Pharmacy accreditation is not just about revenue streams it’s also about being able to service your community.
Many pharmacies are exploring the issue of accreditation.
They wonder:
What will it take?
Will it be worth the time, effort, and investment?
Like other DME retailers, pharmacies that want to sell Medicare-reimbursable products first need to become accredited. The reason, according to Rhonda Pearce, director of operations for Healthcare Quality Association on Accreditation (HQAA), is that accreditation ensures that an organization is operating at a higher level of quality due to having more uniform practices and processes in place.
Why Would a Pharmacy Want to Be Accredited?
Payer agreements may require accreditation in order for the pharmacy to participate in certain programs. Or, they may offer a financial incentive, such as a per claim “bump” for those pharmacies that are accredited.
Pharmacies may also use their accreditation as a way to set themselves apart from their competition when marketing themselves to patients. The equivalent of the Good Housekeeping Seal of Approval, accreditation can reassure patients that their pharmacy and their pharmacist have gone the extra mile and are fully prepared and capable of handling their care and information in a safe manner.
Pharmacy accreditation helps:
Create policies and procedures that follow CMS quality standards, federal and state guidelines, and good business practices. Implement policies and procedures throughout the organization. Ensure all staff is involved in the accreditation process
Once all policies and procedures are implemented, a site visit will be performed to ensure the organization is following their policies and procedures, as well as regulations. A surveyor visit validates that what an organization indicates on paper is what their practices are and are truly implemented as observable processes.
The overall accreditation process for pharmacies is similar to non-pharmacy DME retailers, and their motivations for going through the process include creating new revenue streams, as well as serving the needs of their community.
Considering Pharmacy Accreditation
A lack of industry data on reimbursable sales makes it difficult to pinpoint how many pharmacies become accredited in pursuit of generating more revenue streams. But knowing how accreditation helps build your business is a motivating factor for going through the process.
Accreditation is the gateway to entry in getting a Medicare Part B number for DME. The process, she explains, is directly tied to billing privileges and the products that pharmacies provide. Important to remember is that the accrediting organization reports the products that the pharmacy gets accredited back to CMS. Therefore, knowing your business and customer’s needs is paramount to successful accreditation.
Aside from Medicare revenue, in some states require that if you want to do anything in Medicaid or DME, you also have to be accredited for Medicare. In addition, if the pharmacies want to bill some private insurance, they could require accreditation. So even if you don’t want to compete in the Medicare market, you are still other reasons to get accredited.
Steps towards Accreditation
Before you start the process, first and foremost make sure you understand why you’re getting accredited. A lot of company’s are just assuming they need to get accredited without doing any research. Know what your accreditation goals are.
From there, it’s about who’s on your team. Make sure you have the staff to comply with all the rules, regulations and data that is needed for accreditation. You can’t just say, ‘I’m going to get accredited,’ and expect somebody to do it. You have to have the staff to help you get ready.”
If you’re a new pharmacy, you won’t qualify for the exemption, but if you have been a supplier for at least five years, you should look into whether you qualify for an exemption to accreditation.
Conclusion:
Accreditation will provide you opportunity, whether it’s to get into Medicare or whether it’s to get in to other networks. It will give you opportunity and provide you walk-in business that you might not get otherwise or maybe you’re doing it just to help support the community.
Schedule a Strategy Meeting/ to learn more about Accreditation.
If you’re Suppliers visit our page to improve DME Accreditation Quality & Performance Documentation https://wonderws.com/dme-accreditation-improve-performance-documentation/
