Accreditation's Strategic Value

DMEPOS accreditation isn't simply a Medicare obligation; it can set your HME business apart.

• By David Kopf
• Feb 01, 2018

It’s important to keep in mind how essential Medicare accreditation is from a broad business perspective. While Medicare accreditation means an HME can bill DMEPOS claims, other payers use it as a gold standard. So even if a provider isn’t doing much Medicare, it still needs to use that accreditation to ensure it will pass muster with private payers and health plans.

“Accreditation covers more than Medicare,” explains Sandra Canally, RN, president of deemed Medicare accrediting organization The Compliance Team. “We see a lot of Blue Crosses, a lot of managed care — the Aetnas, the Cignas, the big guys —will not only contact the accreditor to verify the dates of accreditation for a particular DME, but they will also drill down into the product lines that they’re accredited for. In other words, they’re mimicking Medicare.”

The problem with that is that some providers see accreditation solely as an obligation that comes up for renewal every three years. That’s the wrong way to approach the process. Obtaining accreditation demonstrates a provider is following all the right procedures in terms of claims documentation, equipment handling, ensuring satisfaction, and doing the sorts of things that will help optimize patient outcomes. This, in turn, compounds a provider’s reputation with referrals and satisfaction from patients. Some examples of accreditation’s strategic value:

Patient Satisfaction

A key element of maintaining Medicare accreditation is to document patient satisfaction. However, documenting patient satisfaction, simply makes good business sense, because it can give providers the kind of information they can use to improve their businesses. Implementing satisfaction surveys helps a provider business find out whether or not it is meeting the needs of its patient clients, and to pinpoint problems that to be fixed within the business so that mistakes are not repeated. Ultimately this feedback links back to care quality.

CMS looks to accrediting organizations to ensure that providers are using well-documented surveys as a means to assure patient satisfaction. That said, CMS does not outline how AOs should instruct their providers on surveying their patients. Your AO will likely provide guidelines that track patient satisfaction for a variety of criteria, such as timely equipment delivery; that the equipment was ready to use; proper patient instruction on equipment use; the patient has all the necessary contact information for reaching the provider; the provider is answering questions and helping patients after delivery; and that the patient is satisfied overall.

Audits

Medicare accreditation can help considerably in making sure that providers collect the right claims documentation, so that they reduce their audit exposure, and increase their ability to quickly follow up on audit contractor documentation requests. Starting by ensuring the correct documentation for claims, accreditation helps show the provider follows the latest LCDs and keeps accurate and comprehensive documentation at order intake and all the way through to proof that the equipment was delivered, along with the model, serial and manufacturer numbers of the item delivered.

Efficiency

At a time when policies such as competitive bidding are radically reducing Medicare reimbursement, providers find themselves at a painful crossroads: they must ensure that they are living up to the requirements expected of them, but they must also reduce operational costs as much as possible in order to ensure that they can still run a profitable business. This is where accreditation helps, because the process clearly outlines what providers need to be doing in every aspect of their business. From there, providers can start to map those policies and procedures to their workflows, while at the same time, working to streamline those processes where possible.

Business differentiation

When a provider obtains Medicare accreditation it is telling all of their referral partners that the provider meets or exceeds all the policy and procedure requirements that Medicare expects from a DMEPOS supplier in order to serve Medicare beneficiaries with the kind of care, consideration and product expertise that will help ensure that patient derives the expected benefits from their equipment.

That is a huge market differentiator to not only referral partners serving Medicare beneficiaries, but also referral partners with private payer insurance funding, as well as the patients themselves. Savvy providers will communicate this to their patients and referral partners in order to distinguish their businesses as a respected and knowledgeable provider that can be relied on to provide dependable and expert service. When communicated correctly, this message will resonate with clients and referral sources and instill a sense of confidence that they are working with the best in the business.

This article originally appeared in the February 2018 issue of HME Business.