Reporter’s notebook: Love them or hate them, bid contracts at heart of most-read stories

Friday, January 27, 2017

From diabetes supplies to wound care to vents, this year’s list of most read specialty provider stories covered a lot of different markets, but they all had one thing in common: CMS.

The No. 1 story, “CMS’s mail-order program starts to show cracks,” underscored the dangers of having only a handful of providers to cover such a large market when one of those providers, Arriva Medical, had its billing number revoked then reinstated by the National Supplier Clearinghouse.

At press time, Arriva is once again fighting for its billing number. In our No. 4 story, “CMS revokes Arriva’s billing privileges,” CMS the provider with allegedly submitting claims for deceased patients.

Adding to the squeeze: Hudson, Ohio-based Direct Healthcare Supply, another of the mail-order contract suppliers, cancelled its contract; and three others were rumored to be on the selling block.

While diabetes contract suppliers may have sought to exit the bid program, in our No. 2 story, “KCI fights CMS’s decision,” Acelity, the company formerly known as KCI, was asking CMS to reconsider its bids for negative pressure wound therapy in the Round 2 re-compete, which it said were declined on a technicality.

In August, the company said it was partnering with contract winners and would remain in discussions with CMS.

Vents in 2016 remained a product category in flux. In our No. 4 story, “Insurers follow Medicare’s lead on vents,” providers learned—often without advance notice—that private payers had wasted no time in reducing reimbursement for non-invasive ventilators. In January, CMS had reduced its reimbursement by about 33%.

And finally, one spot of brighter news: the No. 5 story, “CMS eases resupply requirements, but questions remain.” The agency has said it will now assume medical necessity has been established for replacement of accessories, making it easier to serve beneficiaries who change providers. While stakeholders seek further clarification, their advice, as always, is to stick to established protocols, they say.