Both Sides and Why Providers Should Protest

I’m an industry consultant, and we have helped hundreds of DMEs through the accreditation process. We know what we are doing and all of our clients pass, and we also don’t gouge people. We didn’t raise our prices when accreditation became mandatory. We have worked with every accredting body on CMS approved list.

I’m not going to use my name here, because I don’t want anyone mad at me. But here is the real deal as I see it, from both sides — the DME provider side, and the CMS side.

1. The industry as a whole has known this requirement was coming for 3 years. It was well publicized. If a DME company did NOT apply to their chosen accrediting body prior to Jan 31, 2008, they probably don’t have much of any excuse for not getting accredited in time. HOWEVER….

2. Their have been plenty of problems with the accrediting bodies themselves. Here are just a few I have seen first hand among my clients:

A. Document submission procceses overseen by truly unqualified individuals who have no idea what they are looking at or looking for. Impossible to believe some of these folks have ever worked in the DME industry.

B. Document submission requirements that are so cumbersome you could have applied by Jan 31st, as suggested, and still not complete the document process by the AO’s deadline in order to be surveyed on time.

C. Very poor customer service with some of the newer AOs that were entirely unprepared for the number of applicants they received. Not acknowledging receipt of application, not sending a decision letter even months after the survey occured. Giving provisional accreditation and never following up with information about steps to be taken for full accreditation (this has happened over and over again).

D. Frankly, some of the surveyors are just very poor. I suppose that is to be expected, but at one point we had to proactively tell our clients not to get upset at some of the outrageous things they were told during their on-site survey, because the AOs board would not let those things into the final report. And they didn’t, but they some of the less than experienced surveyors sure got a lot of folks worked up for no reason.

3. ABCOPP, a CMS approved accrediting body has been accrediting those they could not get to in time without a site visit. Naturally, this is completely unfair to folks waiting for the required survey with other AOs. What I am hearing is that CMS is claiming this is okay because ABCOPP’s document submission process is so rigourous. To that I say an unqualified “BALONEY!” It is no different than any of the other approved accrediting bodies document submission processes. And we work with all of them, so again, baloney. ABCOPP must have a friend at CMS.

So those of you still waiting for a site survey from one of the other AOs should be raising holy hell with CMS / NSC. Ask them if you can just switch to ABCOPP and get the special deal their providers got — “grandfathered in” without having to get a survey. Maybe ABCOPP can take 29K applications this week from all the unaccredited providers so those providers can stay in business.

This list could go on and on, but the bottom line is that CMS has done a very, very poor job of holding the AOs accountable for having a standard process, and has not provided even a mimimum of oversight of the AOs.

One other thing I should mention — the experienced accrediting bodies (ACHC, CHAP, and Joint Commission) did a good job during this process. Their surveyors are well trained, with few exceptions, very professional, and they did get their surveys done on time for folks that applied by the suggested deadline. We have not seen more than a trickle of problems with our clients that choose the experienced AOs. Just a heads up for next time.

(CRE Editorial Note:  Anonymous posts are welcome; we leave each writer with the choice to do so or not. CRE is a regulatory watchdog which has no financial relationship with any federal agency; consequently there is no need for any of  it’s work to be annoymous–others might not enjoy such a luxury).

14 Responses to “Both Sides and Why Providers Should Protest”

  1. Steve Winter said:

    Sep 28, 09 at 10:41 pm

    The Patients will suffer because nobody will take a stand . This is why you see so many ananymous comments.If you beleive somethings wrong you should fight it. Bottom line if any patient does not get a catheter in October because of this mess we are instructing the patients to go to the ER room.
    Not one Medicare patient was ever notified about this potential disaster in October.
    CMS will have to extend the deadline or promise to honor any claim retroactive claim or they will be liable for the disruption of the patients healthcare. If a patient has to reuse a urinary catheter and gets infected everybody loses.
    90 day extension or let every dealer that is scheduled be accredited and if they do not pass their visit they can lose their Medicare number.
    To the competitors of ABCOPP, how did they come up with this creative procedure and you did not .
    Should the nine other companies be liable for not letting their customers know they DID NOT NEED A PHYSICAL VISIT when they told their clients the wole time that they did.
    Somebody did not do their homework or ABCOPP has pulled a fast one and it needs to have Congress investigate the “special treatment”
    Did ABCOPP charge extra to their customers for this “Rapid Service”

  2. CRE said:

    Sep 28, 09 at 11:18 pm

    The ability for ABCOPP to give accreditations without site visits is news to us. We would appreciate information on this matter from our readers who, as you can tell, are very informed on a wide variety of subjects.

    We provide information to CMS on a continual basis.

  3. CRE said:

    Sep 28, 09 at 11:35 pm

    The statements in paragraph 2(C) in the first comment are alarming. To the extent CRE receives supporting documentation, CRE will consider filing a “Petition for Reconsideration” which would request that CMS revist their decision not to grant an extension.

  4. Anonymous said:

    Sep 29, 09 at 3:18 am

    The information is not, to my knowledge, news to CMS, and not to the HME Industry publications. The fear of backlash is what keeps it from being spoken about openly.

    The HME industry publications know about it, but can’t find anyone to quote. We all have children to feed and send to college. There is no Qui Tam for us. I can’t sacrifice my career over it, and besides that we have legally binding confidentiality agreements with providers we assist.

    Accreditation without an on-site survey? Unbelievable, and something I bet every AO wishes they’d had the option to offer – well, except JC, ACHC and CHAP. They have standards they probably would not have compromised even if they had been given the option. But the point is there seems to be different rules for different AOs, and the other AOs were not given the option that CMS is apparently offering to ABCOPP.

    As for 2c, I have several clients that were surveyed prior to July, 2009 that still have not received any decision letter from a particular AO (not ABCOPP). And this is an AO that never answers the phone when my clients call, or, if they do reach a live human being, tells them they will eventually receive an email. No other information, even months after the survey occurred. Unfortunately, at this late date, the email, if it arrives, will be meaningless when it comes to helping them continue their Medicare supplier number. Who knows how long the NSC will take to reinstate the supplier number once the supplier gets the official notification.

    Another AO is repeatedly requesting documents from providers, after the survey, that were turned in at the time of application, and deferring or declining the providers accreditation until they are submitted yet again. Fine, we resubmitted them – no changes, and they were accepted. But this required extra time, expense and aggravation for the supplier, AND delayed the decision process. And if they didn’t think they had them at the time of survey, why didn’t the surveyor just ask for them? They were in place. Obviously their process is a mess. Anyone who is the midst of this kind of process is going to be unfairly harmed by the process.

    Thank goodness there is an anonymous forum to leak this information. Investigate, to the best of the resources you have, is all I can say. Ask CMS what their minimum standards are for an AO to accredit a DME company. Ask what the oversight is. It is non-existent. Call ABCOPP, talk to Scott Williamson, and ask about the special dispensation they claim they have from CMS that no other AO seems to have, which the NSC seems willing to accept.

  5. Anonymous said:

    Sep 29, 09 at 4:06 am

    I am the industry consultant that started this thread and need to correct a typo in my original post… the application date I stated was actually Jan 31st, 2009. I mistakenly typed 2008. I apologize for not proofreading before the post was sent.

    But as long as I am posting again, let me give you some examples of the poor surveyor training:

    1. One surveyor insisted that providers must have different colored folders for different types of patients. I assure you, there is nothing in ANY AOs standards that requires this.

    2. Another surveyor made the rounds of many, many surveys calling patients and quizzing them about their patient rights, and faulting the provider when the patients could not recite the rights, even though each of those providers had signed statements from the patient that they had received the required patient rights from the provider. I ask you, what is the provider supposed to do – give the patient a quiz to make sure they could recite the patient rights, and refuse to provide the equipment or supplies if they could not recite them?

    3. We had clients hire us, after the fact, when a surveyor flunked a provider within an hour of the start of their survey, and then pitched their consulting services to help them pass. Can you say, “conflict of interest” — why does ANY AO allow their surveyors to also offer consulting services “on the side.”

    4. We saw multiple instances of surveyors “flunking” providers based on the surveyor not understanding state licensure rules. In fact, on more than one occasion, we had to print a copy of the state licensure laws and highlight the relevant language that demonstrated that the licensure law in question did not apply to the specific provider and submit that to the AO board. I have to give the AO boards credit for cutting these off at the time of final decision, with our documentation. But in some cases it was a very cumbersome, time consuming process. And shouldn’t a competent surveyor understand the licensure rules in the states they survey in?

    These are just the most egregious items that stick out, but the bottom line is the process is flawed, and CMS has not provided the proper oversight of the AOs.

  6. CRE said:

    Sep 29, 09 at 6:23 am

    We understand completely, and fully appreciate, the reason for your annoymous postings.

    The statements you have made are of such importance that CRE will, within our available resources, initiate an investigation of this matter.

    CRE investigations are very transparent. We post our requests for information and responses thereto on this Discussion Forum.
    In addition, all of our readers are given the opportunity to comment on our actions.

    Government agencies, including CMS and OMB will be advised of our actions.

    CRE was founded and is presently managed by former career of officals of the White House Office of Management and Budget and is cognizant of the importance of preparing objective analyses.

    See http://thecre.com/ombpapers/OMB_Officials.htm

  7. Anonymous said:

    Sep 29, 09 at 8:52 am

    We have met every deadline and are still waiting for our on-site. A question I have not seen addressed yet…if we need to suspend our number, what do we do with all of our existing medicare patients?

  8. Steve Winter said:

    Sep 29, 09 at 10:46 am

    The HME magazines who cannot find quotes can just call ABCOPP.
    I spoke with them yesterday and they fully admit that they accredited dealers without a visit.There is no secret.
    I also spoke with a top CMS rep who stated the same thing.
    They are not hiding anything.
    ABCOPP states they developed a cmprehensive over the phone and information exchange program.
    Who knows when their dealers will finally get a visit.
    The bottom line is everybody else was told that they needed a site visit yet ABCOPP did it without the visit and had the blessings of CMS.
    How this can be fair I do not know but they are not hiding it .
    If you call their company they will tell you the whole story.

  9. D.M. Heckman said:

    Sep 29, 09 at 1:18 pm

    If CMS is going to be turning off the Provider numbers of hundreds (if not thousands) at the request of the providers or as a result of noncompliance with the surety bond or accreditation requirements, what are the rest of us to do with the flood of requests for service that we are sure to receive? How many capped-out (or near to the cap) oxygen patients are going to be unable to find a provider? CMS has made it quite clear that there will be no provision for starting a new rental period in this situation

  10. Anonymous said:

    Sep 29, 09 at 4:15 pm

    Industry Consultant here again: D.M., it’s going to be an awful situation for patients (I have been getting calls all day on this issue), but the bottom line is that providers just cannot afford to take on patients that are well into their capped rental period because of all the costs and responsibilities involved during the remaining 5 yr “useful life” of the equipment when there is little reimbursement left to support the services provided (and required).

    CMS claims this won’t happen. I want to know what cloud they are living on.

  11. Colvin said:

    Oct 01, 09 at 11:29 am

    I would like to see the House bill looked into. According to the wording they voted to allow an extension only for Pharmacy’s providing DME. Excluding small supplier DME’s from the extension. Is this even legal? Where is the EQUAL opportunity. Both pharmacy and DME should receive the extension or none should. No special treatment for one business over another.

  12. anonymos said:

    Oct 02, 09 at 1:44 am

    As a DMEPOS surveyor for one of the original AO’s I would like to make the comment that of the surveys I have performed over the last year many of the worst organizations surveyed were pharmacies. Often times these organizations took the approach that the CMS rules did not apply to them. They most often did not even know what accreditation was and believed that I was a “Medicare Inspector”. I strongly believe that no extension should be granted to pharmacies alone. This would be completely unfair to all of the organizations that took it upon themselves one or more years ago to go out and do the work, read the standards, implement policies and procedures and ultimately get themselves accredited on time. As for the capped oxygen patients that will find it near impossible to find a new provider; maybe it will take something of this magnitude to wake CMS, or more importantly congress, up to the fact that this whole capped payment structure is fundamentally flawed and more importantly make them understand that it is more than just dropping off equipment. Lastly, CMS put out there some very bad advise with regard to the Jan 31st 2009 application deadline. Most long time accredited providers will agree that this is not really enough time to truly prepare for an accreditation survey under all but the best of circumstances. When you add into the mix the sheer number of ill-prepared providers applying at the same time the result was bound to be utter chaos.

  13. ERIC said:

    Oct 02, 09 at 5:26 pm

    TODAY WE HAVE BEEN TURNING DOWN ANY NEW MEDICARE PATIENTS .I GAVE OUT CATHETERS AND CPAP SUPPLIES GRATIS(BENEFICIARY NEEDED THEM I DIDN’T FEEL RIGHT LEAVING THEM STRANDED).THIS IS A MAJOR CATASTROPHE FOR US AND OUR PATIENTS.ODDLY ENOUGH THE MASS ADVERTISERS WILL PROBABLY BE IN GOOD SHAPE TO CONTINUE TO BILL CMS FOR “NO COST TO YOU” POV’S WHILE THE SHADY SUPPLIERS IN SOUTH FLORIDA WILL BE PLANNING THEIR NEXT SCAM.I REALLY DONT BLAME ANYONE BUT WHERE ARE OUR STATE AND NATIONAL ORGANIZATIONS TELLING CONGRESS THIS WILL AFFECT BENEFICIARIES ACCESS AND COST SMALL BUSINESS JOBS,IT SEEMS A PRETTY SIMPLE MESSAGE.

  14. Anonymous said:

    Oct 05, 09 at 11:25 am

    We signed on with an accredating agency before January 1st and as of 6 weeks ago our desk review still wasn’t completed. How is that fair??? It is now after the deadline and our agency still doesn’t know when our desk review will be completed so that they can come survey us. We have two locations, and one is a pharmacy/DME company so we at least have hope for the House bill still.

    Now what do we do besides continue to call and aggravate our accredation agency daily.


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