Issue link: https://read.dmtmag.com/i/45026
12 News Payers cherry pick accreditation agencies BY LIZ BEAULIEU, Editor YARMOUTH, Maine – It's not the first time HME providers have felt like they landed on the short end of the stick when it comes to accreditation. Several years ago, the Depart- ment of Veterans Affairs (VA) came close to limiting providers to being accredited by one accreditation agency. The VA ultimately decided providers could be accredited by any agency, but that the agency's standards had to at least meet the Joint Commission's standards. What's been the impact of that requirement? "We still lost the potential busi- ness of a very large customer based on their fear that the VA wouldn't accept their accreditation," said Mary Nicholas, executive director of HQAA. "But we're making some WWW.HMENEWS.COM / NOVEMBER 2011 / HME NEWS 'IT GETS COMPLICATED' headway with some of the regional centers." Industry stakeholders suspect that WellPoint and the VA have requirements like these as a way to limit the number of providers they have to work with and to reduce the amount of administrative work they have to do. That desire's not going to go away anytime soon. So in many ways, it's up to the accreditation agencies to be aggressive advocates for their standards and their provid- ers, says Tim Safley, clinical man- ager for HME, sleep and pharmacy, for ACHC, which is one of three agencies approved by WellPoint. "We've fought this battle since 1993," he said. "We were around before accreditation was cool and it was only the Joint Commission and CHAP. We've had to prove our worth through countless memos and emails, and through a com- parison of standards. It gets com- plicated." There's another reason for the requirements: Not all accreditation agencies are created equal, even among the 10 agencies approved by Medicare, says Margherita Labson, executive director of the homecare program for the Joint Commission. "That's increasingly become a challenge for payers," she said. "Are they going to recognize all 10 as equivalent or do they look under- neath that and see what's involved in the process? I think it makes really good sense to do that." HME BID CONTINUED FROM PAGE 6 dual eligible population, which is significant," said Shirvinsky. This could even bar non-New Jersey providers from submit- ting a bid, since all bid winners must be able to serve all Medicare recipients within the entire CBA, Shirvinsky said. "So the question is, if I cannot bill dual eligibles in New Jersey, am I even eligible to bid?" he said. Also in New Jersey: There's a requirement that a provider employ a licensed respiratory therapist to visit a patient within 24 hours of oxygen equipment being dropped off. Providers who plan to bid in the Pennsylvania CBAs are work- ing to meet each state's require- ments. Provider Bill Bayer is already licensed to do business in New Jersey, as Bristol, Pa.-based Medical Express is right on the border. He has had to become a licensed RT. "(The respiratory therapist license) wasn't the easiest license to get as far as the whole appli- cation process," said Bayer, who had to fetch his high school tran- scripts after more than 30 years, despite having bachelor's and master's degrees. Even without the obstacles presented by each state's require- ments, Shirvinsky said the CBAs are too big for an industry made up mostly of small businesses. "Metropolitan statistical areas are not healthcare markets," said Shirvinsky. "They're a creation of the census bureau and the depart- ment of labor and they're for data analysis." HME