Don’t let a natural disaster interrupt your patients’ oxygen supply

How prepared are you and your staff for an emergency? Do you have a solid plan for your patients?

Anything that impacts service for your patients should be addressed in your plan

ACHC corporate surveyor Cynthia Gray breaks it down: What to do when nature wreaks havoc on the supply line for oxygen-dependent patients (as recently published in the August edition of AARC Times)

By Cynthia Gray, BS, RRT-RPFT

Cindy Gray

“Providing oxygen tanks for a short amount of time is reasonable. Most home medical equipment companies provide the patient with three times the maximum response time. When a power outage is extended to days, weeks, or even months, alternative plans must be initiated. RTs can be a key resource for patients if that should occur. Patients and their caregivers can plan ahead and be prepared for alternative living arrangements if an extended outage is a possibility.

… In an emergency, a documented plan is easier to follow than trying to remember what was discussed.

… RTs have a great opportunity to help patients understand that early action is imperative. If your institution is alerted about an impending disaster, act early.”


ACHC Surveyor Randy Hughes Shares Expertise on Alternative Delivery Models in HME

At ACHC, our Surveyors are truly experts in their fields. Accreditation Corporate Surveyor Randy Hughes is no exception. Hughes is a registered Respiratory Therapist with over 45 years of experience whose areas of expertise include quality management, operational efficiency and medical gas CGMP compliance. Hughes recently wrote an article  for HomeCare Magazine that examined accreditation considerations for alternative delivery models in HME. Read a condensed version below, or click here to read the full article. Congratulations, Randy!

Changing reimbursement environments, tightening regulatory requirements and managed care are forcing HME providers to develop alternative delivery models for equipment and services. The goal of each has been to provide service more efficiently and effectively while decreasing labor costs.

An important consideration with each model is “who owns the patient?” Who is responsible for providing products to the patient in the appropriate manner? This usually is driven by who bills (and who gets reimbursed) for the equipment or services provided. The “owner” needs to ensure that goods and services are delivered in a manner that meets all accreditation requirements.

The following are examples of alternative delivery models currently in use as well as the associated accreditation implications.

Direct Shipping

  • Not new, but the types of products being shipped have evolved. Oxygen concentrators and CPAP therapy equipment are routinely sent through the mail, so much so that equipment manufacturers have become providers.
  • Accreditation considerations:
    • Documentation of shipping and receipt; patient education; evaluation of safety-related issues and the provision of care process; patient acknowledgement of receipt of patient rights and responsibilities; HIPAA acknowledgement; AOB, etc.

Group patient teaching  

  • New patient “classes” that include group demonstrations, patient education, and interface fitting.
  • Gaining popularity for new and re-instruction CPAP patients and group compressor/nebulizer instructions.
  • Significant increase in staff productivity; patient interactions have resulted in the formation of patient-hosted support teams.
  • Accreditation considerations:
    • HIPAA implications and patient confidentiality
    • Adherence to infection control protocol and practices
    • Assurance that each patient’s documentation is completed thoroughly and accurately and individualizing each patient as patient-specific issues are identified

Sub-contracted delivery

  • The billing entity provides the equipment and supplies while the subcontractor delivers the products. The most common model delivers re-supply items to patients, including reusable and disposable supplies and oxygen cylinders, where new patient teaching and instruction are not required.
  • Accreditation considerations:
    • Well-defined description of expectations from the subcontractor
    • Clear description of the services to be provided, documentation requirements, delivery staff training, orientation and competency and others
    • Written contract detaining the individual responsibilities of each party is required
    • A performance indicator that monitors the services provided by the contracted organization

 Nontraditional oxygen model

  • The goal is to eliminate or minimize resupply visits to a patient’s home after the initial delivery of an oxygen deliver device, usually an oxygen concentrator.
  • The most prevalent examples of this model are the various home oxygen cylinder filling units and the use of portable oxygen concentrators (POCs).
  • Advances in portable technology are resulting in reliable, 3 to 4 LPM continuous flow capability, improved battery life, and continuous-use capability.
  • Accreditation considerations:
    • As long as the equipment is utilized and maintained as required by the manufacturer(s), the same accreditation standards that apply to a traditional oxygen concentrator apply to POCs

Non-clinical ventilator services

  • Today’s ventilators incorporate sophisticated technology to provide multiple modes of ventilation, humidification, and alarm systems in one compact unit. Additionally, the explosion of non-invasive ventilation as an adjunct to or in place of invasive ventilation raises questions as to the need for these patients to receive Clinical Respiratory Services (CRS).
  • Accreditation considerations:
    • Providers who offer ventilator services as non-clinical are considered to be accredited for Equipment Management
    • CRS is not required if the patient does not require ongoing assessment of the patients clinical status via a home clinical assessment ordered by the physician and performed by a licensed clinician

Impact of Technology

  • Significant decline in cost.
  • Will soon see an affordable device that is a POC and oximeter in one.
    • Will include a modem similar to today’s CPAP units that will not only transmit compliance data, it will be an active interface that will facilitate remote troubleshooting, repair, and maintenance
  • Many new questions will be posed from an accreditation perspective.
    • What kind of doctor’s order will be required?
    • What equipment maintenance and documentation is needed?
    • What competency is required for a warehouse employee/delivery driver that remotely accesses a patient’s concentrator for troubleshooting?
    • Is an RT required to teach the patient to self-titrate?

As we move through this continuum, many new questions will be posed from an accreditation perspective. Proactive communication with your Accreditation Organization about what models you are exploring and what impact they have from a standards interpretation perspective will help facilitate this transition.

For more information on ACHC’s accreditation programs or to download ACHC accreditation standards, visit, email or call 855-937-2242.

ACHC Whiteboard Sessions – HME: Doing More With Less

In the video ACHC’s Clinical Educator, Greg Stowell, talks about three strategies to help improve your HME facility.

  • First, Review your Administration department. This includes your P&Ps and staffing needs.
  • Next, Greg suggests that there is always room for improvement in your Operations department.
  • Finally, watch your inventory levels. Having both too much, and not enough can be detrimental to your bottom line.

Learn more by watching the video.

About Greg Stowell:

Greg has over 30 years of industry experience where he has owned and managed local and regional HME and Rehabilitation organizations. He also brings previous experience as a certified Orthotist and holds his RESNA ATP certification. Additionally, he serves as the current chair of RESNA’s Delivery, Outcomes and Policy SIG.

Line Divider 500px

Ready for accreditation? Contact ACHC at (855) 937-2242 to learn more.

Home Health | Hospice | DMEPOS | Private Duty
Pharmacy | Sleep  | Behavioral Health

Screen Shot 2013-11-13 at 7.53.39 AM

Is Your DMEPOS Application Addendum Filled Out Correctly?






One of the most critical aspects of the ACHC application process that DMEPOS providers must complete is the DMEPOS Accreditation Application Addendum.  The DMEPOS Accreditation Application Addendum is a checklist that the customer must complete to show the equipment and supplies that they are currently billing to Medicare Part B.  It is imperative that the DMEPOS Accreditation Application Addendum matches page 9 of the current 855S enrollment application for each Provider Transaction Access Number (PTAN) or Medicare Provider Number.

During the on-site survey, our Surveyors use the completed DMEPOS Accreditation Application Addendum to determine if that the specific location has appropriate inventory and is equipped to provide each product code to patients in a timely manner.   For organizations with multiple locations/PTANs, each location should have its own unique DMEPOS Accreditation Application Addendum even if the equipment and supplies provided is the same.

Before the ACHC survey is completed, the surveyor will sit down with a representative from the organization to review the DMEPOS Accreditation Application Addendum and ensure that the correct product codes have been selected.  The ACHC surveyor and representative will sign and date the form acknowledging the codes that will be reported to Medicare.  When the organization’s Accreditation Advisor issues the approval, they will include a copy of the signed DMEPOS Accreditation Application Addendum with the documentation.

ACHC strongly encourages all of our customers to carefully review their DMEPOS Accreditation Application Addendums when submitting their application and also while on-site with their ACHC Surveyor. Renewing ACHC customers should complete a new DMEPOS Accreditation Application Addendum for each three-year accreditation cycle.

To verify the product codes that you are currently accredited for, please log into your Customer Central account. If you have any other questions or need any assistance in completing a DMEPOS Accreditation Application Addendum, please contact your organization’s Accreditation Advisor at 855-YES-ACHC (937-2242).

Home Health | Hospice | DMEPOS | Private Duty
Pharmacy | Sleep  | Behavioral Health

Line Divider 500px


About the Author:

matthew_hughesMatt Hughes is the Director of Business Development & Customer Service. His primary functions are working with current corporate customers along with identifying new opportunities to help grow ACHC.  He works closely with state associations and other member organizations throughout the country.

Engagement is Everyone’s Job!

ACHC Survey the Expert with Barb

[iOS Users] [3:39]

In today’s Survey The Expert podcast Barb Sylvester, ACHC’s VP of Clinical Compliance, Regulatory, and Quality, will join us to discuss provider engagement in the accreditation process. Barb has over 30 years of nursing experience, including 19 years working in home health and hospice settings.

Episode Highlights:

  • Engagement is the responsibility of both the provider and the accrediting organization
  • How to best leverage strategic partnership between the provider and the accrediting organization and…
  • The best way to engage with the local community

Ready for accreditation? Contact ACHC at (855) 937-2242 to learn more.

Home Health | Hospice | DMEPOS | Private Duty
Pharmacy | Sleep  | Behavioral Health


Are You Unhappy With Your Current Accreditor? Let ACHC Help.

ACHC's Transition Program

ACHC’s Transition Program was created to provide currently accredited DMEPOS and Pharmacy organizations the opportunity to switch to ACHC accreditation, regardless of where they are in their current cycle. In fact, many providers have realized greater benefits by transitioning with more than one year remaining until renewal. The entire process has been streamlined to make the transition as seamless and efficient as possible. This process consists of a few easy steps:

Complete Application
The first step is to complete and submit the transition application to the Transition Coordinator via fax or mail. Be sure to include the required documentation and a $500 deposit (applied to your renewal fees).

ACHC Review
Next, ACHC will review the submitted documents, and the Transition Coordinator will contact your organization to determine the next steps and provide an agreement for accreditation services. Additional requirements may be necessary based on the submitted information.

Transition Approval
Once the review process is complete, and all required documentation has been received, the Transition Coordinator will send your accreditation certificate and the transition approval letter. The agency is now operating under ACHC accreditation and appears on the weekly reports to CMS.

When you choose to transition, ACHC will handle the conversion of your agency’s policies and procedures to align with the standards. The entire process has been created to provide a collaborative and educational experience for the provider.

Get started today by heading to, or by contacting Lindsey Holder at (855) 937-2242 ext. 343.

Home Health I Hospice I DMEPOS I Private Duty I Pharmacy I Sleep Behavioral Health

Special Edition of Survey The Expert Podcast: Federal News Radio


[iOS Users]

José Domingos and Matt Hughes were recently interviewed on Federal News Radio. The discussion was about accreditation, as well as ACHC’s programs and services.

About Federal Tech Talk:
Federal Tech Talk looks at the world of high technology in the federal government. Host John Gilroy of the ARMATURE Corporation speaks the language of federal CISOs, CIOs and CTOs, and gets into the specifics for government IT systems integrators. John covers the latest government initiatives and the latest technology news for the federal IT manager and government contractor.

Home Health I Hospice I DMEPOS I Private Duty I Pharmacy I Sleep Behavioral Health

Survey The Expert Podcast: Episode 6 “Medtrade Spring 2013 Workshops”

Album cover for Survey The Expert: ACHC [iOS Users]


In today’s Survey The Expert podcast, we’ll be joined by Greg Stowell, ACHC’s Clinical Compliance Educator for DMEPOS, Sleep and Pharmacy.  He will discuss the upcoming workshops at Medtrade Spring.

Sign up for the workshops here!

Home Health I Hospice I DMEPOS I Private Duty I Pharmacy I Sleep Behavioral Health

Survey The Expert Podcast: Episode 4 “Becoming Accredited”

Album cover for Survey The Expert: ACHC[iOS users]


In today’s Survey The Expert podcast, we’ll be joined by Lisa Feierstein, VP of Sales for Active Health.  She will discuss the process her organization went through to become accredited with ACHC, and give some tips on how to make accreditation easier for you.

Lisa Says:
• Accreditation takes time and energy, but
• Will help grow your business, and
• ACHC Surveyors are helpful and encouraging

Home Health I Hospice I DMEPOS I Private Duty I Pharmacy I Sleep Behavioral Health

Competitive Bidding: Survival Steps If You Are Not a Successful Round 2 Bidder

Survival Steps If You Are Not a Successful Round 2 Bidder

For the HME supplier who is not awarded a competitive bid contract, the supplier can no longer bill Medicare in its CBA for products covered by competitive bidding. There is no good way to paint such a scenario in a positive light. The following are steps that a HME supplier can take if it is not awarded a competitive bid contract.

Continue as a Grandfathered Supplier

There will be a “grandfathering” process for oxygen equipment and supplies; inexpensive or routinely-purchased items furnished on a rental basis; items requiring frequent and substantial servicing; and capped rental items furnished on a rental basis. Only HME suppliers that began furnishing these grandfathered items prior to implementation of competitive bidding may be eligible to participate as a grandfathered supplier. If a HME supplier chooses to be a grandfathered supplier, then it must do so for all beneficiaries who request the services. For items requiring frequent and substantial servicing and oxygen equipment, the grandfathered supplier will be paid the bid payment amount. For capped rental items and inexpensive or routinely-purchased items, the grandfathered supplier will be paid the lower of the actual charge or rental fee schedule amount.

Expanding Into Geographical Areas Outside CBAs

A DME supplier can open up one or more locations outside a CBA and concentrate on servicing customers in the outlying areas.


Opportunities will avail themselves to work with CBA bid winners. Develop relationships with bidding organizations and position your organization to work with bid winners. Have your subcontracting contracts reviewed by a healthcare attorney. There are many potential pitfalls in subcontract agreements.

Products and Services Not Included in Competitive Bidding

Suppliers should focus efforts to sell products not covered in the competitive bidding program’s product categories. Look for opportunities to sell health products outside of your traditional product offerings.

Cash Sales

One of the fall outs of healthcare reform will be the increased complexity for a Medicare beneficiary to obtain medical equipment. With difficult coverage requirements many clients will be forced to purchase products and services on their own as coverage through Medicare will be more challenging.


The hospice benefit paid to the hospice facility includes the equipment and products used to service the beneficiary. Hospices may purchase or rent this equipment directly from DME suppliers.

Long Term Care Facilities/ACLF’s

Some residents in long term care facilities may receive HME reimbursed by Medicare Part B as if those patients were residents in their own homes. For those long term care facilities that are not paid a per diem rate for the patient’s care HME suppliers may either bill Medicare directly for provision of the equipment or in some cases facilities may choose to contract with the DME supplier.

VA Hospitals and Facilities

The VA is a large purchaser of HME and routinely sends out requests for proposals asking that HME suppliers submit a bid to different VA regions or facilities that service patients. The VA purchases a majority of its requirements for direct delivery through its local Acquisition and Material Management office. Contact each facility for inclusion in its procurement process. Find a facility near you here:


TRICARE is the health care program for uniformed service members, their families, and survivors. TRICARE is another large purchaser of HME which offers both contract and non-contract opportunities for suppliers. TRICARE uses military treatment facilities as the main delivery system and augments direct care with a network of civilian providers and facilities. The program is available worldwide and managed regionally in six separate TRICARE regions.

Workers Compensation

There are workers compensation programs at both the federal and state levels. These insurance programs are another source of business for HME providers. Each of these programs has its own system for enrolling providers.

Resort/Hotels and Travel Clients

Many large resort hotels have begun providing wheelchairs, scooters, and other medical equipment to their guests as a way of making the guests feel more at home. HME suppliers that are located in markets with large hotels and casinos should contact the hotels directly to determine if there is a contracting process and how suppliers may participate. Large travel agencies that focus on foreigners traveling to the USA are another good source of referrals. 919.785-1214.