Risk Management - DME Accreditation & Regulations
Healthcare organizations identify and evaluate risks to promote safety and quality for patients, staff, and visitors. In the world of DME compliance, this risk management process is essential to maintaining operational integrity and regulatory adherence. Risk managers in any healthcare setting—especially those supporting DME accreditation—work both proactively and reactively to prevent incidents and minimize damages after sentinel events. Effective risk planning also supports ongoing DME licensing by ensuring your organization consistently meets the safety, documentation, and performance standards required by federal, state, and commercial payers.
Q-University’s DME Training Center is a great resource for more information.
The Importance of
Risk Assessments & Management Planning
Given that organizations face unique challenges, there is no one-size-fits-all solution to risk management. Data sets vary from provider to provider, as does the information collected from each set. To support DME compliance, our program delivers sophisticated, automated push-technology that enables clients to define the specific data sets they need to collect and analyze—especially those related to measurable performance improvement and risk management activities that directly impact DME accreditation and DME licensing readiness.
QPI’s HARP Light Technology is built to routinely identify potential risks within your organization—functioning much like a continuous SWOT analysis. Our Risk Management team works closely with your leadership to monitor, evaluate, and communicate identified issues. From there, we implement the appropriate risk assessment strategies—whether it’s a PDCA cycle, Corrective Action Plan (CAP), or Root Cause Analysis (RCA)—to ensure your organization maintains compliance and accreditation standards at every level.
Risk Manager Responsibilities (at-a-glance)
Payor Requests
- Appeals & Denials
- Novitas Audits
- Additional Documentation Request
- Corrective Action Plans
- Commercial Payor Audits
- Site Visit Reports
Regulator Training
- Fraud, Waste and Abuse Certification
- Anti-Kickback
- STARK
- Communication Hotlines
- Compliance Reviews and Assessments
- Internal Compliance Audits
- Cybersecurity
- Monitor State/ Federal Regulations
Reporting Tools
- Sentinel Events Assessment
- Fire Drill
- Safety Assessment
- OSHA Assessment
- Hazard Assessment
- Incident Reporting
- Annual Evaluation and Review to BOD
- HIPAA Assessment
Our Risk Management team is dedicated to facilitating assessments and reports virtually on a quarterly basis.
Complaint and Grievance Reporting
Reality: Not every patient will have a positive experience—and that’s okay. Some may express dissatisfaction through verbal or formal complaints and grievances. In support of DME compliance, QPI works closely with healthcare providers to achieve timely resolution of submitted grievances and ensures written notification of the resolution is provided to the patient, in accordance with DME accreditation standards and payer expectations.
Complaint response and resolution due dates are auto-configured in Lavear and appear as daily Risk Management tasks until completion. This real-time accountability supports ongoing DME licensing and ensures no critical follow-up is overlooked. When a response is required, QPI’s Risk Management team works with your organization for immediate, case-by-case resolution.
If similar complaints persist or remain unresolved, QPI escalates the issue directly to your leadership team. Recurrent patterns may prompt our Chief Quality Officer to issue a formal Notice of Non-Compliance, signaling the need for corrective action to maintain your organization’s DME compliance, DME accreditation, and DME licensing standing.
Annual Performance Improvement Report
Managing risks can be daunting. While major risks often demand immediate attention, smaller, recurring risks are frequently overlooked—yet they can be just as damaging to your organization’s compliance, accreditation, and licensing status. QPI’s series of Risk Management Activities are designed to address both, by systematically collecting federally, state, and commercially required performance measures. These include Medical/Patient Record Audits, Billing and Coding Error Logs, Patient Complaints, Adverse Events, and more—on a weekly, monthly, quarterly, and annual basis.
The data gathered from these Risk Management Activities is carefully analyzed by QPI and compiled into a comprehensive Annual Performance Improvement Report. This report supports DME compliance efforts by providing a structured process to monitor and assess every aspect of healthcare delivery within your organization. It also aligns with DME accreditation standards and offers a clear framework to identify improvement opportunities—helping your team enhance quality of care and maintain uninterrupted DME licensing and payer participation.
For transparency and accountability, QPI compiles all performance measures tracked throughout the HARP system year-round into a comprehensive Annual Performance Improvement Report. This report supports your organization’s ongoing DME compliance by consolidating data from all risk management and quality assurance activities. At year’s end, QPI works directly with your leadership team to review and approve the report findings, discuss key insights, and identify actionable strategies for performance improvement as they relate to federal regulations, state statutes, DME accreditation standards, local laws, and other payer-driven requirements.
Failing to prepare for potential risks can lead to serious, long-term consequences. Without a comprehensive risk management plan in place, organizations risk compromising patient care, increasing liability exposure, and violating DME licensing or payer participation requirements—all of which can result in financial losses and reputational harm.
DME Licensing, Enrollment & Credentialing
DME licensing is a formal process guided by established federal and state regulations to ensure that patients receive the highest standard of care from qualified healthcare professionals. It confirms that each provider has undergone thorough evaluation of their education, training, licensure, and overall ability to practice medicine safely and effectively. This process is also foundational to maintaining DME compliance and meeting DME accreditation standards required by CMS and commercial payers.
QPI works with providers and organizations to manage both state and federal licensure renewals—ensuring your organization remains compliant and operational at all times. In addition to DME licensing, we assist providers in obtaining and maintaining privileges and affiliations with local hospitals and healthcare systems, aligning with broader accreditation and payer credentialing requirements.
Credentialing is a critical component of DME accreditation, ensuring that all healthcare personnel meet consistent qualifications across the board. QPI monitors, secures, and maintains credentials for accuracy and timeliness—safeguarding uninterrupted patient care while supporting your ongoing efforts in DME compliance.
