BALTIMORE--In a final rule released last week, CMS detailed accreditation requirements for DMEPOS suppliers and the application process for accrediting organizations, laying the groundwork for competitive bidding.

But according to accreditation expert Mary Ellen Conway, president of Capital Healthcare Group, Bethesda, Md., the rule answers few questions that are on providers' minds. "It gives us more confusion and doesn't say anything. Everything in the rule comes from previous regulations," she noted.

Medicare's DME bid is slated to begin in 10 of the country's largest metropolitan areas next year and expand to 80 areas in 2009. Suppliers that plan on participating in the bid will need to be accredited by early 2007, the rule said. CMS also said it plans to use Competitive Bidding Implementation Contractors to help implement the program.

However, the agency has yet to finalize its supplier quality standards--which HME providers must meet not only to participate in the bid but also to do any Part B business--or approve the accreditors that will apply them. CMS said the standards would be published in the "near future," and that it expects to approve several accrediting bodies in order to meet the bidding dates. The agency said it will request those accreditors to prioritize their surveys to assist suppliers located in the bidding areas for 2007--but those 10 areas also have not been named.

In the document released Wednesday, the agency said it "recognizes that becoming accredited imposes a burden on suppliers and has attempted to minimize the burden" by taking the following actions:

1. Accreditation organization selection--"We expect to select several accreditation organizations, which will induce competition and assist in decreasing accreditation costs."
2. Plan for small businesses--"During the application process we will ask accreditation organizations to include a plan that outlines their methodology to reduce accreditation fees for small/specialty suppliers and suppliers that have multiple locations."
3. Application of streamlined quality standards--"We will encourage accreditation organizations not to expand on streamlined quality standards."
4. Streamlined processes--"We have clarified in the final rule that the role of the accreditation organizations is to ensure compliance with the quality standards and that accreditation should not be contingent on using consultation services or purchasing manuals."
5. Unannounced survey process--"Utilizing an unannounced survey process reduces 'ramp-up' costs and survey preparation time."

But Conway said many of these actions are not helpful. "There are already several accreditation organizations in competition. There's nothing new about that," she pointed out.

Using consultation services and purchasing manuals are already optional, Conway continued. Furthermore, she said she does not understand how unannounced surveys would reduce costs. "Providers are still going to have to do the same things and spend the same amount of money to prepare regardless of whether a survey is announced or unannounced," she said.

CMS said it received approximately 600 comments on the proposed rule, many of which are listed in the final rule, and said it is planning an education campaign about the bidding process, including special bidders conferences, for beneficiaries, referral sources and suppliers.

To view the final rule, click here. The section on accreditation begins on page 131.