Medicare Compliance & Reimbursement

Master DME accreditation now -- or risk falling behind.

Are you ready to seek accreditation as a durable medical equipment (DME) supplier? If not, then brace yourself for Medicare denials.

The situation: For now, only suppliers who take part in competitive bidding must be accredited as DME providers, according to an official with the Centers for Medicare & Medicaid Services (CMS). But "all suppliers--including physicians who are supplying DME only to their own patients--will eventually need to be accredited," says the official. CMS could announce a national accreditation deadline at any time.

The problem: Accreditation "can be quite costly," worries Chris Acevedo with Acevedo Consulting in Delray Beach, FL. The hardest hit: orthopedic practices providing walkers, canes and crutches to patients with broken limbs; ophthalmologists providing glasses to patients; and oncology practices providing implanted infusion pumps.

This burden on physician practices "is one of the unintended consequences" of Medicare's push to eliminate fly-by-night DME suppliers, says Acevedo. "It's really designed for the large organizations, to crack down on fraudulent business practices," he explains. Medicare should exempt physicians from this requirement, he argues.

Watch out: Many physician offices won't know about the accreditation requirement until they receive a payment denial, Acevedo notes. "And the accreditation process is not an overnight process." Accreditation includes on-site inspections and annual per-site fees. You may have to pay for lodging for your site inspector, Acevedo adds.

Some accreditation standards wouldn't apply to physician offices because you don't have a warehouse or storefront, notes Sherry Hedrick, director of compliance and accreditation with the Accreditation Commission for Health Care (ACHC). But ACHC would just apply most of its standards "a little differently because of the setting."

Most ACHC standards for DME are pretty common sense, Hedrick adds. They require you to separate clean and dirty items, provide clear instructions to the patient on how to use the item, and make the patient aware of the cost of the item up front. Above all, you should follow "consistent rules" in dispensing DME, Hedrick says.