CMS begins telling beneficiaries about competitive bidding

Sunday, May 18, 2008

BALTIMORE - Political maneuvering aside, CMS has ramped up its information campaign for Round 1 of national competitive bidding (NCB), including two separate educational teleconference calls last Tuesday.

First off, there's a new Web site for competitive bidding:

Last Monday, the first installment of an Internet-only claims processing manual was posted on the site. Chapter 36 of the manual deals specifically with DMEPOS competitive bidding, said a CMS official during the first call.

With the July 1 start of the program just six weeks away, CMS has begun an outreach to let beneficiaries "know what's coming," said a CMS official during the second call.

"What we are trying to do is reach out to the advocacy community and ask them to partner with us," she said. "We have tip sheets, flyers and other information available, and we've also set up a call line to report fraud. If any provider has beneficiaries ask them questions, we have stuff for them."

The second call revealed that providers aren't alone in their fear that some Round 1 contracts went to unqualified HMEs who have little or no experience in the categories they won.

A physical therapist who called in during the second teleconference's Q&A session stated: "The concern among a lot of therapists is the companies that are going to be getting the bid for our areas are companies who have never provided complex rehab," she said. "They don't understand the complexity of it. Is there some mechanism that we can contact to say--from a clinical perspective--that a company can't provide the service?"

CMS official: "If they won the bid, they are already accredited. If there's a clinical issue, (accrediting agencies will) investigate."

Another official added that investigations could also be conducted through the National Supplier Clearinghouse and the Program Safeguard Contractors, and CMS will soon announce an ombudsman program for the CBAs.

Other key points discussed at length, during the teleconferences were grandfathering and mail order diabetes supplies.

-- Grandfathering applies only to rental items, including oxygen, capped rental DME and routinely purchased expensive DME, like walkers. If a supplier was providing any of these items prior to the July 1, 2008 start date of NCB, they may choose to continue offering these items. If they chose not to become a grandfathered supplier, they must notify the beneficiary. Providers can also choose which items they want to be grandfathered for, but must provide those items for all beneficiaries in the CBA.

-- Mail order pertains to items ordered by phone, e-mail, Internet or mail and delivered to the beneficiary's residence by a common carrier, such as the U.S. Postal Service, FedEx or UPS. Mail order does not include items obtained directly from local storefronts.

-- Diabetic testing supplies delivered to beneficiaries residing in one of the first 10 competitive bidding areas must be billed using KL modifiers. Both contracted and non-contracted providers supplying mail order diabetic supplies must use the modifier, or risk penalties under the false claims act.

Several callers expressed confusion with what CMS defines as a local storefront, and CMS officials planned to issue a clarification.