CMS Accreditation Update - The Latest from the MSAs:

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CMS Accreditation Update - The Latest from the MSAs:

  1. 1. 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 . Mary Ellen Conway President
  2. 2. Overview <ul><li>What is the Accreditation Requirement? </li></ul><ul><li>First 10 MSA’s, Next 70 </li></ul><ul><li>When do YOU Need to be Ready? </li></ul><ul><li>Current Important Legislative Activity </li></ul><ul><li>“ Inconspicuous Items” </li></ul><ul><li>Report from the First 10 CBA’s </li></ul>
  3. 3. Overview Continued <ul><li>How Do You Get Started? </li></ul><ul><li>Tips on Choosing Your Accreditor </li></ul><ul><ul><li>Issues with fees/costs </li></ul></ul><ul><li>The Current Ten Recognized Accreditation Providers </li></ul><ul><li>Models/Formats </li></ul><ul><li>Video Examples </li></ul><ul><li>Main Reasons Organizations Fail </li></ul><ul><li>How Long Does It Take? </li></ul><ul><li>Ten Things You Can Do Now to be Ready </li></ul>
  4. 4. Common Acronyms <ul><li>CBA Competitive Bid Area </li></ul><ul><li>CBIC Competitive Bidding Implementation Contractor </li></ul><ul><li>CMS Center for Medicare Medicaid Services </li></ul><ul><li>DME Durable Medical Equipment </li></ul><ul><li>DMEPOS Durable Medical Equipment, Prosthetics, Orthotics and Supplies </li></ul><ul><li>HME Home Medical Equipment </li></ul><ul><li>MMA ’03 Medicare Modernization Act of ’03 </li></ul><ul><li>MSA Metropolitan Statistical Area </li></ul>
  5. 5. What is the Accreditation Requirement? <ul><li>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 </li></ul><ul><li>There are between 117,000 and 150,000 Medicare Part B supplier numbers </li></ul><ul><li>This applies to DME’s as well as pharmacies billing for identified items </li></ul>
  6. 6. The “Dominos” <ul><li>CMS is enforcing the law that requires competitive bidding in 2007 </li></ul><ul><li>(Slated to begin July 2008) </li></ul><ul><li>Only accredited organizations can be awarded a bid </li></ul><ul><li>Accreditation must be by recognized accreditors </li></ul><ul><li>Provider must comply with Final Quality Standards (Released 8-14-06) </li></ul>
  7. 7. Why is this happening? <ul><li>High profile fraud and abuse cases </li></ul><ul><li>New price list alone will not solve </li></ul>
  8. 8. Competitive Bidding Timeline <ul><li>Bidding opened May 15, 2007 </li></ul><ul><li>Bidding closed September 26, 2007 </li></ul><ul><li>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 CBA’s and in a additional 70 (for a total of 80) to begin July 1, 2009 </li></ul><ul><li>See website www.dmecometitivebid.com </li></ul>
  9. 9. The First 10 CBA’s <ul><li>Charlotte-Gastonia-Concord: NC-SC </li></ul><ul><li>Cincinnati-Middletown, OH-KY-IN </li></ul><ul><li>Cleveland-Elyria-Mentor, OH </li></ul><ul><li>Dallas-FT Worth-Arlington, TX </li></ul><ul><li>Kansas City, KS-MO </li></ul><ul><li>Miami, Ft Lauderdale, Miami Beach, FL </li></ul><ul><li>Riverside, San Bernadino, Ontario, CA </li></ul><ul><li>Orlando, Kissimmee, FL </li></ul><ul><li>Pittsburgh, PA </li></ul><ul><li>San Juan, Caguas, Guaynabo, Puerto Rico </li></ul>
  10. 10. Next 80 Largest MSA’s <ul><li>Los Angeles New York Chicago San Diego </li></ul><ul><li>Washington, DC St Louis, MO/IL Richmond, VA Louisville </li></ul><ul><li>Phoenix Seattle Houston Atlanta </li></ul><ul><li>Nassua/Suffolk Oakland, CA Denver Newark, NJ </li></ul><ul><li>Portland, OR Ft Worth, TX Las Vegas San Jose, CA </li></ul><ul><li>Boston Indianapolis San Antonio Virginia Beach </li></ul><ul><li>Columbus, OH Milwaukee Bergen, NJ New Orleans </li></ul><ul><li>Salk Lake City Greensboro, NC Austin Nashville </li></ul><ul><li>Providence. RI Raleigh/Durham Hartford Buffalo </li></ul><ul><li>Middlesex/Somerset Memphis W Palm/Boca Monmouth </li></ul><ul><li>Jacksonville Rochester, NY Grand Rapids Fresno </li></ul><ul><li>Philadelphia, PA San Francisco, CA Tampa Detroit </li></ul>
  11. 11. Next 80 Largest MSA’s Con’t <ul><li>Oklahoma City Greenville, SC Dayton, OH Honolulu </li></ul><ul><li>Albany Tucson Tulsa Ventura, CA </li></ul><ul><li>Syracuse Omaha Albuquerque Akron </li></ul><ul><li>Knoxville El Paso Bakersfield Gary, IN </li></ul><ul><li>Allentown, PA Harrisburg Scranton Toledo, OH </li></ul><ul><li>Jersey City Baton Rouge Youngstown, OH Springfield, MA </li></ul><ul><li>Little Rock Ann Arbor Stockton, CA Wichita </li></ul><ul><li>Charleston New Haven, CT Mobile, AL Columbia, SC </li></ul><ul><li>McAllen/Edinburg, TX Sarasota/Bradenton </li></ul>
  12. 12. The CBA (Competitive Bid Area) <ul><li>Can be multiple MSA’s </li></ul><ul><ul><li>Applies to defined Zip Codes where the beneficiary resides , not where the provider is located </li></ul></ul><ul><ul><li>Check CBIC website for service area zip codes- can be an enormous service area </li></ul></ul>
  13. 13. When Do You Need to Be Ready? <ul><li>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. </li></ul><ul><li>In order to bid, you will need to be accredited </li></ul><ul><li>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 </li></ul><ul><li>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” </li></ul>
  14. 14. What if You Provide Products and Services in Rural Areas Only? <ul><li>You may never have to participate in Competitive Bidding </li></ul><ul><li>You will get a rate adjustment as CMS will begin to reimburse providers the rates paid in the closest MSA’s </li></ul><ul><li>You must be accredited by some finite date </li></ul>
  15. 15. <ul><li>Final Product Categories </li></ul><ul><li>Oxygen Supplies and Equipment </li></ul><ul><li>Standard Power Wheelchairs, Scooters and Related Accessories </li></ul><ul><li>Complex Rehab Power Chairs and Related Accessories </li></ul><ul><li>Mail Order Diabetic Supplies </li></ul><ul><li>Enteral Nutrients, Equipment and Supplies </li></ul><ul><li>CPAP, RAD’s and Related Supplies and Accessories </li></ul><ul><li>Hospital Beds and Related Accessories </li></ul><ul><li>Negative Pressure Wound Therapy Pumps and Related Supplies and Accessories </li></ul><ul><li>Walkers and Related Accessories </li></ul><ul><li>Support Surfaces (Groups 2 mattresses and overlays) in Miami and San Juan only </li></ul>
  16. 16. Product Selection <ul><li>CMS selected products for CB based on: </li></ul><ul><ul><li>High cost </li></ul></ul><ul><ul><li>High-volume </li></ul></ul><ul><ul><li>Greatest potential for savings </li></ul></ul>
  17. 17. Legislative Activity
  18. 18. What’s the update from the First 10 CBA’s?
  19. 19. Deadlines were VERY tight <ul><li>Many suppliers had their applications and funds returned at the end of June/beginning of July (before the extension was announced) from accreditors </li></ul><ul><li>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 re-visits </li></ul><ul><li>All has to be complete by October 31st </li></ul>
  20. 20. Multiple Bidding Issues <ul><li>Geographic area in each was VERY extensive </li></ul><ul><li>Capacity issues- wait to be seen who is awarded bids </li></ul>
  21. 21. The Next 70? <ul><li>Complaints in Florida about 20 minute accreditation surveys </li></ul><ul><li>Results of validation surveys? </li></ul><ul><ul><li>PAOC Meeting scheduled for October 11, Baltimore, MD </li></ul></ul><ul><li>CMS announced that they are ready for the next 70 CBA’s- could be before the first round contracts begin </li></ul><ul><ul><li>Herb Kuhn, AAHC Legislative Conference, June 6 </li></ul></ul>
  22. 22. How Do I Get Started???
  23. 23. Must Have <ul><li>Performance Management </li></ul><ul><li>Beneficiary satisfaction surveys </li></ul><ul><li>Patient complaint log </li></ul><ul><li>After hours (on call) log to prove timeliness of response to questions, problems and concerns </li></ul><ul><li>Log that documents frequency of billing and/or coding errors </li></ul><ul><li>Log documenting adverse events (as defined by your P & P manual) </li></ul><ul><li>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 </li></ul>
  24. 24. Performance Improvement Examples are Everywhere… <ul><li>Where do you see them? </li></ul>
  25. 27. Tips to Use in Choosing Your Accreditor <ul><li>CMS is not your only payer! </li></ul><ul><ul><li>Payer or state licensure requirements to be accredited ex: Anthem BC, State of Florida, Oklahoma Medicaid </li></ul></ul><ul><li>What is the accreditor’s schedule and what are the requirements for in-between? </li></ul><ul><ul><li>ex: Triennial and or annual updates </li></ul></ul><ul><li>Fees paid vs. administrative costs </li></ul><ul><li>Other services (infusion, home health) </li></ul><ul><li>Process (electronic vs. paper) </li></ul><ul><li>Interview/discussions with accrediting organization—your perceptions </li></ul><ul><li>Your peer’s experience </li></ul>
  26. 28. The Current Ten Recognized Accreditors Not every organization is an option for you
  27. 29. Comparing “Apples-to-Apples” <ul><li>Product Category Definitions </li></ul><ul><li>DME Limited Mobility Aids: Manual W/C, Cane, Walker, Crutches, </li></ul><ul><li>Stationary Commode Chairs, Wound Care and Ostomy Supplies Urological Supplies: Bedpans, Urinals </li></ul><ul><li>DME includes Limited and - Manual and Electric Beds, Traction Equipment </li></ul><ul><li>Medical Supplies- Diabetic Supplies, Enteral Products (Non-home visit items) </li></ul><ul><li>Respiratory- Home medical equipment and supplies covered include respiratory </li></ul><ul><li>equipment and supplies, oxygen, concentrators, reservoirs, </li></ul><ul><li>conserving devices, cylinders and oxygen accessories and supplies, </li></ul><ul><li>home invasive mechanical ventilators, respiratory assist devices, </li></ul><ul><li>continuous and intermittent positive pressure breathing devices, </li></ul><ul><li>nebulizers </li></ul><ul><li>Rehabilitation- Power Mobility devices including complex Rehab and Assistive </li></ul><ul><li>Technology </li></ul><ul><li>Orthotics and Prosthetics- Custom fabricated, custom fitted, custom-made orthotics, prosthetic </li></ul><ul><li>devices, somatic, ocular and facial prosthetics, therapeutic shoes, braces </li></ul><ul><li>and artificial limbs </li></ul>
  28. 30. Accreditation Commission for Healthcare (ACHC) <ul><li>www.achc.org </li></ul><ul><li>DME- All Equipment </li></ul><ul><li>Medical Suppliers (Pharmacies) </li></ul><ul><li>Respiratory </li></ul><ul><li>Rehabilitation </li></ul><ul><li>Orthotics and Prosthetics </li></ul>
  29. 31. American Board of Certification for Orthotics and Prosthetics (ABC of O&P) <ul><li>www.abcop.org </li></ul><ul><li>Orthotics and Prosthetics </li></ul><ul><li>DME Limited- Wound Care/Incontinence, Mobility Aids only if in conjunction with O&P </li></ul><ul><li>Merged with the Board for Certification in Pedorthics (www.cpeds.org) </li></ul>
  30. 32. Board of Orthotic/Prosthetist Certification (BOC) <ul><li>www.bocusa.org </li></ul><ul><li>DME- All Equipment </li></ul><ul><li>Medical Suppliers (Pharmacies) </li></ul><ul><li>Respiratory </li></ul><ul><li>Orthotics and Prosthetics </li></ul>
  31. 33. Commission on Accreditation of Rehabilitation Facilities (CARF) <ul><li>www.carf.org </li></ul><ul><li>Rehabilitation </li></ul><ul><li>Orthotics and Prosthetics </li></ul>
  32. 34. Community Health Accreditation Program (CHAP) <ul><li>www.chapinc.org </li></ul><ul><li>DME- All Equipment </li></ul><ul><li>Medical Suppliers (Pharmacies) </li></ul><ul><li>Respiratory </li></ul><ul><li>Rehabilitation </li></ul><ul><li>Orthotics and Prosthetics </li></ul>
  33. 35. The Compliance Team <ul><li>www.exemplaryprovider.com </li></ul><ul><li>DME- All Equipment </li></ul><ul><li>Medical Suppliers (Pharmacies) </li></ul><ul><li>Respiratory </li></ul><ul><li>Rehabilitation </li></ul><ul><li>Orthotics and Prosthetics </li></ul>
  34. 36. Healthcare Quality Association on Accreditation (HQAA) <ul><li>www.hqaa.org </li></ul><ul><li>DME- All Equipment </li></ul><ul><li>Medical Suppliers (Pharmacies) </li></ul><ul><li>Respiratory </li></ul><ul><li>Rehabilitation </li></ul><ul><li>Orthotics and Prosthetics </li></ul>
  35. 37. Joint Commission (JCAHO) <ul><li>www.jcaho.org </li></ul><ul><li>DME- All Equipment </li></ul><ul><li>Medical Suppliers (Pharmacies) </li></ul><ul><li>Respiratory </li></ul><ul><li>Rehabilitation </li></ul><ul><li>Orthotics and Prosthetics </li></ul>
  36. 38. National Association of Boards of Pharmacy (NABP) <ul><li>www.nabp.net </li></ul><ul><li>DME Limited- Wound Care/Incontinence, Mobility Aids </li></ul><ul><li>Medical Suppliers (Pharmacies) </li></ul>
  37. 39. National Board of Accreditation for Orthotic Suppliers (NBAOS) <ul><li>www.nbaos.org </li></ul><ul><li>Orthotics and Prosthetics </li></ul>
  38. 40. Models/Formats <ul><li>Models/Format of Programs </li></ul><ul><li>Additionally </li></ul><ul><ul><li>Paper Based vs Electronic </li></ul></ul>
  39. 41. Video Examples <ul><li>Anxiety about the Surveyor </li></ul><ul><li>Home Visit </li></ul>
  40. 43. Home Visits <ul><li>GO OUT AND SEE WHAT’S HAPPENING!!! </li></ul><ul><li>Surveyors will interview patients, asking how they were oriented, how to reach the office, how the services has been, any problems… </li></ul>
  41. 45. Main Reasons Organization Fail <ul><li>Lack of Preparedness </li></ul><ul><li>Few Staff Aware of Process/Requirements </li></ul><ul><li>Lack of Focus and Follow-through </li></ul><ul><li>Main items: </li></ul><ul><ul><li>Physician Orders </li></ul></ul><ul><ul><li>Infection Control </li></ul></ul><ul><ul><li>Incomplete HR Files </li></ul></ul>
  42. 46. How Long Does It Take? <ul><li>Generally at least 4 – 6 months from start to completion </li></ul><ul><li>Do you have everything you need? </li></ul><ul><ul><li>Policies and Procedures, Educational Materials, etc. </li></ul></ul><ul><ul><li>How long will it take for you to get these in place? </li></ul></ul><ul><li>Once you gather your information, how long will it take for you to coordinate and submit your materials? </li></ul><ul><ul><li>Average is 2 – 3 months </li></ul></ul><ul><li>When you notify your accreditation company that you are ready, how long until your survey? </li></ul><ul><ul><li>Schedules are usually 45 – 60 days in advance-Surveys must be un-announced within a window of time that you are ready </li></ul></ul>
  43. 47. 10 Things You Can Do <ul><li>1. Download and become VERY comfortable with the final quality standards---read them carefully </li></ul><ul><li>2. Review and talk to your payers to make an informed decision as you choose your accreditation provider right away </li></ul><ul><li>3. Send for your accreditor’s standards ASAP </li></ul><ul><li>4. Review and update your P&P (or BUY one!) </li></ul><ul><li>www.vgmeducation.com/shop </li></ul><ul><li>www.accreditationresources.com </li></ul><ul><li>5. Identify your team(s)--- review the standards by team and identify what you need to do </li></ul>
  44. 48. 10 Things You can Do <ul><li>6. Educate the staff NOW- practice discussions </li></ul><ul><li>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 ready </li></ul><ul><li>8. Review all patient education materials to see what you will need to update/change so that they match the final standards </li></ul><ul><li>9. Review physical plant, warehouse, vehicles </li></ul><ul><li>10. Perform a Mock Survey - make corrections </li></ul><ul><li>Notify your provider that you’re ready! </li></ul>
  45. 49. <ul><li>Stay Tuned! </li></ul><ul><li>Watch for updates in the media on a weekly basis </li></ul><ul><li>Release of the next 70 CBA’s (can be multiple MSA’s) </li></ul><ul><li>Conferences held by the CBIC to instruct beneficiaries </li></ul><ul><li>Pricing for items for bid in the first CBA’s </li></ul>
  46. 50. <ul><li>The Most Effective Way to Survive and Thrive in Your Business is to </li></ul><ul><li>Be Prepared </li></ul>
  47. 51. Your Questions ???
  48. 52. Thank You! <ul><li>Mary Ellen Conway </li></ul><ul><li>President </li></ul><ul><li>Capital Healthcare Group, LLC </li></ul><ul><li>Bethesda, MD </li></ul><ul><li>301-896-0193 </li></ul><ul><li>www.capitalhealthcaregroup.com </li></ul>

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