On September 30, 2009, less than 1 year away, all DME providers will have to be accredited by an approved accrediting organization to continue to be reimbursed by Medicare. Preparation is time-consuming, and most of the accrediting bodies have deadlines for applying for surveys that are months prior to the CMS deadline. It takes time for the accrediting organizations to schedule, complete the survey, then review the surveyor's findings prior to issuing a final accreditation decision. Given those facts, you are already in a time crunch if you haven't started preparing for accreditation yet.

Roberta Domos

In many ways, preparing for a successful accreditation survey is a test of a company's organizational skills. And nothing makes an accreditation survey go more smoothly than anticipating what the surveyor will want to see and having it readily available. And since resurveys occur at intervals of every 2 to 3 years, staying organized and ready for subsequent surveys is extremely important as well.

Documenting aspects of the care you provide to clients, organizing paperwork for easy retrieval, compiling performance improvement data, logging equipment cleaning, repair, and maintenance, and tracking inventory are all tasks more easily completed with the help of computers and technology. Luckily, your HME software system can help you with these and other aspects preparing for an accreditation survey.

It is extremely important that all rental equipment is cleaned and checked for proper function between rentals. In addition, manufacturer-recommended preventive maintenance tasks must be completed in a timely manner. And naturally, all of these activities must be documented.

Too many companies still keep maintenance records on 3x5 cards or some paper equivalent. Those can work, at least until the paper logs are lost—but even if you never misplace a document, a paper system is a highly inefficient method. Paper logs cannot be queried against, so there is no easy way to determine which items have an incomplete service history.

Your HME software is an excellent place to record the cleaning and function check of rental items between patients, and to track the preventive maintenance history and repair of company-owned equipment. Most HME software systems can be set to print a service/delivery ticket when maintenance is due, enabling you to schedule maintenance in advance so that it can be completed when a technician is in the area. This prevents the need for a special trip to the patient's home to complete required maintenance.

The accrediting body quality standards, and FDA regulations, require that you track serial numbers and lot numbers of certain items such as oxygen to their current location so that items that have been recalled by a manufacturer can be retrieved from patients. When serial/lot numbers are entered into your computer and attached to the patients receiving them during the delivery confirmation process, a recall list can then be produced on demand, if needed. Lot number expiration dates can also be monitored to ensure the older product is sold first. Expired products can then be identified, removed, and returned to the distributor or manufacturer.

Another aspect of your HME software system is patient education, documentation, and communication. It is critical that you maintain documentation of a home safety and patient functional assessment, in addition to an equipment management plan of care and patient education activities. Many systems either allow you to document these activities directly into your HME database, or let you load custom forms that you can complete to document these activities. Some systems even contain, and will print out, patient education guides for the most common equipment rented to patients. Laser-sharp patient education materials look more professional than the "copies of copies," and are sure to leave a better impression with patients and surveyors.

Other mandatory quality standards include documenting and logging patient communications—particularly the occasional patient complaint, and your response to it. Again, many HME software systems provide you with the ability to complete this documentation from within the system, and can even print reports that summarize complaints for review by company performance improvement teams.

A robust performance improvement program is mandated by every CMS-approved accrediting organization, and there are several mandatory indicators that must be tracked by your organization to be compliant with CMS and accrediting body standards. In addition to the patient complaint tracking and reporting noted above, many HME software systems can also assist you with tracking Medicare billing and coding errors by analyzing and aggregating the data contained in the electronic remittance advice you receive from Medicare. And even if your software does not provide this feature, either as part of its routine feature set or as an add-on module, there are third-party software programs that can compile the data. The time saved is enormous.

Fully completed and current detailed written orders and certificates of medical necessity are integral to a successful accreditation survey. A document imaging system can help by making sure scanned copies of the most current order are archived on a hard drive, and always available for review. In addition, your basic HME software system can print reports that list which orders are set to expire. These reports will give you ample time to ensure that all patients have a current order in their patient file at the time of survey.

Speaking of document imaging, HME companies must display all licenses, permits, and certificates for the facilities they operate. Why not keep an electronic copy of these in your imaging system for easy retrieval? In the case of multibranch operations, it is easier for the administrative staff in your company to look in the system for license/permit/ certificate expiration dates than it is to visit every branch and check their wall for currency. To easily do this, set up a folder on your hard drive and scan all of the licenses, permits, and certificates into it, categorized by their respective types. Then, when you are asked for a copy, you can simply point and click to bring it up on the screen.

Roberta Domos, RRT, is owner and president of Domos HME Consulting Group, Redmond, Wash. She can be reached via her Web site: www.hmeconsulting.com.