Common Questions for Diabetes Self-Management Program Accreditation

Does my organization need to be accredited to bill for DSMT services?

Answer: Yes. In order to bill Medicare for DSMT services, your organization’s DSMT program must be accredited. If you are not accredited or have not notified National Government Services of your accreditation, your claims for DSMT services will not be reimbursed.
Can NGS assist our organization with applying for accreditation of our DSMT program?

Answer: No. The only entities that can assist you with the accreditation process are the ADA or the ADCES. The ADA and ADCES have been approved by CMS to manage the accreditation process for the DSMT program.

Association	Contact Information
American Diabetes Association	Address: 2451 Crystal City Drive, Suite 900 Arlington, VA 22202 Phone: 888-232-0822 Email: ERP@diabetes.org Website: https://professional.diabetes.org/
Diabetes Care & Education Specialists	Address: 125 S. Wacker Dr. Suite 600 Chicago, IL 60606 Phone: 800-338-3633 Email: deap@adces.org Website: https://www.diabeteseducator.org/

How do I apply for accreditation?

Answer: Both the ADA and ADCES have their own applications, requirements, and process for accreditation. You may contact each entity directly to begin the application process. Below is a summary of the requirements for the initial application and renewal process for ADA and ADCES.

ADCES Accreditation Program (DEAP)	ADA Accreditation Program (ERP)
4-year Accreditation Period	4-year Accreditation Period
Application Process: Complete online application within 90 days of starting process. Gather and upload supporting documentation. At least one patient has completed the program through follow-up, and documentation for that patient is submitted. Must collect at least one clinical and one behavioral outcome measure. Be prepared to submit an Annual Status Report 30 days before and up to 30 days after accreditation anniversary date annually. Complete telephone interview. Application Review process: four-six weeks.	Application Process: Contact ADA to set up online access. Complete the online application. Online application can be submitted alone. Supporting documents and payment must be submitted within two weeks of application submission. Submit supporting documentation. At least two outcomes must be tracked for service effectiveness: Participant-defined goals and measure of goal attainment. Other outcome (metabolic, clinical, quality of life) with measure of attainment. Applications are reviewed on a first-come, first-served basis; this process can take up to 30 days.
Renewal Process: Submit online renewal application. Resubmit/Update: Stakeholder Input minutes, CQI project results and plan. Submit Annual Status Report. Pay Renewal fee.	Renewal Process: Complete the online renewal application. Re-submit/Update supporting documentation. Pay Renewal fee.
Audit Process: About 5% of practices are audited with a minimum of 44 on-site audits per year and up to a maximum of 70 on-site audits per year. Two weeks’ prior notice provided.	Audit Process: About 5% of practices are audited with a maximum of 70 on-site audits per year. Two weeks’ prior notice provided.
Initial and Renewal fee- $1100 Main Site, $100 per Additional Site/Branch location*	Initial and Renewal fee- $1100 Main Site, $100 per Additional Site/Branch location*
For more information visit: ADCES	For more information visit: ADA

*Cost of additional locations varies depending on types of location.
**Both programs were updated to reflect the 2017 National Standards for Diabetes Self-Management Education and Support.
2017 National Standards Link

Do I have to renew my DSMT accreditation?

Answer: Yes. The accreditation period lasts for four years. When your organization is up for renewal, you will have to update and resubmit all supporting documentation requested by the accreditation entity.
What is the cost to get my DSMT program accredited?

Answer: The initial and renewal cost to get your DSMT program accredited is $1,100. There may be additional fees per location/branch. You can contact ADCES and ADA directly for more information on your organization’s cost for the program.
Do all of my providers have to be accredited for the DSMT program?

Answer: Providers do not need to be accredited. The accreditation is for your organization’s DSMT program.
I am a CDE with a Medicare provider number. Is it possible to bill DSMT services under my Medicare number?

Answer: Registered nurses and CDEs are not recognized as Medicare providers, so they cannot bill for services under their provider number. In order to bill Medicare for DSMT, you must have an accredited program through either the ADA or ADCES. The billing for DSMT would then be done under the provider number that is the sponsor of the accredited program.
Can pharmacists bill Medicare for services provided by an accredited DSMT program?

Answer: A pharmacist can be an instructor for an ADCES accredited or ADA recognized DSMT program, but they are not recognized as providers and therefore cannot bill independently. The billing for DSMT would be done under the pharmacy’s NPI number assigned to the DSMT program. Many pharmacies already bill services to Medicare either as a DME supplier or Part D provider, but the pharmacy must also separately enroll with its Medicare Contractor, even if they have already completed a Form CMS-855S.
What are the benefits of becoming accredited for DSMT?

Answer: There are many benefits to accrediting your DSMT program. Some include:

To be able to bill Medicare for outpatient DSMT.
To put a structure around the services your organization is providing.
To market services as being of high quality and meeting national standards.

What do I do once my organization has completed the accreditation process and we are accredited?

Answer: Please fax your ADA certification to: J6 317-841-4436 or JK 315-442-4365.

State/Region	Toll-Free Number	Hours of Service
JK: CT, ME, NH, NY, RI, VT	888-379-3807	Monday–Friday: 8:00 a.m.–4:00 p.m. ET Closed for training on the 2^nd and 4^thFriday of the month: 12:00–4:00 p.m. ET
J6: IL, MN, WI	877-908-8476	Monday–Friday: 8:00 a.m.–4:00 P.M. CT Closed for training on the 2^nd and 4^th Friday of the month: 11:00 a.m.–3:00 p.m. CT

I have already been accredited but Medicare is not paying my DSMT claims, who should I contact?

Answer: If you believe your organization has already been accredited, but you continue to see claim denials, please call the NGS Provider Contact Center.

State/Region	Toll-Free Number	Hours of Service
JK: CT, ME, MA, NH, NY, RI, VT	866-837-0241	Monday–Friday: 8:00 a.m.–4:00 p.m. ET Closed for training on the 2^nd and 4^thFriday of the month: 12:00–4:00 p.m. ET
J6: IL, MN, WI	866-234-7340	Monday–Friday: 8:00 a.m.–4:00 P.M. CT Closed for training on the 2^nd and 4^th Friday of the month: 11:00 a.m.–3:00 p.m. CT

What is the average reimbursement for education?

Answer: Use NGS’ fee schedule lookup tool to determine the appropriate fee. Enter the CPT code G0108 and/or G0109 and your state and locality to return results.

Common Questions for Diabetes Self-Management Program Accreditation

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