Page 21 - HME Business, May 2019

Using the Accreditation Multi-Tool
The role accreditation plays in HME has expanded beyond a simple Medicare requirement. How can providers maximize its value?
By David Kopf
EVER SINCE PROVIDERS had to become accredited in order to bill Medicare, the importance of accreditation has continued to grow. Where accreditation once was something providers sought out as mainly a requirement they needed
to fulfill, they quickly realized that accreditation can help them better respond to immediate industry changes and market opportunities.
Moreover, accrediting organizations now offer specialized accreditation programs to help providers distinguish themselves as expert providers in certain types of care, which helps them differentiate from their competitors.
A STRATEGIC ASSET
While providers continue to need accreditation to bill Medicare, how providers are using accred- itation has changed over the years, according to Timothy Safley, MBA, RRT, program director of DMEPOS Pharmacy and Slate for Accreditation Commission for Health Care (ACHC).
“We’re seeing more and more people get accredited but are not necessarily playing in the Medicare market,” he says. “In other words, they’re getting accredited for payers, but CMS may or may not be one of them.”
For example, sometimes a state Medicaid program or a private payer will require providers to be Medicare accredited. Or, the provider might not even need Medicare accreditation, but continue to seek it out because they feel it brings value, Safley says.
“I think providers are using it strategically because even if they’re not playing in the overall Medicare market, they’re using it to be a differ-
entiator between themselves, say, for a national contract,” he explains. “To give you an example, we have many companies that decided they’re not going to play with Medicare, so they’re
not mandated to be accredited. However, they chose to be accredited, because they see it as a differentiator between them and other people when they put out their bids.”
Earning accreditation is a way for providers
to affirm their business model, and inherently reflects the use of solid, verified best practices, says Matthew Gruskin, MBA, BOCO, BOCPD, credentialing director for Board of Certification/ Accreditation (BOC).
“Accreditation sends a message to patients and the competitive community that a facility is committed to meeting and exceeding national standards for competence, professionalism and safety,” he notes.
ACCREDITATION AND
THE BIDDING GAP
When it comes to market and changes and opportunities, once such trend immediately facing providers is the competitive bidding
gap. Per CMS’s final ESRD/DMEPOS rule issued in November 2018, competitive bidding went dormant for a period lasting 18 to 24 months starting Jan. 1. Moreover, per CMS Final Rule any
Medicare accredited DMEPOS provider can offer items for which they didn’t have a contract.
For providers that were unable to successfully bid a contract for a competitive bidding area
or a product category they might have previ- ously served, this could represent a tremendous opportunity. That said, they might have let their Medicare accreditation for a particular category lapse and would need to get accredited again.
“It’s an opportunity for them to not only rise to the occasion for their own businesses, but to serve their patients in their community in addi- tional ways, but they’ve got to be mindful and strategic about it,” says Sandra Canally, RN, the founder and CEO of The Compliance Team, a CMS-approved accreditation organization that is celebrating its 25th anniversary.
First, it’s all about market assessment. Canally says providers must first assess the number of patients in their area that would likely use these additional products. Then they must identify what referral sources are going to actually give them orders over, and how they can help those physicians and other healthcare professionals better meet the needs of their patients.
Once providers have done that, then they can approach accreditation, and there are several things they must do in that regard, she says.
“We have a variety of things that we tell the
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