Accreditation of Medicare Certified Providers & Suppliers

Section 1865(a)(1) of the Social Security Act (the Act) permits providers and suppliers "accredited" by an approved national accreditation organization (AO) to be exempt from routine surveys by State survey agencies to determine compliance with Medicare conditions.  Accreditation by an AO is voluntary and is not required for Medicare certification or participation in the Medicare Program.  A provider’s or supplier’s ability to bill Medicare for covered services is not impacted if it chooses to discontinue accreditation from a CMS-approved AO or change AOs.  Section 1865(a)(1) of the Act provides that if the Secretary finds that accreditation of a provider entity by a national accreditation body demonstrates that all applicable conditions are met or exceeded, the Secretary may deem those requirements to be met by the provider or supplier.  Before permitting deemed status for an AO's accredited provider entities, the AO must submit an application for CMS review and approval.
 

See the downloads section below for more specific information.

For Initial Surveys for New Medicare Providers- please see Survey and Cert Letter 08-03.

For Accreditation and its Impact on Various Survey and Certification Scenarios – FAQs- please see Survey and Cert Letter 09-08.

FY 2015 Report to Congress (RTC): Review of Medicare’s Program Oversight of Accrediting Organizations (AOs) and the Clinical Laboratory Improvement Amendments of 1988 (CLIA) Validation Program (Refer to the Survey and Cert Letter 16-07).

FY 2016 Report to Congress (RTC): Review of Medicare’s Program Oversight of Accrediting Organizations (AOs) and the Clinical Laboratory Improvement Amendments of 1988 (CLIA) Validation Program (Refer to the Survey and Cert Letter 17-40).