're not alone. Not surprisingly, during a year when competitive bidding and new power mobility codes have grabbed headlines, accreditation has sometimes been given a lower priority by mobility and rehab suppliers who figured they would deal with it later.

Well, "later" is now. As 2005 draws to a close, it's time to sharpen our collective pencils in preparation for accreditation.

When's It Due?

Before starting any big project, it's wise to work out an internal set of deadlines. So here's the first question: When does a mobility/rehab supplier's accreditation need to be in place?

Libbie Lockard has been working with DME providers for more than 25 years and is probably best known for her tenure with the VGM Group. Now president of LWL Productions, based in North Olmsted, Ohio, Lockard does consulting work with clients of The Compliance Team, a for-profit accreditation firm. However, she talked to MM in more general terms about accreditation, its benefits and how mobility/rehab suppliers can start the process.

"All those (providers) who are waiting for a definitive decision by CMS (Centers for Medicare & Medicaid Services) —a deadline for the last minute —it's arrived," she states, pointing out that some accrediting organizations require pre-accreditation process homework that can take months to complete.

Lockard acknowledges that the "waiting game" many providers have been playing up until now has been based on CMS' own vagueness. "The deadline that's the stake in the ground right now is 2007," she says. "We don't know when in 2007; there are people who are monitoring the CMS Web site (www.medicare.gov)." Still, the fact that CMS has so far not released a more specific 2007 date does not really change the current urgency, Lockard says.

"Being prudent, we have to assume (the deadline is) January 1, at this point, until a date comes out. Naysayers will say, 'I can wait because Medicare always delays the deadline —look at HIPAA.' Well, (CMS) will probably delay the deadline for them(selves), but not for the provider. For example, look at HIPAA, where you had to file your business associates? agreement by a certain date, and you had to indicate that you were ready for electronic filing by a certain date. That didn't mean that CMS was ready to process electronic claims, but you had to be ready as a provider. So we want to cite that history to people who are now saying, 'Look at history.'"

The other reason to make your accreditation plans now, Lockard says, is a matter of numbers. Thousands of suppliers nationwide who need to be accredited, only a handful of accrediting bodies, a 2007 deadline... you can do the math.

Why Are We Doing This?

The other immediate question that comes up with accreditation is "Do we really need this?"

"I like to say that as Medicare goes, so goes Medicaid," Lockard explains. "It's really C-M-M-S: the Centers for Medicare and Medicaid Services. Even though the funding has fallen to the states, the rules are the same, and they're promulgated by CMS based on federal legislation. So, if (providers) say, 'We don't take Medicare assignments, but we sure enjoy that Medicaid business' —it's the same deadline. And that's 2007."

The penalty for failing to get accredited by the deadline, Lockard says, "is losing your Medicare supplier number. Now, we don't know to what degree you really wouldn't be able to bill, but let's assume it's the worst ... as every payor source gets accredited, they can only then buy from accredited providers."

In fact, Lockard says, providers should read between the lines if payor sources say they're not interested in working with additional suppliers. "All those payor sources who've said, 'Oh, we've got all the people we want' are really saying, 'Oh, we see you're not accredited, therefore we're not even going to put you on our waiting list or pay attention to your application because we can only deal with accredited suppliers.' For some reason (those payor sources) haven't responded that way to providers; they've simply said, 'We're full up.' But you're not ever 'full up' where your beneficiaries want to shop. But beneficiaries will increasingly want to shop where something is accredited."

As an example, Lockard says, "You wouldn't want to send your child to a university that wasn't accredited; that's throwing your money away. It makes their diploma seem less than sterling. And you also wouldn't want to go to a hospital that wasn't accredited."

Here's the good news, however. Accreditation in the DME community is most often spoken of with fear and loathing —suppliers bow to it because they have to if they want to stay in business. However, Lockard says suppliers should demand more than mere survival from the accreditation process. Choose the correct accrediting body for your business, and your business can drastically improve.

In other words, accreditation may be mandatory for a lot of suppliers, but it can also be a good thing. The key, Lockard says, is to choose the right accreditation team for your needs.

"This should be all about choice," Lockard says. "Getting accredited should not be about meeting a Medicare deadline. It should be about saying, wow —here is the answer in our hands. We've struggled in the rehab field about 'Is it going to be licensure, is it going to be accreditation, are we going to create our own standards?' Well, Medicare has made it easy for us. Since they're the principal payor source, they've said this is how it's going to be —everyone needs to be accredited to be in the ballgame."

Who Should Work on This Project with Me?

So the first question when devising an accreditation plan, Lockard says, is "What are my choices?"

At press time, Lockard says CMS recognized five accrediting bodies: the Board for Orthotist/Prosthetist Certification (BOC); The Compliance Team; Accreditation Commission for Health Care (ACHC); Community Health Accreditation Program (CHAP); and Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

"Nobody is 'approved,'" Lockard emphasizes. "(CMS) uses the word 'recognized.'" Lockard adds that there are other accrediting bodies as well, beyond the five that were 'recognized' by CMS at the time of the interview. When deciding which accrediting body to work with, Lockard suggests the opening consideration should be "What is important to the accrediting body?" In other words, where does its expertise lie?

"If you are an orthotic/prosthetic provider, you might find BOC is your best avenue," Lockard says, as an example. "But be sure they can also cover the pure DME/rehab side of your business as well. That may be the fastest avenue for you. BOC is certainly a choice if you're one of those ultimate-niche RTS's who is approaching things from an orthotics standpoint."

Other questions suppliers should ask when interviewing accrediting bodies:

  • What do you do in your business that fits with my business? Make sure the accrediting body meets the specific and unique needs of your business. Also ask the reverse question: What's important to the accrediting body? What do they value?
  • What are the total costs to be accredited by you? Do you have to hire additional consultants or contractors yourself to complete parts of the accrediting process? What out-of-pocket expenses will you have to pay in addition to the main fee paid to the accrediting body?
  • Who else have you accredited in my field? Ask for references and the names of clients with businesses similar to yours, in your niche.
  • What is your ethical history? In other words, who is the accrediting body accountable to?
  • By how many payor sources are you approved? Ask the accrediting body how you can be sure that your own major payor sources will in fact accept you if you are accredited by this particular firm. Lockard: "If the payor sources will approve you, then you're golden. Hence (in your state), who are the primary payors, and which accreditors are getting claims paid? Which accreditors that have accredited RTS's in your state are getting their claims paid?"
  • Do you understand my business? Can the accrediting body be flexible to your specific needs? Will it help you improve your business and help it to grow, or is the accrediting body's main/sole concern to be a regulatory body? What do you want to ultimately gain from the accreditation process? Lockard: "What do you do for my business that makes you unique, like my business is unique? How will you flex your business to fit my business? Show me you're not going to add more work for me."
  • How long will the entire accreditation process take, from start to finish? Ask if there is additional work before or after the formal accreditation process that you need to budget time for.
  • What do I get for my money? What services and materials will you receive for your accreditation investment? What services will cost extra?
  • Are you recognized by my state association? And, if you're a member of your state association, will there be any licensure fee benefits once you're accredited? "In Ohio, the (licensure) fee is half if you're accredited," Lockard says.

What Should I Get Out of This?

Pick the right accrediting body for your business, and the end results should be far more than just being able to keep your Medicare supplier number, Lockard says.

The benefits for the RTS, Lockard says, include the fact that "you can get in with more payors. More payors means a stronger business not reliant on Medicare/Medicaid."

Also, Lockard says, "You are going to get any documentation required by the regulators that you would need. You are going to get a tie to pull your operations together so you can focus on patient care —because what this is all about is focusing on clients. That should be the core outcome of getting accredited. Not to meet (the requirements of) CMS or any other regulatory body, but to have your business professionalized, made more efficient, trimmed up and mainstreamed so that the owner, the salespeople and the customer service people do not have to be worrying about operations issues, delivery issues, management issues, inventory issues —because all that's humming along nicely. And you don't have to worry about meeting new education requirements, because guess what —you're already doing your continuing education."

Other advantages to accreditation, and to starting the accreditation process promptly, according to Lockard:

  • You keep your Medicare supplier number and expedite the payment process.
  • You should see more efficient business operations.
  • You can market your accredited status to clinicians.

Go to the Head of the Class

Make no mistake, Lockard says: Accreditation is not all-stick and no-carrot. There are definite opportunities for suppliers to make tremendous gains through accreditation.

"That's the intangible benefit," Lockard says. "(By getting accredited) you meet the challenge of today's minimum requirement to be in the game." Getting accredited can improve your business' report card all the way around. So sharpen your pencils, get your interview questions ready ... and prepare for accreditation success!

This article originally appeared in the October 2005 issue of Mobility Management.

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