CMS Accreditation Update - The Latest from the MSAs: What Do You Need to Do and When Do You Need to Be Ready? Tuesday, October 2, 2007 MedTrade. - PowerPoint PPT Presentation

About This Presentation

CMS Accreditation Update - The Latest from the MSAs: What Do You Need to Do and When Do You Need to Be Ready? Tuesday, October 2, 2007 MedTrade.


CMS Accreditation Update - The Latest from the MSAs: What Do You Need to Do and When Do You Need to Be Ready? Tuesday, October 2, 2007 MedTrade. – PowerPoint PPT presentation

Number of Views:250
Avg rating:3.0/5.0
Slides: 53
Provided by: CKull


Transcript and Presenter's Notes

Title: CMS Accreditation Update - The Latest from the MSAs: What Do You Need to Do and When Do You Need to Be Ready? Tuesday, October 2, 2007 MedTrade.

CMS Accreditation Update - The Latest from the
MSAs What Do You Need to Do and When Do You
Need to Be Ready?Tuesday, October 2,
  • Mary Ellen Conway
  • President

  • What is the Accreditation Requirement?
  • First 10 MSAs, Next 70
  • When do YOU Need to be Ready?
  • Current Important Legislative Activity
  • Inconspicuous Items
  • Report from the First 10 CBAs

Overview Continued
  • How Do You Get Started?
  • Tips on Choosing Your Accreditor
  • Issues with fees/costs
  • The Current Ten Recognized Accreditation
  • Models/Formats
  • Video Examples
  • Main Reasons Organizations Fail
  • How Long Does It Take?
  • Ten Things You Can Do Now to be Ready

Common Acronyms
  • CBA Competitive Bid Area
  • CBIC Competitive Bidding Implementation
  • CMS Center for Medicare Medicaid Services
  • DME Durable Medical Equipment
  • DMEPOS Durable Medical Equipment, Prosthetics,
    Orthotics and Supplies
  • HME Home Medical Equipment
  • MMA 03 Medicare Modernization Act of 03
  • MSA Metropolitan Statistical Area

What is the Accreditation Requirement?
  • The Medicare Modernization Act of 2003 (MMA 03)
    states that ALL DME Providers billing Medicare
    for identified Part B products must be accredited
    by 2007--- this will be enforced initially
    through the Competitive Bidding Requirement
  • There are between 117,000 and 150,000 Medicare
    Part B supplier numbers
  • This applies to DMEs as well as pharmacies
    billing for identified items

The Dominos
  • CMS is enforcing the law that requires
    competitive bidding in 2007
  • (Slated to begin July 2008)
  • Only accredited organizations can be awarded a
  • Accreditation must be by recognized accreditors
  • Provider must comply with Final Quality Standards
    (Released 8-14-06)

Why is this happening?
  • High profile fraud and abuse cases
  • New price list alone will not solve

Competitive Bidding Timeline
  • Bidding opened May 15, 2007
  • Bidding closed September 26, 2007
  • Competitive bidding contracts will be awarded for
    3 years (with the exception of mail order
    diabetic supplies), starting July 1, 2008 in the
    identified 10 CBAs and in a additional 70 (for a
    total of 80) to begin July 1, 2009
  • See website

The First 10 CBAs
  • Charlotte-Gastonia-Concord NC-SC
  • Cincinnati-Middletown, OH-KY-IN
  • Cleveland-Elyria-Mentor, OH
  • Dallas-FT Worth-Arlington, TX
  • Kansas City, KS-MO
  • Miami, Ft Lauderdale, Miami Beach, FL
  • Riverside, San Bernadino, Ontario, CA
  • Orlando, Kissimmee, FL
  • Pittsburgh, PA
  • San Juan, Caguas, Guaynabo, Puerto Rico

Next 80 Largest MSAs
  • Los Angeles New York Chicago San Diego
  • Washington, DC St Louis, MO/IL Richmond,
    VA Louisville
  • Phoenix Seattle Houston Atlanta
  • Nassua/Suffolk Oakland, CA Denver Newark, NJ
  • Portland, OR Ft Worth, TX Las Vegas San Jose,
  • Boston Indianapolis San Antonio Virginia Beach
  • Columbus, OH Milwaukee Bergen, NJ New Orleans
  • Salk Lake City Greensboro, NC Austin Nashville
  • Providence. RI Raleigh/Durham Hartford Buffalo
  • Middlesex/Somerset Memphis W Palm/Boca Monmouth
  • Jacksonville Rochester, NY Grand Rapids Fresno
  • Philadelphia, PA San Francisco,
    CA Tampa Detroit

Next 80 Largest MSAs Cont
  • Oklahoma City Greenville, SC Dayton, OH Honolulu
  • Albany Tucson Tulsa Ventura, CA
  • Syracuse Omaha Albuquerque Akron
  • Knoxville El Paso Bakersfield Gary, IN
  • Allentown, PA Harrisburg Scranton Toledo, OH
  • Jersey City Baton Rouge Youngstown,
    OH Springfield, MA
  • Little Rock Ann Arbor Stockton, CA Wichita
  • Charleston New Haven, CT Mobile, AL Columbia, SC
  • McAllen/Edinburg, TX Sarasota/Bradenton

The CBA (Competitive Bid Area)
  • Can be multiple MSAs
  • Applies to defined Zip Codes where the
    beneficiary resides, not where the provider is
  • Check CBIC website for service area zip codes-
    can be an enormous service area

When Do You Need to Be Ready?
  • If you provide any of the identified products or
    services to Medicare beneficiaries in any of the
    defined areas and wish to continue, you will be
    required to bid.
  • In order to bid, you will need to be accredited
  • If you do not bid, or do not win the bid, you are
    excluded for three years- you CAN NOT bill from
    an office in another area
  • All others may be required to be accredited
    (whether or not there is Competitive Bidding in
    your service area) as early as April 1, 2009
    Everyone else after that

What if You Provide Products and Services in
Rural Areas Only?
  • You may never have to participate in Competitive
  • You will get a rate adjustment as CMS will begin
    to reimburse providers the rates paid in the
    closest MSAs
  • You must be accredited by some finite date

  • Final Product Categories
  • Oxygen Supplies and Equipment
  • Standard Power Wheelchairs, Scooters and Related
  • Complex Rehab Power Chairs and Related
  • Mail Order Diabetic Supplies
  • Enteral Nutrients, Equipment and Supplies
  • CPAP, RADs and Related Supplies and Accessories
  • Hospital Beds and Related Accessories
  • Negative Pressure Wound Therapy Pumps and Related
    Supplies and Accessories
  • Walkers and Related Accessories
  • Support Surfaces (Groups 2 mattresses and
    overlays) in Miami and San Juan only

Product Selection
  • CMS selected products for CB based on
  • High cost
  • High-volume
  • Greatest potential for savings

Legislative Activity
Whats the update from the First 10 CBAs?
Deadlines wereVERY tight
  • Many suppliers had their applications and funds
    returned at the end of June/beginning of July
    (before the extension was announced) from
  • For many who were surveyed in time, they had
    extensive amounts of follow-up that needed to be
    done due to incomplete work. This often included
  • All has to be complete by October 31st

Multiple Bidding Issues
  • Geographic area in each was VERY extensive
  • Capacity issues- wait to be seen who is awarded

The Next 70?
  • Complaints in Florida about 20 minute
    accreditation surveys
  • Results of validation surveys?
  • PAOC Meeting scheduled for October 11, Baltimore,
  • CMS announced that they are ready for the next 70
    CBAs- could be before the first round contracts
  • Herb Kuhn, AAHC Legislative Conference, June 6

How Do I Get Started???
Must Have
  • Performance Management
  • Beneficiary satisfaction surveys
  • Patient complaint log
  • After hours (on call) log to prove timeliness of
    response to questions, problems and concerns
  • Log that documents frequency of billing and/or
    coding errors
  • Log documenting adverse events (as defined by
    your P P manual)
  • Most accrediting organizations require at least
    three months of surveys collected and summarized
    with plans for improvement or you will have to
    provide written follow-up and possible a re-visit

Performance Improvement Examples are Everywhere
  • Where do you see them?

(No Transcript)
(No Transcript)
Tips to Use in Choosing Your Accreditor
  • CMS is not your only payer!
  • Payer or state licensure requirements to be
    accredited ex Anthem BC, State of Florida,
    Oklahoma Medicaid
  • What is the accreditors schedule and what are
    the requirements for in-between?
  • ex Triennial and or annual updates
  • Fees paid vs. administrative costs
  • Other services (infusion, home health)
  • Process (electronic vs. paper)
  • Interview/discussions with accrediting
    organizationyour perceptions
  • Your peers experience

The Current Ten Recognized AccreditorsNot every
organization is an option for you
Comparing Apples-to-Apples
  • Product Category Definitions
  • DME Limited Mobility Aids Manual W/C, Cane,
    Walker, Crutches,
  • Stationary Commode Chairs, Wound Care and
    Ostomy Supplies Urological Supplies Bedpans,
  • DME includes Limited and- Manual and Electric
    Beds, Traction Equipment
  • Medical Supplies- Diabetic Supplies, Enteral
    Products (Non-home visit items)
  • Respiratory- Home medical equipment and supplies
    covered include respiratory
  • equipment and supplies, oxygen, concentrators,
  • conserving devices, cylinders and oxygen
    accessories and supplies,
  • home invasive mechanical ventilators,
    respiratory assist devices,
  • continuous and intermittent positive pressure
    breathing devices,
  • nebulizers
  • Rehabilitation- Power Mobility devices including
    complex Rehab and Assistive
  • Technology
  • Orthotics and Prosthetics- Custom fabricated,
    custom fitted, custom-made orthotics, prosthetic
  • devices, somatic, ocular and facial
    prosthetics, therapeutic shoes, braces
  • and artificial limbs

Accreditation Commission for Healthcare (ACHC)
  • DME- All Equipment
  • Medical Suppliers (Pharmacies)
  • Respiratory
  • Rehabilitation
  • Orthotics and Prosthetics

American Board of Certification for Orthotics and
Prosthetics (ABC of OP)
  • Orthotics and Prosthetics
  • DME Limited- Wound Care/Incontinence, Mobility
    Aids only if in conjunction with OP
  • Merged with the Board for Certification in
    Pedorthics (

Board of Orthotic/Prosthetist Certification (BOC)
  • DME- All Equipment
  • Medical Suppliers (Pharmacies)
  • Respiratory
  • Orthotics and Prosthetics

Commission on Accreditation of Rehabilitation
Facilities (CARF)
  • Rehabilitation
  • Orthotics and Prosthetics

Community Health Accreditation Program (CHAP)
  • DME- All Equipment
  • Medical Suppliers (Pharmacies)
  • Respiratory
  • Rehabilitation
  • Orthotics and Prosthetics

The Compliance Team
  • DME- All Equipment
  • Medical Suppliers (Pharmacies)
  • Respiratory
  • Rehabilitation
  • Orthotics and Prosthetics

Healthcare Quality Association on Accreditation
  • DME- All Equipment
  • Medical Suppliers (Pharmacies)
  • Respiratory
  • Rehabilitation
  • Orthotics and Prosthetics

Joint Commission (JCAHO)
  • DME- All Equipment
  • Medical Suppliers (Pharmacies)
  • Respiratory
  • Rehabilitation
  • Orthotics and Prosthetics

National Association of Boards of Pharmacy (NABP)
  • DME Limited- Wound Care/Incontinence, Mobility
  • Medical Suppliers (Pharmacies)

National Board of Accreditation for Orthotic
Suppliers (NBAOS)
  • Orthotics and Prosthetics

  • Models/Format of Programs
  • Additionally
  • Paper Based vs Electronic

Video Examples
  • Anxiety about the Surveyor
  • Home Visit

(No Transcript)
Home Visits
  • Surveyors will interview patients, asking how
    they were oriented, how to reach the office, how
    the services has been, any problems

(No Transcript)
Main Reasons Organization Fail
  • Lack of Preparedness
  • Few Staff Aware of Process/Requirements
  • Lack of Focus and Follow-through
  • Main items
  • Physician Orders
  • Infection Control
  • Incomplete HR Files

How Long Does It Take?
  • Generally at least 4 6 months from start to
  • Do you have everything you need?
  • Policies and Procedures, Educational Materials,
  • How long will it take for you to get these in
  • Once you gather your information, how long will
    it take for you to coordinate and submit your
  • Average is 2 3 months
  • When you notify your accreditation company that
    you are ready, how long until your survey?
  • Schedules are usually 45 60 days in
    advance-Surveys must be un-announced within a
    window of time that you are ready

10 Things You Can Do
  • 1. Download and become VERY comfortable with the
    final quality standards---read them carefully
  • 2. Review and talk to your payers to make an
    informed decision as you choose your
    accreditation provider right away
  • 3. Send for your accreditors standards ASAP
  • 4. Review and update your PP (or BUY one!)
  • 5. Identify your team(s)--- review the standards
    by team and identify what you need to do

10 Things You can Do
  • 6. Educate the staff NOW- practice discussions
  • 7. Create/review your PI program NOW begin to
    collect patient satisfaction data and implement
    the required logs ASAP--- Gather at least 3 mos
    of data before notifying accreditor that you are
  • 8. Review all patient education materials to see
    what you will need to update/change so that they
    match the final standards
  • 9. Review physical plant, warehouse, vehicles
  • 10. Perform a Mock Survey- make corrections
  • Notify your provider that youre ready!

  • Stay Tuned!
  • Watch for updates in the media on a weekly basis
  • Release of the next 70 CBAs (can be multiple
  • Conferences held by the CBIC to instruct
  • Pricing for items for bid in the first CBAs

  • The Most Effective Way to Survive and Thrive in
    Your Business is to
  • Be Prepared

Your Questions ???
Thank You!
  • Mary Ellen Conway
  • President
  • Capital Healthcare Group, LLC
  • Bethesda, MD
  • 301-896-0193
Write a Comment
User Comments (0)