Competitive bidding: CMS gives few details during 'frustrating' meeting

Sunday, October 14, 2007

BALTIMORE - Industry representatives had plenty of questions when they met with CMS last week to discuss competitive bidding. Unfortunately, CMS officials didn't have very many answers.

"It was frustrating," said one industry watcher who attended Thursday's meeting between CMS and the Program Advisory and Oversight Committee (PAOC) for competitive bidding. "They didn't even announce a schedule for the second round of competitive bidding but said they would very soon."

CMS officials came to the meeting prepared to talk about educating beneficiaries and referral sources on competitive bidding. PAOC members, however, were more concerned with program details that directly affect HME providers: How will financial standards be applied? How will CMS determine when a competitively bid price is too low? How many providers registered in the first 10 CBAs, and how many of those submitted bids? On what date will CMS require all HME providers to become accredited?

"CMS clearly wanted to address issues that if felt were important, but didn't make time to address policy issues important to PAOC members," said Walt Gorski, vice president of government affairs for AAHomecare. "We continue to be troubled by CMS's unwillingness to share fundamental information from the first round of bidding."

For example, CMS anticipated receiving bids from 15,000 providers in the first 10 bidding areas, but it appears to have received only a fraction of that--1,500 to 2,000 by one estimate. If that's the case, it could create major access problems for beneficiaries, say industry watchers.

Given that mandatory accreditation is a key initiative to address fraud and abuse--an initiative the industry strongly supports--CMS's failure to announce a final deadline left many wringing their hands.

"No one who has true criminal intent will go to the trouble of developing policies and procedures to get accredited," said industry attorney Asela Cuervo, a PAOC member. "That's the whole reason I think DME is an easy target. You can set up a business without having (accreditation)."

Going forward, Gorski stressed the need for CMS to work more closely with the HME industry.

"I think we will both be more efficient that way and get things correct right out of the box," he said. "I think they are trying to put together a system that is workable, but they have so many different things to do, so many moving parts. I hope they put themselves in our shoes for claims processing, for submitting a bid, for complying with Medicare requirements. I think that would be helpful."