Frustration Over ZIP Codes Spreads to Round One

ATLANTA–With only days left before the implementation of
competitive bidding in 10 of the country’s largest metropolitan
areas, last week some HME providers said they were stumped about
ZIP codes–but not about those in round two, the ZIP codes in round
one.

Not knowing the ZIP codes that will define the next 70
competitive bidding areas has been one of the industry’s main
questions since the round two MSAs were announced Jan. 8.

But the focus quickly shifted to round one last week when a
number of providers–working to notify patients of the Medicare
changes coming July 1–thought the agency had added ZIP codes to
the original bidding area list.

In a message Thursday, the Midwest Association of Medical
Equipment Suppliers said Sheila Showalter-Roberson from Criticare
Home Health Services in Lawrence, Kan., was working on her
company’s grandfathering letters and noticed 37 “new”
ZIP codes on the list for the Kansas City CBA. And Gerald Sloan of
Progressive Medical Equipment, Lenexa, Kan., found that after
matching the ZIP codes to counties, a majority were outside the
original MSA, not just the CBA.

Other providers also notified the American Association for
Homecare that a CBIC file outlining the CBAs appeared to include
additional ZIP codes, said Walt Gorski, vice president, government
relations.

But, Gorski said, CMS assured the association that “no new
ZIP codes were added.”

What happened, he said, is that the CBIC commingled the ZIP
codes for mail order and non-mail order items into one master
file.

In that file, said MAMES Executive Director Rose Schafhauser,
“there is no way to distinguish if there truly are just
certain zip codes for diabetic supplies versus all of the other
product categories included in competitive bidding. It’s not clear
on the CBIC Web site if there are two different lists, and they are
expecting suppliers to be compliant with the grandfather letter.
But how are they supposed to be doing that?”

According to Gorski, “Suppliers had every reason to be
concerned because there is no distinction between mail order and
non-mail order in that master file.”

In an update on its Web site Friday, the CBIC said two ZIP code
files–one with mail order ZIP codes and one with non-mail order
ZIP codes for each of the round one CBAs–would be posted “in
the near future.”

Until the new files are available, however, providers were
advised to use the “Find a CBA” tool on the home page of the CBIC
Web site to access lists of mail order and non-mail order ZIP
codes.

“We consider this a very serious issue, especially since
there are only 16 business days left before implementation,”
Gorski said. “It’s very confusing.

“While we are pleased that CMS is clarifying this issue,
we are still extremely concerned that suppliers may have
incorrectly notified patients that they must now find a new
supplier. This is just another example of the hasty rush to
implement the program rather than ensure that it is done in a
proper manner.”

“We’ve only got so many days left,” added
Schafhauser. “Providers are really scrambling trying to get
notification out to their customers, and this makes it worse.

“It’s just another thing to shake your head at,” she
said.

To view mail order and non-mail order ZIP codes for each round
one CBA, click here.

Next, use the “Competitive Bid Areas” link on the left
side of the page, then “Select a state/territory” and
“Select a CBA.” ZIP codes for non-mail order items are
listed under the “CBA” link.