Using DMEPOS Accreditation Strategically
Don't look at DMEPOS accreditation simply as a requirement. Rather, consider how you can leverage its value both in your internal procedures and in your healthcare marketplace.
If a DME pharmacy wants to bill
Medicare for DME items beyond the
pharmacy exemption’s limit, then
obtaining DMEPOS accreditation
is an absolute necessity, quite simply
because the claims you submit won’t be
processed without it. But if anything,
obtaining accreditation is a strategic
asset because it puts into place policies
and procedures that ensure the DME
pharmacy is doing everything it needs to
do in order to ensure it is dotting its “I”s
and crossing its “T”s when it comes to
working with referral sources and providing
service to Medicare beneficiaries.
And that’s especially important these
days, when documentation is such an
incredibly important consideration
when working with physicians and other
healthcare entities. You want to ensure
that you are obtaining all the required
documentation so that you have a clean
claim and that you will be able to quickly
and comprehensively respond in the
case of an audit, and your referrals want
to ensure that the claim will go through
without a hitch.
But documentation is only one
element of why accreditation offers
considerable strategic value. It also
demonstrates that you are following all
the right procedures in terms of equipment
handling, ensuring satisfaction, and
doing the sorts of things that will help
optimize patient outcomes. Let’s examine
some key aspects of accreditation’s
strategic value:
PATIENT SATISFACTION
A key element of maintaining Medicare
accreditation is to document patient
satisfaction. In fact, if DMEPOS suppliers
neglect to track satisfaction, it can cost
them points on their accreditation score.
And while there might be a requirement
to do so, documenting patient satisfaction
simply makes good business sense
because it can provide pharmacies with
the kind of information they can use to
improve their businesses. Implementing
satisfaction surveys will help a DME pharmacy
business find out if it is meeting
the needs of its patient clients, and if not
it can use that data to determine what
needs to be fixed within the business so
that mistakes are not repeated.
That’s important because, ultimately,
the feedback is related to care quality.
For instance, an improperly set-up
wheelchair or an oxygen patient not
understanding how to use his or her
equipment can negatively impact that
patient’s care. That’s why CMS looks to
accrediting organizations to ensure that
DME pharmacies are ensuring patient
satisfaction, and using well-documented
surveys as a means to do that.
CMS does not outline how AOs
should instruct DMEPOS suppliers on
surveying their patients, so your AO
will likely provide guidelines that track
patient satisfaction for a variety of criteria
related to the provisioning of DME.
Those factors can include timely delivery
of supplies; that the equipment was
ready for the patient to use and that the
patient was given proper instruction on
how to use it; that the patient has all the
necessary contact information for reaching
the DME pharmacy in case something
goes wrong or because they might have
a question; that the pharmacy is answering
questions and helping patients after
the DME has been provisioned; and that
the patient is satisfied.
AUDITS
When it comes to implementing solid
documentation policies and procedures,
Medicare accreditation can help considerably
in making sure that DME suppliers
collect the right documentation so that
they reduce their audit exposure and
increase their ability to quickly follow up
on audit contractor documentation requests.
Starting with ensuring the correct
documentation for claims, accreditation
helps the DME pharmacy keep accurate
and comprehensive documentation at
order intake and all the way through to
prove that the equipment was delivered,
along with the model, serial and manufacturer
numbers of the item delivered.
Also, accreditation will help DME
pharmacies follow the local coverage
determination for the items billed, which
can mean additional documentation
requirements, such as a face-to-face visit,
depending on what DME is billed.
EFFICIENCY
At a time when policies such as competitive
bidding are radically reducing
Medicare reimbursement, DME pharmacies
can 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 can help, since the
process clearly outlines what pharmacies
need to be doing in every aspect of their
DME business. From there, they can start
to map those policies and procedures
to their workflows, while simultaneously
working to streamline those processes
where possible. Moreover, accrediting organizations
are cognizant of the fact that
DMEPOS suppliers face difficult funding
circumstances and keep those business
constraints in mind.
DIFFERENTIATION
When a pharmacy obtains DMEPOS
accreditation, it is telling all of its referral
partners that it 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 business differentiator to not only
referral partners serving Medicare beneficiaries,
but partners serving patients
with private payor insurance, and, of
course, the patients themselves.
This article originally appeared in the DME Pharmacy December 2021 issue of HME Business.