CMS backs off patient-contact restriction--for now

Sunday, January 23, 2011

BALTIMORE - CMS won't enforce its ban on direct solicitation of beneficiaries for now, officials told listeners during last Wednesday's Open Door Forum.

"Unanticipated issues have arisen regarding the implementation of the newly expanded portion of the provision," said John Spiegel, director of the Medicare Program Integrity Group, during the call. "CMS feels further investigation is necessary to determine the best way to apply these changes."

The Office of Inspector General (OIG) created some confusion early in 2010 when it issued an alert that stated providers may not contact beneficiaries "based solely on treating physician's preliminary written or verbal orders."

CMS backed off on the provision, which many in the industry argued would hamper common business practices. But, when it released the updated supplier standards, which went into effect Sept. 27, the agency attempted to clarify the rule by including a ban on "direct solicitation." The provision expanded the ban to include in-person contacts, e-mail and instant messaging, in addition to telephone contacts.

It may be that the definition of "direct solicitation" is not yet clear, said Neil Caesar.

"It's likely that if they are having implementation difficulties, it (might) have to do with the new things they've done and the way they worded it," said attorney Neil Caesar, president of the Health Law Center. "Or, they are figuring out a more logical and consistent way of handling the physician's oral orders."

Also during last Wednesday's call: Officials reminded grandfathered providers in the competitive bidding areas to use KY modifiers when billing for purchased accessories and supplies for use with grandfathered equipment. There are 24 codes that fall into that category: CPAP supplies, hospital beds and related items, and walkers and related accessories.

"Suppliers are reminded to please submit the single payment amount so that the claim will process correctly," said CMS.