Applying for Accreditation

We offer a simplified and streamlined application process that meets the highest quality requirements set forward by the Centers for Medicare & Medicaid Services. In addition, we offer one complimentary one year membership to all new applicants.

Initial Application Pre-Work

Thank you for your interest in pursuing accreditation through the AADE Diabetes Education Accreditation program (DEAP). To decrease the likelihood of delays in processing and approving your application, please read the following questions and considerations, the What Else Do I Need to Know section, and then follow steps 1-3 for the application process.

Q: Have I done a scan of the region to see where other similar services are offered, if there is a perceived need, if there are enough providers willing and able to refer?

Suggested groundwork:
  • Understand the competition
  • Determine needs of the community
  • Determine perceived needs of potential referring providers
  • Come up with a marketing strategy based on the above

Q: Do I have the support of my organization?

Organizational support may include:
  • A letter of support from at least one level above you in your sponsoring organization on their letterhead  
  • Funds to pay for the application
  • A DSMES Quality Coordinator job description
  • IT support for data collection and aggregation
  • IT support for documentation and reporting
  • Support for attaining required continuing education hours
  • Support of method for obtaining stakeholder input
  • Support for conducting a continuous quality improvement project
  • Billing and coding support

Q: Do I understand how to bill for my services and do I have everything in place to be able to bill once accredited?

Considerations:
  • The most common reason for program closure is billing/reimbursement issues.  Therefore, it is vital that you become knowledgeable in this area in order to sustain your services.
  • Find out who your Medicare administrative contractor (MAC) is. You will need to provide your accreditation certificate to your MAC in order to bill for diabetes education services.  They can also answer billing questions.  
  • Determine if you will be billing under a specific provider’s NPI or the organization’s NPI and make sure the name of your program matches the name of the billing entity.
  • Please note: Medicare or AADE can audit you even if you are not billing for your services. Set a goal to see at least 10 patients per year, whether you are billing or not in order to have data to maintain accreditation.  The items an auditor will look for during an audit are listed here:  Auditor Checklist for 2017 Standards
  • Meet with your billing specialists to make sure you and they know what codes to use to bill for DSMES (G0108 and G0109) and that you understand CMS’s rules for coverage of diabetes education.

Q: What will the structure of the DSMES services look like and what level of staffing will I need?

Considerations:
  • Structure is not rigid; it needs to be flexible enough to meet individual learning needs of participants. Standards 1-4 outline the structure needed to provide DSMES services
  • Class times and frequency should be accessible without long wait times after diagnosis and should match what works best for your target population. Medicare defines a group as 2-20 participants.  Groups can be a mix of Medicare beneficiaries and participants with other insurance plans.
  • There are no standard staffing ratios for diabetes education. Start with finding out the size of your pool of potential participants and then estimate your referral rates. 
 

What Else Do I Need To Know?

You need to:

  1. Become familiar with the National Standards and Interpretive Guidance*
  2. Identify who the Quality Coordinator and team members will be and ensure they have current credentials and licenses (see Standards 4 and 5)
  3. Know sources and estimated cost for diabetes-related continuing education 
  4. Line up training and competencies for any paraprofessionals on your team in order to submit them as qualified instructors/team members (see Standard 5)
  5. Two documents you need to submit for your application are time-sensitive:
    • continuing education must be obtained within the 12 months prior to the application date
    • your de-identified chart must be for a participant that went through your services within 6 months prior to the application date
  6. Research whether you need to list community or branch locations in addition to your main site.  Here is a tool to help you differentiate between them: Additional Sites Defined
*Interpretive Guidance changes pending approval from CMS, which is expected by December 15, 2017.

Application Process

You have 90 days to complete your application, once started.  The average time to approval after you submit a “clean” application is about 4-6 weeks.  Online payment with a credit card is the quickest method of payment.  Once payment has been processed, your application is considered submitted and will go into review.

STEP 1: Develop policies and procedures and supporting documents that meet each of the 10 Standards.  

  • Use the outlines along with the Interpretive Guidance as your guide.  (see Putting Together Your Documentation)
  • Do them in chronological order starting with Standard 1.  
  • Create a separate document file for each standard, as you will need to upload them separately in the online application.  
  • Please upload ONLY the documents and information specified in the Interpretive Guidance/Checklist.

STEP 2: Once you have all of your documents completed and ready to upload, you will need to create an AADE account, unless you are already an AADE member.

You will need to provide the following information:

  • Your name
  • Your preferred address
  • Your preferred email address (all AADE communication will be sent to this email)

STEP 3: Complete the online application

Have the following information ready:

  • Name and address of your sponsoring organization
  • Name of your program (this will be the name on your accreditation certificate, so make sure it matches the name of your billing entity)
  • Quality Coordinator name, address, phone number
  • Name and address for any branch or community sites
  • Names and credentials for all team members (professional instructors and community health workers)
  • If paying online, have credit card ready.  If paying by check, make sure to indicate when prompted and mail using a method that provides tracking information.

Plan to submit the entire application in one sitting. Upload the supporting documents for each standard separately; do not combine them into one large PDF.

Once your application and payment are submitted, the staff will review for completeness and you will be contacted to set up a phone interview. All communication with the staff should be sent to DEAP@aadenet.org.

 

Putting Together Your Documentation

Use the following outlines for each Standard to learn what components you need to include in your supporting documents for your application.

New sample documents for each standard coming soon.

My DEAP Application:

Once you have thoroughly reviewed all of the steps and guidance, you have your supporting documents ready to upload, and can complete the application from start to finish in one sitting (allow up to an hour), click here to start your application:




DSMT Reimbursement Tips

The accreditation process through AADE is essential to obtain Medicare reimbursement for DSMT. However, it is a separate process and does not guarantee Medicare payment. In addition to the accreditation process, a DSMT program should do the following:
  • Sponsoring organization must have an NPI number as well as be enrolled as a Medicare provider for services other than DSMT
    • NPI application forms:  https://nppes.cms.hhs.gov  or for paper application, call 800-465-3203
    • If new to Medicare, need to submit Form 855I to enroll as a Medicare provider (obtain forms through local Medicare Administrative Contractor (MAC)
    • DME/Pharmacy providers must also enroll as a Part B provider to bill for DSMT services
  • Must submit notice of AADE accreditation to local Medicare Administrative Contractor (MAC)
  • Confirm that the HCPCS codes for billing DSMT are loaded in billing system (G0108 and G0109)
  • Submit accreditation notice to contracted commercial payers and verify that DSMT codes G0108 and G0109 are included in contract.
  • If off-site locations are added to accredited program, follow process and recommended steps included on AADE website.
  • Consider purchasing reimbursement resources such as AADE’s “Navigating the Maze: Overcoming the Obstacles to Reimbursement for Diabetes Self-management”
  • Members of AADE can seek additional information from the AADE “Reimbursement Expert” located in our Member Center. Please review the FAQs first because your question may have already been answered.

Questions? Email us at DEAP@aadenet.org or call 800.338.3633.

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Practice Resources

Related Resources

*Interpretive Guidance changes pending approval from CMS, which is expected by December 15, 2017.