Commentary: Nothing ‘Bona Fide’ about Rebid

HME provider Rob Brant of City Medical
Services, North Miami Beach, Fla., is president of Accredited Medical Equipment
Providers of America.

Editor’s Note: Fourteen months after “an overwhelming number
of out-of-area companies, inexperienced businesses and illegitimate
bidders forced Congress to delay the DMEPOS competitive bidding
program, registration has opened for the Round 1 rebid,” said
Rob Brant, president of the Accredited Medical Equipment Providers
of America. And despite assurances that the problems from the first
bid have been eliminated, inexperienced companies will still be
able to win with illegitimate bids, Brant believes.

This commentary from Brant follows CMS’ Sept. 2 Special Open
Door Forum on the rebid, called “Learn the Rules to
Submit a Bid Successfully.”

Webster defines “bona fide” as “authentic” or “true.” During the
teleconference, the Medicare official warned providers that any bid
that was not “bona fide” would be thrown out. But Medicare’s
definition of “bona fide” is simply the lowest wholesale price for
the bid item, checked against the manufacturer’s invoice, not the
“true” cost of providing patient care, which must include
services.

During the question-and-answer segment of the teleconference, I
asked if Medicare will take into consideration the cost of
providers to guarantee a patient’s CPAP compliance according to the
new payment rules which began last November. I asked if Medicare
has conducted a study to calculate the cost of revisiting the
patient, downloading data from their CPAP, sending a report to the
patient’s physician, coordinating the patient’s follow-up,
face-to-face re-examination with the doctor and acquiring doctors’
notes, which assure patient compliance.

After a 30-second pause, I was answered “No.” The CMS
representative continued, “‘Bona fide’ bids are based on the
ability to purchase equipment at the cost of an invoice, not cost
of service.”

Out-of-Area Providers

When 90 percent of providers were excluded from the program,
health care groups complained about patients’ access to care. This
was a great concern in Orlando, where 40 percent of the oxygen
providers were located over 100 miles outside of Orlando.

Medicare stressed that all providers must be licensed in the
state in which they were bidding or their bid would be
disqualified, but that does not fully resolve the issues of access
to care. A question was later asked if a licensed company in
Pensacola, Fla., located over nine hours and 600 miles outside of
the Miami MSA, needed any additional requirement to bid or prove
they could administer care from such a distance.

Again the answer was “No.”

As an additional note, the original 2008 program also required
bidders to have state licensure or be disqualified. However, that
did not stop Medicare from awarding contracts to nine oxygen
providers without an oxygen license from Florida’s Department of
Health.

Submitting Subcontract Agreements

Another contradiction that Medicare is touting as a “program
fix” is in the area of subcontracting. Unlike the previous bid,
Medicare now requires that they be notified of any subcontracting
agreements, and subcontractors must now be accredited. However, a
bidder is not required to have a subcontract agreement in place to
prove they can provide products and services to patients in a
competitive bidding area. The only requirement is that “if” a bid
winner has a subcontract agreement in place, they must notify
Medicare within 10 business days of the contract award.

Clearly Medicare has made an effort to respond to a few of the
problems that Congress identified when it delayed the
implementation of the program. However, it is also exceedingly
clear that Medicare has not made any significant changes in their
policy to exclude illegitimate bids and have a “bona fide”
program.

Rob Brant can be reached at [email protected]. See Accreditation
Fastball: It’s ‘Bottom of the Ninth’ for details of an AMEPA
study that found the number of providers in South Florida has
dropped by 30 percent since last year’s aborted Round 1
bid.