Meeting Medicare Quality Standards

By Daniel Gurley, AOPA Government Affairs Department

Daniel Gurley is manager of regulatory affairs in AOPA’s Government Affairs department. Questions? Contact him at (571) 431-0812 or dgurley@AOPAnet.org.

Do you have questions about the new Medicare Quality Standards? These standards were introduced in conjunction with the durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) competitive bidding program that was first mandated by the Medicare Modernization Act of 2003.

CMS has stated that the quality standards and accreditation requirements must be met by all O&P providers sometime in the near future, though no specific deadline has been given and O&P is not included in the current round of competitive bidding. We know you’re concerned about how these standards will
affect your practice, and what you can do to prepare.

Here are some answers to common questions AOPA receives about the quality standards:

Q: Why does Medicare want to implement quality standards? How are they going to help patients and providers?

A: CMS believes that implementing quality standards will:

• Help reduce the risk of fraud and abuse in the Medicare program by unscrupulous providers and suppliers;
• Enhance a provider or supplier’s ability to improve the efficiency of its operations and service;
• Provide additional safeguards for the Medicare program;
• Be a tremendous step in the right direction for promoting quality and safety for Medicare beneficiaries who depend on home medical equipment; and
• Be the most potent weapon against opportunistic and unreliable suppliers who take advantage of Medicare beneficiaries.

Q: Don’t I only have to implement the quality standards if my facility participates in competitive bidding?

A: Currently, only participants in competitive bidding must meet Medicare Quality Standards and be accredited. However, at some point in the near future all­ DMEPOS suppliers must meet the standards, even if they don’t participate in competitive bidding.

At press time, CMS had not yet developed a timeline for DMEPOS suppliers not participating in competitive bidding to implement the quality standards. However, no one is sure of the amount of lead time that CMS will provide before implementation. The best thing to do is to get an early start on reviewing and implementing the Quality Standards.

Q: How do the new Quality Standards affect my facility?

A: Most facilities will find that, if they are currently meeting accreditation and Medicare supplier standards, they are also meeting the majority of the Quality Standards. AOPA is working on “crosswalking” the Medicare Quality Standards to both the Medicare supplier and accreditation standards, combining and comparing the requirements from each souce. AOPA will publish this information in an upcoming guide.

Q: The new quality standards state that facilities and companies should have one or more persons in place to perform leadership functions and direct the organization and its key activities and operations. Will this standard change the existing leadership structure of my company/facility?

A: In the standard, CMS defines what it considers “leadership.” For example, the leadership structure can be a single owner/employee or a management team reporting to a corporate headquarters. The standard just ensures that one person, or a group of people, are responsible for basic company function and control, so even small providers may not need to change their current structure.

Q: The standards keep referring to delivery and setup requirements. These are not applicable
to my facility. What should I do?

A: The Medicare Quality Standards are written in several parts: “Business Services,” “General Product-Specific Service Standards” and three appendices, of which “Appendix C: Custom-Fabricated, Custom-Fitted, Custom-Made Orthotics, Prosthetic Devices, Somatic, Ocular and Facial Prosthetics, and Therapeutic Shoes and Inserts” is relevant to AOPA members.

The first two sections are meant to be general and address all types of DMEPOS suppliers. This is the reason that several requirements do not seem to fit O&P suppliers. CMS is aware that not all suppliers will be able to meet requirements that are not related to their services.