Frequently Asked Questions

Home Health

  • Do I need an 855A?

    An agency seeking initial Medicare certification must have an approved CMS 855A Medicare Enrollment Application– Institutional Providers form to begin the accreditation process.

  • How many patients do I need to be eligible for an Initial Medicare Certification Home Health survey?

    The organization must have provided care to a minimum of 10 patients requiring skilled care (not required to be Medicare beneficiaries). At least 7 of the required 10 patients should be receiving skilled care from the home health agency at the time of the Medicare survey, unless in a medically underserved area as determined by the Regional Office.

  • What services do I need to be providing for my Initial Medicare Certification Home Health survey?

    You must be providing or have provided skilled nursing care and at least one other therapeutic service such as physical therapy, occupational therapy, speech therapy, home health aide services and/or medical social services.

  • Do I need a Certificate of Need (CON)?

    To determine if a CON is required for the state in which you want to operate a home health agency, visit the National Conference of State Legislatures CON-Certificate of Need State Laws page online.

  • Are there Medicare capitalization requirements for Home Health?

    Yes. You can find the requirement on the CMS website

  • What is the CMS Home Health Definition of Skilled Nursing Services?

    The CMS definition of Skilled Nursing Services can be located in the Medicare Benefit Policy Manual, Chapter 7, Home Health Service.

  • Do you provide the licensure surveys on behalf of any states for Home Health?

    ACHC currently provides licensure surveys on behalf of Texas, Florida, and Missouri.  The process for Texas licensure surveys is the same as our Medicare certification process, but we have a two-step process for Missouri and Florida licensure surveys. The following tools provide more information about ACHC’s two-step process in these states:

  • What is the ACHC compliance date?  Does this date apply to the Medicare CoPs as well?

    The ACHC compliance date is the date on which you acknowledge that your organization was/is/will be in compliance with the ACHC Accreditation Standards.   The compliance date does not apply to state and Medicare CoPs, as agencies must always be in compliance with these requirements from the initiation of patient care.

Hospice

  • Are there Medicare capitalization requirements for hospice?

    There are no capitalization requirements for a hospice. A hospice may have its own capitalization budget for future growth, adding an inpatient, etc.,  but it is the hospice governing board’s decision on when to use it. However, some states may have a capitalization requirement through their licensure or CON.

  • How many patients do I need to have for Initial Medicare Certification Hospice survey?

    The organization must have provided care to a minimum of 5 patients (not required to be Medicare beneficiaries).  At least 3 of the required 5 patients must be receiving care at the time of the Initial Medicare Certification Survey, unless in a medically underserved area as determined by the Regional Office.

  • Is it a requirement to provide short-term inpatient care as a start-up hospice seeking Initial Medicare Certification?

    Yes. All hospice providers, regardless of the ability to bill, must be able to provide all four levels of care: routine, respite, continuous, and short-term inpatient.

  • Do I need a Certificate of Need (CON)?

    To determine if a CON is required for the state in which you want to operate a home health agency, visit the National Conference of State Legislatures CON-Certificate of Need State Laws page online.

  • Do you provide the licensure surveys on behalf of any states for Hospice?

    ACHC currently provides licensure surveys on behalf of Texas, Missouri, and New Mexico. The process for Texas licensure surveys is the same as our Medicare certification process, but we have a two-step process for Missouri licensure surveys.

  • What is the ACHC compliance date?  Does this date apply to the Medicare CoPs as well?

    The ACHC compliance date is the date at which you acknowledge that your organization was/is/will be in compliance with the ACHC Accreditation Standards.   The compliance date does not apply to state and Medicare CoPs, as agencies must always be in compliance with these requirements from the initiation of patient care.

Private Duty

  • How many patients do I need to have for initial Private Duty Accreditation with ACHC?

    The organization must have provided care to a minimum of 5 clients/patients, having 3 active at time of survey unless state law requires more.

DMEPOS

  • I cannot accept patients until I am approved for accreditation for Medicare billing purposes.  How do I provide patient files for my survey?

    Agencies can provide 5 mock files at the time of survey if equipment or supplies have not been provided.   A mock file is a sample patient file that should be set up to include all required information/content that would be present in a true patient file.

  • When do I submit the CMS855S to apply for my Medicare Provider Transition Access Number (PTAN)?

    You should apply to CMS for your DMEPOS Medicare number after you have been approved for accreditation.

  • What are the Medicare DMEPOS supplier standards?

    They are standards that every Medicare DMEPOS supplier must meet in order to obtain and retain billing privileges.  Please note you must also be in compliance with Medicare DMEPOS Quality Standards. Learn more about the Medicare DMEPOS supplier standards.

Pharmacy/PCAB

  • What are the advantages of PCAB Accreditation?

    THIRD-PARTY RECOGNITION - PCAB Accreditation meets compliance requirements for a growing number of payors and networks.

    IMPROVED QUALITY AND SAFETY - In achieving PCAB Accreditation, pharmacies benefit from consistent practices that result in improved safety, efficiency, and quality of care.

    RISK AVERSION - Adherence to PCAB standards helps pharmacies maintain compliance with all applicable USP guidelines.

    MARKET ADVANTAGE - PCAB Accreditation allows pharmacies to distinguish themselves among their competitors by demonstrating a commitment to compliance with USP  guidelines as well as industry best practices.

    OPERATIONAL EFFICIENCIES - PCAB’s educational approach to accreditation enhances business operations, helps inform effective strategies, and improves patient outcomes through evidence-based best practices.

    CONTINUITY OF SERVICE - PCAB facilitates a standardized level of service that includes sound procedures, documentation, and training to ensure consistent performance across the entire organization.

  • For how many days must I have been compounding prior to my PCAB Accreditation survey?

    There is no specific requirement; however, enough information about compounding must be demonstrated for the Surveyor to assess compliance with PCAB standards. This includes record keeping, ingredient selection, and personnel training and competency. If you are not currently compounding, please schedule time to speak with your Account Advisor about your unique situation.

  • What is the difference between PCAB and ACHC Inspection Services (AIS)?

    PCAB remains the gold standard in compounding accreditation, providing the pharmacy with a peer review of practices and corrective measures to achieve compliance with USP guidelines.

     

    AIS serves a different purpose as it seeks to fulfill regulatory requirements, most commonly assisting pharmacies with an inspection of compounding practices to fulfill state licensure requirements for non-resident pharmacies.

  • What is the difference between PCAB and Infusion Pharmacy accreditation?

    IRX is chosen by those pharmacies that have or need a Medicare Part B billing number (for the billing of infusion pumps). Compounds prepared by IRX pharmacies are usually low- to medium risk in nature. IRX surveys are normally scheduled for two days due to the Medicare regulations that need to be reviewed.

     

    PCAB is appropriate for any site including community pharmacies, hospitals, infusion centers, and physician practices that want to demonstrate compliance with USP guidelines on sterile and non-sterile compounding. Surveys for both sterile and non-sterile are usually one day and focus primarily on the process of compounding.

     

ACHC Process

  • What is the Unduplicated Admission number?

    The total number of patients admitted one time over the past 12 months, regardless of the type of services, frequency of admission, or payor source.   If a patient was admitted, discharged, and later in the year readmitted, that patient should NOT be counted twice. If a patient is evaluated, but not admitted, that patient should not be counted.

  • How do I submit my application and deposit?

    Your accreditation application and deposit can be submitted by logging on to Customer Central.

  • How long does it take to become accredited once I submit my application?

    The time frame to complete the accreditation process is dependent upon how soon your organization submits all required information.  This includes the signed Accreditation Agreements and signed PER Checklist.  Generally speaking, your organization can expect an on-site survey within 45-70 days from the submission date of all required information.

  • What is a PER Checklist?

    The PER (Preliminary Evidence Report) Checklist is a document listing all required items to be completed prior to continuing the accreditation process.  You will sign and attest that your organization has met all of the requirements noted on the checklist to be ready for an on-site survey. Only organizations applying for initial accreditation need to complete the PER Checklist, which can be found on Customer Central.

  • Are the on-site surveys announced?

    Most surveys are unannounced.  However, there are some instances in which we conduct announced surveys.   Announced versus unannounced surveys depend upon the  program and services for which you are seeking accreditation. Your personal Account Advisor will be able to provide you with more specific information.

  • What should I expect during my on-site survey?

    Notification call – 1-2 hours in advance of the on-site survey, the Surveyor will call the contact provided on your application to notify your organization of the survey.

     

    Opening conference – The Surveyor will hold a short opening conference to set expectations for the survey.

     

    Tour of facility – The Surveyor will ask for a brief tour of the facility.

     

    Personnel record review – The Surveyor will review a random sampling of personnel records including key administrative and clinical staff.

     

    Patient chart review – The Surveyor will review a representative sample of patient charts.

     

    Patient home visits/calls –  Depending on the program being surveyed, the Surveyor will either call patients or conduct home visits to observe services and care being provided

     

    Interviews – The Surveyor will conduct interviews with staff, management, governing body, contracted personnel, and volunteers throughout the on-site survey.

     

    Policy & Procedure Review – The Surveyor will review the agency’s implementation of policies and procedures, including Performance Improvement (PI).

     

    Exit conference – For surveys lasting more than one day, the Surveyor will hold a mini exit conference at the end of each day to review progress of the survey and outstanding items to be reviewed. At the end of the survey the Surveyor will hold a final exit conference to discuss the findings and offer guidance on how to correct the deficiencies. Surveyors will not be making an accreditation decision on site.

  • What qualifications and training do ACHC Surveyors receive?

    All ACHC Surveyors have extensive experience in the field they survey and have completed on-site orientation and a preceptorship as well as ongoing training. All Home Health, Hospice, and PD Surveyors are Registered Nurses; all Pharmacy Surveyors are Pharmacists with management experience; and all DME Surveyors have HME management, compliance, or accreditation experience.

  • What items do I need to have available for my accreditation survey?

  • How far in advance do I need to submit my renewal application?

    To help ensure that your organization experiences no lapse in accreditation, we recommend that you submit your renewal application 6 months prior to your expiration date.  This allows time for your agency to prepare for the on-site survey.

  • Does ACHC offer assistance in preparing for accreditation?

    Accreditation University (AU) offers a variety of exceptional educational resources to help your organization prepare for and maintain accreditation. If you are new to accreditation, coming up on renewal, or just want to learn more, our program-specific accreditation workshops are a great place to start.

  • Do you charge annual fees to remain accredited?

    We do not charge any annual fees to remain accredited.

  • Do you charge for Surveyor expenses?

    No, we do not charge for any Surveyor expenses.

  • What are the payment options?

    1) Balance is due in full within 30 days of execution of signed contract

    2) Balance is broken down into 3 equal payments due 30/60/90 days (3 months) after execution of signed contract

    3) Balance is broken down into 6 equal payments due 30/60/90/120/150/180 days (6 months) after execution of signed contract

    *NOTE – If you choose option 2 or 3, there will be a one-time 10% surcharge added to the balance.  Both options can also be set up to auto draft.

CMS Deeming Authority For: Home Health, Hospice & DMEPOS  |  Certified to ISO 9001:2008

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