Volume 2025 | No. 2
SURVEYOR
FROM THE PROGRAM DIRECTOR
DMEPOS
A survey with no findings—no identification of non-compliance—is exceedingly rare, and that knowledge can be daunting. The important takeaway when exploring deficiency data is growth and improvement. This Quality Review edition of Surveyor identifies and analyzes the most challenging standards for the ACHC DMEPOS Accreditation Program. This year’s data span initial and renewal surveys conducted between June 1, 2024, and May 31, 2025.
DMEPOS Trends This is my first Quality Review issue of Surveyor since joining ACHC to lead the DMEPOS team. I have found it to be a valuable resource. For me, it offers insight into where we may need to provide additional training to ensure that suppliers have a full understanding of what compliance looks like in practice. For a customer, it offers actionable tips to improve their organization. The ten standards identified in this publication were noncompliant on over 15% of DMEPOS accreditation surveys. Three of the ten are related to the provision of information to clients/patients ( DRX2-2A , DRX 2-4B , and DRX2-4C ). Compliance with DRX2-4B and DRX2-4C has improved since 2022 when this cohort of organizations was last surveyed. However, surveyed organizations now have more deficiencies related to DRX2-2A with a rate of 18% noncompliance compared to 15% three years ago. Missing documentation and inadequate staff training are the usual culprits behind these citations. We urge you to assess competencies regularly and audit your intake processes against both ACHC Standards and the CMS Quality Standards for DMEPOS. This year’s most frequently cited deficiency is DRX7-12D , which has been the case for five years running. The good news is we are seeing significant improvement over time. In 2022, this
standard was deficient on 42% of DMEPOS surveys. This year I’m pleased to report a decrease to 30%—but that number is still a bit high. DRX7-12D details requirements for cleaning, storage, transportation, delivery, and setup of equipment. Proper separation areas in both warehouses and delivery vehicles continue to miss the mark. Storage and delivery of oxygen tanks are also primary sources of concern. Compliance with the requirements of DRX7-12D will increase greatly with consistent audits of warehouses and delivery vehicles. I encourage you to create learning opportunities by conducting mock audits with your team. Incorporate the requirements into your PI Program. Emphasize the importance of this standard with every member of your staff. In other areas, accredited suppliers are making significant strides. When we compare rates of noncompliance with those from three years ago, DRX6-3C has dropped from 25% to 18%. DRX7-4A has greatly improved, from 29% to 17%. DRX4-8A is perhaps the most impressive, with 36% non-compliance in 2022 lowered to 16% in this year’s report. These achievements show that accredited suppliers are committed to ongoing improvement, and I’m proud of the progress that has been made.
Changes in 2026 CMS changes to the requirements for DMEPOS reimbursement are the subject of current discussion and concern across organizations of all sizes. The biggest shift is the change from a three year survey cycle to an annual survey beginning January 1, 2026, for both new and renewing organizations. If you were surveyed this year, your accreditation term will not change. Annual surveys will begin with the expiration of your current accreditation. Despite the regulatory change, ACHC’s educational approach remains consistent. I encourage you to frame the more frequent surveys as an opportunity for a closer partnership.
Together, your organization and ACHC will be able catch compliance errors at the earliest possible moment, when they are often easiest to correct. That means less time remediating deficiencies, and more time making meaningful improvements to impact the quality of your patient support, and the sustainability of your business. As I continue my journey leading ACHC DMEPOS Accreditation, I look forward to your feedback on how my team can better support your success. Please reach out at any time.
Deborah Panza, BS, RRT, RPSGT Associate Program Director
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