Competitive bidding problems, rumors and innuendos
Since competitive bidding, for better or worse, kicked off Jan. 1, we've been getting a steady stream of e-mails from readers reporting problems, rumors and innuendos associated with the program. It'd be a full-time job to follow up on this stuff and some of it would be nearly impossible to verify, but I wanted to throw it out there, anyway, to see what sticks.
Here's a taste for what we've received so far:
*One provider says he's been approached by contract suppliers to be a sub-contractor in some of the competitive bidding areas (CBAs) for power wheelchairs. We hear there's a lot of this going on, even at this late stage. No big deal, right? Well, this provider says these contract suppliers want him to be their sub-contractor because they have no idea what they're doing! The provider said in an e-mail in HME News: "They are contacting us because they have no idea how to go about the paperwork process, work with the physician, what paperwork is necessary, who to order the chair from, etc., in order to be compliant with Medicare guidelines for power wheelchairs." While CMS may have put contract suppliers through the ringer when it came to being financially sound and meeting all applicable accreditation and other requirements, as far as I know, the agency didn't do anything to make sure they had provided the product in the past or they were at least familiar with the process of doing so. Don't most employers consider past experience a must-have for most jobs? Geez.
*Also in that vain: Another provider says he put some of the contract suppliers to the test, in terms of their knowledge of the process for supplying power wheelchairs, and he was shocked by what he found out. In a nutshell, the provider called the contract suppliers, told them he was in town over the holiday and his father, who has neuropathy in both his hands and feet and has fallen recently, needed a power mobility device. One of the contract suppliers told him all he needed to do was have his father's physician send him a valid prescription and his father would get the equipment the next day. Another contract supplier told him a face-to-face exam was required, but when he asked what that was, the supplier told him it involved a visit between one its reps and his father. Then it would send a form to his father's doctor to fill out and he would get the equipment. That's pretty fast and loose. Will Medicare know the difference?
* One provider says he heard "through the grapevine" that CMS was curtailing audits on contract suppliers, so the agency wouldn't impact the success of competitive bidding. The provider wrote: "On the surface this certainly smacks of unethical and illegal behavior, not to mention partiality, on the part of CMS, assuming it’s accurate. Kind of makes sense in a way, the way CMS has gone about ignoring the flaws in the program and surging forward with blinders on." I don't know what to think about this one.
*One provider says his claims for diabetic testing supplies have been getting denied across-the-board. He called Cigna, the DME MAC for his jurisdiction, and was told it was a claims processing error and that Cigna would re-process his claims automatically, but it would not say when. CMS has already released one patch for billing errors and I don't suspect it will be the last.
Anyone else experiencing these problems or hearing these rumors and innuendos?