Page 22 - HME Business, May 2019

providers to do,” she says. “Number one is,
they really need to identify the state licensure database through the Supplier Clearinghouse and look at what licenses may be needed to do these additional products, whether it’s license and certification of personnel, or whether it’s they’ve decided that, okay, they’re in Illinois, and they also want to get into Ohio, and Iowa, and so forth. Well, then they need to check whether or not licensed personnel or even state license is required to do that.
Also, providers pursuing accreditation for new lines opened up by the bid gap need to under- stand the varying state requirements related to the categories they want to serve.
“They need to review the HCPCS codes and for what they’re considering and what is catego- rized as capped rentals and so forth — what’s off the shelf, what is prefab — all of the things for which the different states have different require- ments,” she explains. “The other thing that is relevant is the local coverage determination. They must have a good understanding of what the key elements are for coverage.”
And there are additional requirements, such as training, that are part of the accreditation process, according to Canally.
“We ask for the additional license,” she explains. “We ask for proof of training, proof
of policies and procedures that relate to these additional products where they haven’t really done them before, and we want to make sure that they’re capable with doing the right instruc- tion of the patient.
“Last but not least, The Compliance Team or any AO’s quality standards and how they can ensure that they’re meeting the evidence of compliance to meet those quality standards, whoever they’re accredited by,” Canally adds.
SPECIALIZED ACCREDITATION
At this point, it should be clear that over the years accreditation has morphed into a strategic asset for providers. Accreditation is not just a list of tasks that a provider must fulfill in order to meet billing requirements on a state or a federal level. Rather, it is a competitive edge that shows how they can provide solid product category knowledge so that their referral partners and their patients are going to feel that they are working with an expert resource.
And, to that end, accrediting organizations are starting to offer special designations to help them do that.
“We’re looking at elevating the standard
so that these providers are raising the bar so that they do have that market differentiation,” Canally says. “... It goes back to the value-based care models across the country.
Bearing that in mind, The Compliance Team introduced a special accreditation program called Patient-Centered Medical Home into the pharmacy arena that helped pharmacists communicate to prescribers that they offered additional service levels and would help act as a “hub” for medication care management. This has led to other specialized accreditation services, Canally says.
“It was a very successful model, and now, we’ve taken it a step further into respiratory
with Patient-Centered Respiratory Home,”
she explains, adding that this latest special-
ized accreditation program helps respiratory providers show referrals that they focus on “the higher level of clinical expertise and quality being delivered to these patients; that care coordination; taking that respiratory DME and having them partner with the pulmonologist and the various physicians that are managing their patients for COPD.”
The respiratory service sets higher quality thresholds so that providers holding the distinc- tion can further differentiate the respiratory services and quality standards they offer to referral partners’ patients. The program, which won HME Business’s 2018 New Product Award for Business Services, is the first accreditation program designed to help advanced respiratory care providers perform at the top of their license to better serve patients. The program uses concise measures to help the provider prove it functions to a higher standard, Canally says.
“There’s a real opportunity there for the providers, for their patients, to get this addi- tional care and service,” she adds.
In addition to the business, there are ways that providers can work with accrediting organiza- tions to also ramp up their staff’s skills, as well, BOC’s Gruskin adds.
“Many HME providers now pursue staff certi- fication as an additional opportunity to gain
a competitive edge. Unique certifications like BOC’s Certified Durable Medical Equipment (CDME) Specialist allow businesses to prove HME proficiency to patients, referral sources, payers and any additional stakeholders,” he explains.
Ultimately, what these special designations help providers show how they can contribute to value-based care, Canally adds.
“It’s differentiating yourself and that vali- dation of quality by a third party,” she says. “Sometimes, I say, “Forget the word ‘accredita- tion.’ Call it something else. Call it your blueprint to quality and your quality initiative, and this is how you can show payers that you’re helping patients stay out of the hospital, stay out of
the emergency department. This is what we’re focused on now.”
PICKING AN ACCREDITING ORGANIZATION
So, if accreditation can offer multiple ways to help providers sharpen strategic edge — a multi-tool to help HME providers run their busi- nesses, so to speak — how do they find they right accreditor?
ACHC’s Safley advises them to shop around, and a primary selection criterion is communica- tion; providers want an accrediting organization that provides useful and regular communication.
“It can’t be about you paying money and
then you walk away and you don’t hear from
an accreditor for three years,” he says, adding that this is particularly important for smaller providers. “Being a small provider, it’s so hard to have the resources to reach out for regulations that change or to ideas that change.
“The accreditation needs to be a resource
for you to understand ongoing compliance
and regulatory issues pertaining to whether it’s government or whether it’s private payers, or whether it’s even acceptances of an accreditor or acceptance of your program,” he continues. “That’s the most value that any accreditation can give today.”
Ultimately, what providers need is a partner, Safely says.
“Accreditation can be used as a blueprint or a guide to make sure you’re not only meeting the regulatory statues in either federal or state levels, but also to give you a blueprint to help run your own business,” he explains. “It’s not about getting accreditation just so you can check a box. It’s about choosing an accreditor that can help you help yourself succeed.” n
22 HMEBusiness | May 2019 | hme-business.com
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“Many HME providers now pursue staff certification as an additional opportunity to gain a competitive edge.”
— Matthew Gruskin, MBA, BOCO, BOCPD, Board of Certification/Accreditation (BOC)