Conference Call Erupts as Suppliers Take CMS to Task

BALTIMORE–What was billed as CMS’ third provider training call
on competitive bidding erupted into a veritable war of words
Thursday during a question-and-answer session with listeners.

Dedicated solely to the implementation of round one and aimed at
referral sources and non-contract suppliers, the call began with
pertinent updates, including:

–MLN Matters Article 6119 has been released, laying out phase
two of manual revisions that reflect changes resulting from
competitive bidding and the Deficit Reduction Act. Click here to access the article and scroll
down to Transmittal R1532CP.
–A direct mail beneficiary outreach from CMS is expected to begin
June 20 (see “Weems Shines Up Competitive Bidding” in this issue).
A coordinated package containing information for suppliers in the
CBAs should also be mailed around the same date.
–The final versions of six beneficiary tip sheets on specific
types of equipment under competitive bidding should be released
“within the next week or two.”
–A central mailbox for questions concerning competitive bidding
has been set up at [email protected].
–According to CMS’ Joel Kaiser, “Suppliers should only be
sending notifications about grandfathering to beneficiaries who are
residing in competitive bidding areas.”
–Also, Kaiser said, “If a beneficiary does not get back to
you, that’s the same thing as not electing to receive the item from
you, so you will be picking the equipment up in that
situation.”
–If a beneficiary elects to stay with a grandfathered supplier,
that supplier is expected to obtain detailed documentation
concerning the beneficiary’s decision for Medicare billing
purposes.
–Clarification on providing mail-order diabetic supplies is on its
way “in the near future.”

But the blows began when CMS answered questions from callers,
including this exchange on contract winners for negative pressure
wound therapy:

Caller: “My question is, how will you
deal with a contract winner for negative pressure wound therapy
that doesn’t at the time of the bid have product or the competency
to be able to delivery that specialty piece to the patient? And how
[are] the physicians going to feel about putting these patients in
the hands of subcontracted people or contractors that don’t have it
together? I mean, these people made bids … that have never done
it before … How’s that going to be dealt with?”

CMS: “First of all, every supplier that
was awarded a contract was accredited for DMEPOS, so if you’re
accredited for providing products then you can provide them
…”

Caller: “Accreditation does not go by
pieces of equipment. Accreditation is accreditation. So if they
have no experience in providing a specialty piece nor do they have
the product, my concern is where are they going to get
product?”

CMS: “I would note that they have as much
experience as any provider has had or is required to have in the
past. But also an important thing to notice is that this is a very
new market in terms of new growth and new products that are
available. There are more suppliers coming into this market. It’s
not because of competitive bidding, it’s because the market is
changing and is being opened up to more suppliers and more
manufacturers so it is very new for a lot of entities
…”

Caller: “No. I didn’t say that. What I am
saying is that, by July 1, can a company find enough product and
people to support the beneficiaries in the 10 top MSAs where they
don’t even reside?”

CMS’ final reply: Because contracted suppliers
were scrutinized for both estimated capacity and financial
standing, these two criteria should eliminate the caller’s
concerns.

Responding to a question about beneficiary information on
competitive bidding, CMS said beneficiaries could access
information online, but a caller pointed out “the majority of
our patients–the beneficiaries–don’t leave their homes and are
not laying in their hospital beds with the Internet on their lap.
The majority of this beneficiary information plan that you have
spoken about … [is] how the patient has to contact you through
the Internet … We are greatly concerned about how these patients
are going to get this information.”

According to CMS, “We have engaged in a pretty proactive
outreach program for our beneficiaries for a couple of months now.
Primarily it’s focused on working with our partners in educating
various consumer advocates … and others that deal
face-to-face with the beneficiaries.” CMS noted beneficiaries
also can call 1-800-MEDICARE.

Another caller, asking about the liability of large retailers in
obtaining ABNs from beneficiaries, said she was having “a
hard time wrapping her head around” CMS’ requirement that
every customer purchasing a competitive bid item be asked by a
store employee about whether they are willing to purchase items
that may be covered by Medicare.

“What if we have as many as 30 registers at the front of the
store?” she asked.

“Everyone needs to ask them when they are carrying a box
with a walker to the cash register ‘Are you a Medicare
beneficiary?’” was the answer from CMS. As a mass retailer,
“if you’re going to enroll and be given a supplier number,
you don’t get any waiver on the rules that apply to other DME
suppliers. You are a DME supplier. You have to follow all the rules
that other DME suppliers follow.”

Delivery of diabetic supplies was another concern.

CMS said it had not yet “clarified” definitions on
what constitutes a mail-order supplier, but one caller pressed,
“Can you give us some kind in inkling as to when [this
clarification] is going to happen? Because I have emailed Joel
Kaiser twice and never heard back … I emailed the CBIC on
June 5 and also on May 27 and I still have not received an answer
back.

“You have a ton of companies out here who are sitting in
limbo that have employees on the line. Our entire future is on the
line. Unemployment, health care, all on the line,” the caller
continued. “There are thousands of people across this country
waiting for an answer to this question. I’ve already purchased
$50,000 worth of vehicles. I have hired three full-time employees
who have company-paid benefits … This is really not fair to
us suppliers. When do you think you’re going to have an answer for
us?”

CMS dodged the question by asking the caller about her vehicles
and location before answering, “We realize that this is an
important issue for everyone … The clarification of the
definition will affect everyone, so it is very important and we
understand that and we are working on it.”

But the caller persisted, “Can you give us some kind of
time frame? We have a lot at risk right now … Can you give us
an answer? We’re within almost two weeks now” [of round one
implementation].

”You sent an email on June 5 to me? Did it include the
details you have talked about today?” Kaiser asked.

Replied the caller, “Absolutely.”

Said Kaiser, “I will make sure I get to your email. I am
human so I can only deal with so many messages at a time. We as an
agency will be looking into this and be getting back to you as soon
as possible.”

After a continued back-and-forth, Kaiser admitted he is waiting
on information from the agency’s general counsel before he could
announce clarification on diabetic supplies. “It is important that
we get this legal advice first,” Kaisesr said. “Once we do, we will
be making an announcement as soon as possible.”

CMS also said the agency has not further defined the term
“essential services” for subcontracting–a question
originally raised during a previous provider training call.

To listen to Thursday’s teleconference in its entirety, call
800/642-1687 and enter passcode 49895703. The playback will be
available through June 17.