Issue link: https://read.dmtmag.com/i/45026
10 News Commercial insurer says providers must be accredited by one of three agencies BY LIZ BEAULIEU, Editor YARMOUTH, Maine – WellPoint, a health plan that owns and admin- isters Blue Cross Blue Shield (BCBS) plans in 14 states, has thrown a monkey wrench into the operations of certain HME providers. WellPoint recently notified pro- viders in Georgia that to remain part of its network they must be accredited by one of these three accreditation agencies by March 1, 2012: The Joint Commission, ACHC and CHAP. Though it only notified providers in Geor- gia, industry stakeholders say the requirement is a "national policy" that applies to all the states where it has a presence. "I'm angry," said Mary Nicho- las, executive director of HQAA. "And my providers are angry. It's another blow, in addition to the WWW.HMENEWS.COM / NOVEMBER 2011 / HME NEWS Accreditation: Medicare's requirement not foolproof audits and the other threats to their businesses." In 2009, through a bill called the Medicare Modernization Act (MMA), Medicare started requiring that HME providers be accredited by one of 10 "deemed" agencies. The Joint Commis- sion, ACHC and CHAP were on the list, but so were HQAA, The Compliance Team and five others. As it stands right now, provid- ers that aren't accredited by one of the three agencies must become accredited by an additional agen- cy or switch agencies to meet WellPoint's requirement. "We have numerous providers that are already part of WellPoint's network," said Sandy Canally, president of The Compliance Team. "This means they have to leave the network and re-enroll once they're accredited by one of the three agencies." Because Medicare has no WELLPOINT SEE PAGE 14 DEFICIT CONTINUED FROM PAGE 4 its first and second recommenda- tions, for example, for what geo- graphical areas? "It's not good news," said Cara Bachenheimer, senior vice presi- dent of government relations for Invacare. "But for a lot of these, we just don't know what they're talking about." In fact, some of the recommen- dations and savings may be, at least in part, already implemented and realized, stakeholders say. "Some of these recommenda- tions come from a June 2003 report from MedPac," said Seth Johnson, vice president of gov- ernment affairs for Pride Mobil- ity Products. "These recom- mendations are dated and don't reflect Wayne Stanfield what's already in place." Both MedPac and the president recommend requiring prepayment reviews for all power wheelchairs for $200 million in savings over 10 years (MedPac's estimate). The president's recommendations, which represent a total of $248 billion in savings over 10 years, also include: "Limit federal reim- bursement for a state's Medicaid spending on certain DME servic- es to what Medicare would have paid in the same state for the same services" for $3 billion in 10-year savings. Congressional committees with jurisdiction, like the House Ways and Means Committee, will also make recommendations to the "supercommittee." It will likely be more of the same, stakeholders say. "You've got the administration and CMS touting competitive bid- ding and now you've got MedPac touting competitive bidding," said Wayne Stanfield, president and CEO of NAIMES. "What impact will this have on the 'supercom- mittee'? You can bet that DME is going to be hit in some way." HME