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CMS to Enhance Oversight of Accrediting Organizations


CMS to Enhance Oversight of Accrediting Organizations

On October 4, 2018, CMS informed the public about several new enhancements to its oversight of accrediting organizations (AOs) and increased transparency regarding AO Performance. Health care providers that obtain Medicare certification via deemed status may find that AOs will be more conscientious than ever about ensuring that the provider satisfies all Medicare Conditions of Participation (COP) in addition to all AO internal standards.

Provider certification to participate in the Medicare program can be achieved in one of two ways: (a) survey by a state agency that contracts with CMS, or (b) survey by an AO, which is a private organization that contracts with CMS. Examples of AOs include The Joint Commission, American Osteopathic Association, Community Health Accreditation Partner, and DNV GL-HealthCare, among others. 

Before CMS will contract with an AO, CMS must be satisfied that the AO can properly evaluate health care providers’ compliance with MedicareCOP. To do this, it screens proposed AOs and monitors their continued performance. Monitoring typically occurs by CMS validation surveys, at which either federal or state surveyors repeat a survey conducted by the AO and compare findings to determine if the AO is over or under reporting provider deficiencies.

CMS now plans to restructure the validation survey process. Instead of a two survey system, CMS will pair federal or state surveyors with the AO surveyors during the AO standard accreditation survey. This will enable CMS to evaluate AO performance in real time and make immediate corrections to facilitate a more accurate single standard accreditation survey. Further, CMS will also use state complaint surveys that occur between AO standard accreditation surveys to determine if AOs should have captured health provider deficiencies earlier during the standard accreditation survey.

In an effort to increase public transparency about AOs, CMS has also posted information about AO performance on its website. CMS describes the newly posted information as: “The latest quality-of-care deficiency findings following complaint surveys at facilities accredited by AOs; a list of providers determined by CMS to be out of compliance, with information included on the provider’s AO; and overall performance data for AOs themselves.”

In addition, “CMS has also posted the most recent annual Report to Congress, the “Review of Medicare’s Program for Oversight of Accrediting Organizations and the Clinical Laboratory Improvement Validation Program Fiscal Year 2017,” on the CMS website.” 

Health providers preparing for their AO accreditation survey should pay special attention to ways in which the AO’s private standards may differ from the Medicare Conditions of Participation. This often requires cyclical review of published AO standards, published Medicare regulations and Guidance to surveyors, and review of provider policies and procedures as well as review of actual provider operations. The goal is to adhere to the most stringent standard of both the AO and Medicare in order to achieve Medicare deemed status certification.

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