Making the use of DME and the Medicare Therapeutic Shoe Program easier.

Physician Login/Register

Obtaining Facility Accreditation to Get Paid by Private Insurers for Dispensing DME

Question:

Josh,
My office is currently having problems getting paid by some insurance plans as they question our ability to dispense products. Like you, I graduated from the CCPM School and I believe I have great training in orthotics, AFO, and DME equipment that makes me more qualified than most DME suppliers. The bottom line that most private insurance companies are saying I need to be certified by ABC or another group. Has your office done this and if so what certification organization did you use? Did you get certified as an individual or group? Do you have any recommendations or suggestions that would help?

Answer:

Sorry to hear about your troubles getting qualified to get paid by private insurers for DME.

DSPMs are lucky in that we are exempt from obtaining facility accreditation to get paid for dispensing DME. Non-physician suppliers like orthotists, prosthetists, CPeds, pharmacists are not. They get Facility Accreditation form either BOC or ABC.

DPMs can get facility accreditation and in fact Jonathan had his facility pass the requirements.

Private insurers can make their own rules and so I believe it is legitimate what they are asking of you to be a qualified provider.

Getting facility accreditation for your practice is not that onerous and might be very much worth it for the benefit of providing products to these patients. It might even open the door to other non-accredited providers referring their patients to you. The few DPMs I know who have gone through it have said that the process improved their organization overall.

Below are links and info for the accrediting organizations.

Here is a copy of a presentation I prepared several years ago when it was looking like a Medicare requirement for DPMs:
Basics of Facility Accrediation

As always, SafeStep is here to help.

Best regards,
Josh

Accreditation Links:

http://www.bocusa.org/becoming-accredited

http://www.bocusa.org/files/Facility_Accreditation_Standards.pdf

http://www.abcop.org/accreditation/OrthoticsProsthetics/Documents/ABC-Acc-Standards%209-23-12lores.pdf

http://www.abcop.org/accreditation/FacilityAccreditationFAQ/Pages/Default.aspx