Think beyond Medicare

Q. If I don’t need to get accredited, for a certain payer, is it still important?
Friday, December 28, 2012

A. Yes. No matter how long you have owned your practice or facility and how successful you have become, policies change and reimbursements fluctuate. In many cases, certain products continue to have a higher profit rate than others. To be able to provide those products, you must have proper staff and credentials. That is where accreditation can help.

Another thing to consider is the increase in the number of Medicare audits, causing millions of dollars to be recouped annually from providers. Being accredited helps to provide you with a proper intake process and it will help you and your employees better understand and comply with the documentation requirements and supplier standards.

No one can predict what will happen when it comes to Medicare. What is required today could change tomorrow. 

What you may not know is that there are many state funded and private insurers that will require you to be accredited before they will review your application. The problem is, they do not always follow the same rules as Medicare does. So, even if you are exempt from carrying that accreditation for Medicare and you apply to one of those insurers, the rules may differ. Also, remember that private insurers do not necessarily recognize all of the accrediting organizations that Medicare has deemed acceptable. 

As the industry grows and payers try to keep costs down, you will see this begin to happen more and more. It is important to do your research before signing up with any accrediting agency. Know what they are offering to you based on what the insurance companies require of you.

Roni Pidcock is vice president of Quality Healthcare Systems. She can be reached at 855.747.5555 or