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NCQA earns new accreditation rights

Ambulatory Surgery Reimbursement Update, November 16, 2004

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the American Association for Ambulatory Health Care (AAAHC) have some new competition when it comes to the accrediting of preferred provider organizations (PPOs).
 
According to a story on modernphysician.com, the National Committee for Quality Assurance (NCQA) was recently granted the authority to offer accreditation to PPOs within the Medicare Advantage program. The JCAHO and AAAHC had held deeming status for those PPOs since 2002.

What this means is that the NCQA will now-like the JCAHO and AAAHC-be allowed to act as an independent third party and accredit health plans that participate in the Medicare Advantage program. The CMS' deeming program allows plans to use that third party accreditation, rather than a full CMS audit, to satisfy federal regulatory oversight requirements. The NCQA has already had approval to accredit Medicare HMOs since 2002, and currently accredits 50 of 150 such HMOs.
 
"This is our second big vote of confidence from CMS and our second opportunity to relieve some of the oversight burden for plans that serve Medicare beneficiaries," said NCQA President Margaret E. O'Kane, in a statement posted on the organization's Web site. "We look forward to serving the needs of a growing Medicare Advantage PPO market and to ensuring that beneficiaries get the best possible care no matter which type of plan they choose."

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