Take the High Road When It Comes to Accreditation

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The future of regulations for orthotic and prosthetic providers is changing. In 2003, the U.S. Congress included a provision in the far-reaching Medicare Modernization Act calling for the Centers for Medicare & Medicaid Services (CMS) to overhaul regulation of and reimbursement to all suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).

CMS responded by creating a competitive bidding program and quality standards for all DMEPOS providers. Released in August 2006, the new quality standards will be phased in, and all DMEPOS providers must meet the mandatory accreditation requirement, regardless of whether or not they are participating in the competitive bidding program.

What Does This Mean for the O&P Profession?

This means that the question for O&P business owners and practice managers is not whether to become accredited, but when and by whom .

Private insurance companies and managed care organizations have begun to adopt accreditation requirements for network providers, and CMS is already requiring accreditation from those facilities that are applying for provider status under the competitive bidding program. The American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC) estimates that 50 percent of all O&P patient care facilities are already ABC accredited. Those that are not yet accredited are running the risk of being left outside of changing insurance networks and, ultimately, being excluded from the Medicare payment system.

In the article "What You Should Know about Accreditation" (The O&P EDGE, May 2007), John Latsko, a leading healthcare attorney, addressed several important points relating to the issues O&P suppliers need to take into account when determining which accreditation organization is right for their practice. The first critical point is that not all accrediting organizations are the same. "It is important that a supplier pick an accrediting organization that has a solid reputation and long history for maintaining high standards, accredits entities that also have good reputations, and does not market itself as an 'easy' accreditation," Latsko writes.

The genesis for this statement comes from the CMS quality standards themselves. In the standards, CMS lays out strict guidelines for "Deemed Accrediting Organizations" to follow. The idea is for accrediting organizations to provide a baseline accreditation that meets the strict CMS guidelines and ensures that only professional, non-fraudulent suppliers are able to continue in the Medicare DMEPOS payment system.

Long-standing accrediting organizations, such as ABC, have an advantage in meeting the requirements of CMS to remain a "Deemed Accrediting Organization." In ABC's 59-year history, thousands of O&P suppliers have been awarded accreditation. Hundreds have not. This is important from Medicare's point of view because, as Latsko points out, "CMS knows that all potential suppliers do not meet its quality standards." O&P suppliers should be skeptical of new, unproved accreditation organizations that promise easy accreditation, as CMS will be monitoring the accrediting organizations closely. Latsko further cautions: "Some suppliers will look to the accreditation organization with the lowest cost, the least burdensome survey procedures, and the highest 'pass rate.' This may be a mistake."

Is it really worth risking the future viability of your practice by seeking accreditation from a questionable source?

Accreditation Does Not Happen Overnight

Achieving accreditation is a process. Meeting the standards and preparing for the survey may take months of preliminary work. For example, proper documentation is an important part of the CMS quality standards. Each patient visit must be noted in a HIPAA-compliant chart, and each prescription must be kept and followed. The use of index cards is no longer an acceptable method of documentation. Although many facilities may need to change some of their internal procedures to meet CMS standards, the ABC accreditation and survey process can help.

ABC's accreditation program is designed to help O&P facilities meet a high standard. The survey process is consultative in nature as ABC surveyors are helpful in developing solutions to any deficiencies uncovered in the survey process. Achieving ABC accreditation is a sound business decision.

Tom Derrick is the director of public relations, marketing, and ethics for the ABC. He can be reached at  tderrick@abcop.org. For more information on accreditation, including the ABC Accreditation Guide and Standards Manuals, visit  www.abcop.org.

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