Turf wars

For AOs, approved by Medicare doesn’t necessarily mean approved by private insurers
Friday, September 25, 2015

When it comes to accreditation, many private insurers need to get with the times, accreditation organizations say.

Private insurers are requiring accreditation, too, but, in some cases, they’re listing only a limited number of the 10 accreditation organizations that Medicare has approved for the task.

“The credentialing departments within the BCBSs and the Aetnas may be using paperwork and policies and processes that go back before the deemed status days of DME, so they may be like, ‘OK, in the old days, Joint Commission was the only game in town,’” said Sandra Canally, founder and president of The Compliance Team. “They don’t realize that marketshare has shifted over the years.”

Medicare made accreditation a requirement in 2009, giving 10 accreditation organizations, including The Compliance Team, “deemed authority.”

Newer insurers trying to take advantage of the steady stream of states privatizing their Medicaid programs also aren’t up on what’s what in accreditation, says Mary Nicholas.

“We just learned from one of our customers that one of the private insurers in Michigan doesn’t accept HQAA,” said Nicholas, president and CEO of the accreditation company, also a  “deemed authority” with Medicare. “In their application for becoming accredited for DME, they list 12 places to check off, but only three of them are Medicare-deemed authorities.”

So what are providers in these situations to do? Write in their accreditation company and send the insurer a copy of their certification or, even better, their full report, Canally says.

“A lot of times that will work,” she said.

It’s always good to call the insurer and point out the discrepancy and the possible impact on members, both Canally and Nicholas say. In tougher cases, as in Arkansas, where it took BCBS in that state nearly six years to list HQAA as an accreditation organization, it’s a necessity.

“I’ve made my fifth call to this insurance company in Michigan,” Nicholas said. “I have more than 50 customers in Michigan, so I’d like to talk to them.”