Delay details trickle in

Sunday, July 20, 2008

WASHINGTON - CMS on Friday afternoon held a teleconference for beneficiaries on the delay of national competitive bidding, but it was providers who burned up the phone lines.

During a question-and-answer period, several providers queried CMS officials on the logistics of the 18- to 24-month delay. They didn't get very far. For the most part, officials rehashed the few details already released earlier in the week.

Those details include: Durable medical equipment can now be provided by any Medicare-approved provider. Beneficiaries have the option to stay with a contract provider, return to their former provider or select a new provider. Non-competitive bidding payments and co-payments have been reinstated retroactively to July 1, competitive bidding's launch date.

CMS plans to relaunch the competitive bidding process some time in 2009 in the same competitive bidding areas (except Puerto Rico) and for the same product categories (except high-end power wheelchairs and negative pressure wound therapy).

In the "near future," officials said, CMS plans to issue guidance on how it will handle claims submitted from July 1, competitive bidding's launch date, to July 15, the program's delay date.

"I can say now that claims back to July 1 will be reprocessed for suppliers," said Laurence Wilson, director of CMS's Chronic Care Policy Group. "We can expect that to happen in the near future."

Also in the near future, CMS plans to notify 3.7 million beneficiaries living in the 10 competitive bidding areas of the delay.

CMS plans to hold another teleconference specifically for providers "in the next week," officials said.

Other tidbits from Friday's teleconference:

* What's the new timeframe? "The new law doesn't give a particular timeframe," Wilson said. "It does say the competition must occur in 2009, so we'll be working within that timeframe. We are looking at the new law and looking at the many things we want to accomplish for this re-bid. Once we have worked through all the various steps--procedural, legal, regulatory--we will put out a timeline for when we'll be implementing the program and let suppliers know what to expect."

* What's the deal with the 9.5% cut? "Under the law, that would be effective Jan. 1, 2009," Wilson said. "As we always do, with the fee schedule at the beginning of the year, we would make the change and it would be for items and services furnished on or after that date."

* Are high-end power wheelchairs exempt from the 9.5% cut? "It's something we can look into as we move forward in implementing the statute," Wilson said.

* Do providers re-bill beneficiaries for the difference between the competitive bidding and non-competitive bidding co-pays? "Because the law established a higher fee schedule as the basis of payment back to July 1, it could very well be that a supplier bills a beneficiary for the additional co-insurance," Wilson said. "It is not clear that they have to do that. That's something that we're looking into."

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