Why does my facility need accreditation?

Your facility needs accreditation to ensure quality patient care and to be able to bill Medicare and other insurance carriers.

Does my facility need to be accredited?

If your facility wishes to bill Medicare Part B claims or participate in the Competitive Bidding process, you will need to be accredited.

Insurance companies have implemented all, or parts, of the Medicare Quality Standards such as: Fraud, Waste & Abuse, Conflict of Interest and Medicare Exclusion Verification protocols for plan participation.

Should I apply for the pharmacy exemption?

The pharmacy exemption is only for pharmacies who are doing very little Medicare DMEPOS items.  To qualify for the exemption;

  • Pharmacy must have an active Medicare PTAN for 5 years or more
  • Pharmacy EIN/TIN must be 5 years old or more
  • Pharmacy must have no disciplinary actions taken towards them from any state or federal agency (i.e. State Board of Pharmacy cites the pharmacy for having expire medications will exclude the pharmacy from the exemption rule)
  • Must have Medicare DMEPOS sales less than 5% of pharmaceutical and OTC sales

The exemption only exempts the accreditation survey, all of the rules, regulations and requirements must continue to be used.

CMS and other organizations are providing confusing information and the regulations and LCD’s are constantly changing. The only thing certain is that accreditation is here to stay. The requirements will continue to grow. Everyone must evaluate their own operation and make an informed decision on what is best for them.

How much time does Medicare accreditation take?

Typically, the process will take 6 months from start to finish.

Are there off-the-shelf programs available?

Yes, there are several programs available for purchase. However, these programs require you to write your own facility’s procedures for each Medicare policy. 

Is HIPAA part of Medicare Accreditation?

Yes, HIPAA is a major component of the Quality Standard, Information Management Section

What statutes regulates accreditation?

Primary

  • Medicare Quality Standards
Additional Regulations
  • Medicare DMEPOS Supplier Standards
  • Medicare DME MAC Region Local Coverage Determinations
  • HIPAA Compliance regulations
  • OSHA standards
  • Fraud, Waste and Abuse regulations
  • Human Resource standards

Is there anyone that can help prepare our pharmacy/medical supply company for Medicare Accreditation?

Yes. R.J. Hedges & Associates prepares your policies and procedures for your operation. The HIPAA Guy™ and his staff are well versed in preparing government documentation and taking complicated requirements and converting them into easy to follow procedures that integrate into your work practices.