"Why Don't You Take Medicare/Medicaid?"

As a medical supply provider, we get asked the question "Why don't you take Medicare/Medicaid?".

A little over two years ago, we made the very difficult decision to exit our relationship with CMS, or Centers for Medicare & Medicaid Services, which is the US federal agency which administers Medicare, Medicaid. At that time, in an effort to reduce fraud, CMS was requiring providers to become "Accredited", which is a very lengthy and expensive process. For larger chain providers, this was not as big of an issue, but for mom-n-pop shops such as ourselves, this was a daunting task.

Couple the accreditation requirements adding substantial overhead, with the already low reimbursement rates, and it simply no longer made business sense.

As the years have come and gone, the government has added competitive bidding to the requirments for some areas of the nation. In an effort to reduce spending by streamlining vendors and subsequent billing, suppliers - and by suppliers we mean BIG suppliers - have to submit and win a bid to supply certain areas of consumers with DME products that are paid for by the government. Again, this was an issue for mom-n-pop shops and we were simply squeezed out because of the format provided to those that wanted to submit a bid.

Just last week, HME News, the business newspaper for the home medical equipment provders, discovered that accredited providers were potentially having to go through the accreditation process all over again. Why? Because, "WellPoint, a health plan that owns and administers Blue Cross Blue Shield plans in 14 states, has notified providers in Georgia that to remain part of its network, they must be accredited by one of only three accreditation agencies by March 1, 2012."*

This is a huge blow for two reasons.

For one, CMS gave a list of ten accreditation agencies for providers to obtain accreditation from. This means that if a provider chose one that is NOT one of the three WellPoint has approved, a provider has to switch accreditation agencies. It is unknown what that process entails, since nobody anticipated any reason to have to switch. And as stated previously, this is a very lengthy and expensive process, especially for a small mom-n-pop shop.

Second, WellPoint has only notified Georgia providers, but their industry stakeholders say that this is a "national policy". If they successfully make this a national policy, it opens the door for other healthcare plans to require suppliers to change their accreditations as well.

How does this effect you, the consumer? Several ways, actually. If you enjoy buying your Medicare/Medicaid products locally, these requirements will ensure that mom-n-pop shops can no longer provide them. Most smaller suppliers are interested in providing quality over quantity, which means lesser quality products will be the only option for Medicare/Medicaid recipients. Also, it is widely known in the industry that one of the biggest issues with these changes is service. If your wheelchair malfunctions, service and repairs will be very difficult to find.

Accusations that corporations are making money hand over fist is false. Several of our local competitors have closed their doors in the past few years. In this economy with these requirments, its survival of the biggest corporation, not survival of the fittest (or best). And unfortunately, we feel its the consumers that will suffer.

*HME News, November 2011, Accreditation: Medicare's requirement not foolproof by Liz Beaulieu