Accreditation stakes are high under new rule

WATERLOO, Iowa – A new accreditation guide from VGM & Associates and the Healthcare Quality Association on Accreditation (HQAA) is well-timed, with reports of home medical equipment (HME) providers falling short in their resurveys under a new Medicare rule that requires 100% compliance on all standards starting this year.

Depending on their accreditation timeline, providers who fail to meet the standard risk a lapse in accreditation followed by a temporary revocation of their provider transaction access number (PTAN). To avoid that scenario, Craig Douglas, CEO and executive director of HQAA, recommends building additional time into resurvey planning.

“There are always going to be some deficiencies, right, and all of that needs to be corrected,” he said. “So, having to meet 100% compliance makes the process potentially go longer.”

The guide reviews commonly cited deficiencies, including meeting state licensure requirements.

Accrediting organizations also face added pressure

Accrediting organizations (AOs) are also navigating increased oversight. All AOs are currently undergoing a revalidation process to maintain their deemed status with the Centers for Medicare & Medicaid Services (CMS).

CMS distributed revalidation applications in early March with a submission deadline of May 1. The agency has up to 210 days from that date to complete its review and issue determinations.

“They said they would acknowledge receipt and they’ve done that for us,” Douglas said.

Fraud – and CMS oversight – driving changes

CMS has framed the changes as part of a broader effort to reduce fraud, waste and abuse. However, Douglas said the updates may also reflect the agency reasserting control over the accreditation process after two decades without major changes.

“I look at accreditation as their thing and they’ve outsourced it to AOs,” he said. “They have the ultimate say in how it looks and how we do it on their behalf. While AOs certainly have some say in how their respective programs are structured, CMS still makes and enforce the rules.’”

Resurvey timing, moratorium reshape market

While much of the attention has focused on CMS’s move to a one-year resurvey, Douglas said providers may not feel the full impact until 2027 or 2028, as existing accreditation cycles phase out.

In the meantime, another CMS anti-fraud measure is already affecting the market: a six-month moratorium on new supplier numbers for DMEPOS providers. The moratorium is slowing new entrants and, in turn, reducing demand for accreditation services, Douglas said.

“Suppliers thinking about entering the market aren’t going to get accredited under a one-year resurvey requirement because they can’t get a number right now,” he said. “Many are also waiting to see if the moratorium gets extended.”