Accreditation status needs to be verified

Friday, July 31, 2009

ALEXANDRIA, Va.--There’s a chance that accreditation for home infusion may not pass muster with Medicare’s quality standards for durable medical equipment and supplies (DMEPOS).

“It’s not that they are not meeting CMS’s quality standards, it’s that they are not certified as meeting them by their accrediting organization,” said Bruce Rodman, vice president of health information and policy for the National Home Infusion Association (NHIA).

All providers who bill for Medicare Part B must be accredited by Sept. 30. Most infusion pharmacies are already accredited to meet extensive quality standards that pertain to home infusion. CMS’s DMEPOS quality standards are more generic, without any specific standards for home infusion, said Rodman.

“There seems to be a need for better clarification on what happens when a home infusion provider has been accredited and how it relates to being accredited for Medicare DMEPOS,” he said. “We are working with our members to make sure all the I’s are dotted and T’s are crossed with the NSC.”

Infusion pumps, enteral and total parenteral nutrition fall under the DMEPOS umbrella, said Sandra Canally, president of The Compliance Team.

If an infusion provider only offers the infusion drugs and contracts with a DME to provide the pumps, they aren’t required by Medicare to be accredited, although most are, said Canally.

“A lot of managed care payers want them to get accredited, but outside of what comes under DMEPOS, it’s not mandated,” she said.

Some of the confusion could stem from simple paperwork errors, said David Franklin, CEO of Vital Care in Meridian, Miss.

“When you get accredited you have to fill out a document stating what you supply,” he said. “If they don’t check off DME thinking they don’t do DME - when in fact they do - they could have problems.”

NHIA recommends that recently accredited home infusion providers file their CMS-855s form with the NSC, alerting them of their accreditation status and then following up to ensure their record of accreditation has been accepted.