Medicare Compliance & Reimbursement

Final version of standards due this month.

Expect a quality-standards wake up call this month if you're a home medical equipment supplier.

That's when the Centers for Medicare & Medicaid Services (CMS) plans to release the final version of its quality standards for suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS), insiders say.

The release of the proposed standards, most likely via program instructions, will be the first of three big remaining steps toward realizing the feds' plan to bring accreditation to Medicare-certified DMEPOS suppliers.

Next: This fall, CMS plans to publish its final rule on DME competitive acquisition (a.k.a. competitive bidding), spelling out particulars necessary to move ahead with implementing the soon-to-be-issued final quality standards.

"There's been some confusion about the time frame for moving toward accreditation," reports Maryanne Popovich, executive director of the home care accreditation program at the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which is likely to be one of the groups approved for DME accreditation by CMS.

Third step: Just who will be able to grant DME accreditation for Medicare standards will be the subject of yet another final rule. Look for that rule to come out some time early this fall, Popovich predicts.

3 Steps To Successful Accreditation Preparation

In addition to reading the final standards carefully once they're published, suppliers should take the following steps to be sure they're on the right track to meet quality standards in a timely manner:

1. Review consultants' claims carefully. Though reputable consultants may be able to help you prepare for accreditation, they can't grant CMS-approved accreditation themselves. Only a handful of established accrediting organizations with existing ties to CMS will ultimately be chosen, explains Popovich. And those won't be named until publication of the relevant final rule, she says.

Even JCAHO, based in Oakbrook Terrace, IL, can't yet claim to accredit for purposes of the coming federal DME quality standards. "We will have to apply like everyone else," she reminds.

2. Know the key contenders. CMS is likely to select only a handful of accreditors--and those are likely to be groups already working with CMS, suppliers and providers in other health care fields, experts predict.
 
Organizations hoping to offer CMS-sanctioned DME accreditation must apply to participate in Medicare's Part B quality standards program, which will in turn allow them to certify that suppliers meet Medicare quality standards, explains attorney Robert Falk of Powell Goldstein in Washington, DC.

Good idea: To get a head start, get to know the groups viewed as most likely to be named: JCAHO, the Community Health Accreditation Program based in Washington, DC, and the Accreditation Commission for Health Care based in Raleigh, NC. These groups are offering special teleconferences and "tool kits" to help DME suppliers get up to speed on accreditation.

3. Time it right. Your deadline for achieving accreditation depends on your products, your location--and what CMS decides to include in the first round of competitive bidding.

Example: If you happen to provide a product that's included in competitive bidding and you operate in one of the 10 metropolitan areas selected to roll out the program, you'll need to be accredited next year, possibly before you can even submit a Medicare bid.

Don't Waste Time In Line

All DME suppliers serving Medicare beneficiaries will need to be accredited for quality standards by the end of 2010.

Though you may be inclined to put off accreditation, it's probably best to forge ahead, experts say. You'll be ready should the first wave of competitive bidding affect you--and ahead of the game even if it doesn't. If you are accredited by an organization that CMS later chooses to oversee the new quality standards, you'll be grandfathered in.
 
Advantage: Make moves toward accreditation now and you could beat long lines at the accrediting organizations: Only 10 percent of DME suppliers are currently accredited by JCAHO and its counterparts, reports Popovich.

The draft quality standards are at www.cms.hhs.gov/CompetitiveAcqforDMEPOS/.