Providers Still Have Questions on NCB

INDIANAPOLIS — National Government Services, the
Jurisdiction B DME MAC, has posted a summary of questions and
answers from its Ask-the-Contractor teleconference on Dec. 7.

At the time of the conference call with only days until
implementation of national
competitive bidding Jan. 1, many of the questions providers
asked were about the bidding program. Subjects ranged from claims
filing and traveling beneficiaries to rules for furnishing Group 2
power wheelchairs, CPAP, oxygen and mail-order diabetic
supplies.

A sampling of questions from the teleconference follows, with
answers given by representatives from CMS’ Competitive Bidding
Implementation Contractor (CBIC). For an audio playback or
transcript of the teleconference, along with the entire Q&A
summary, see the NGS website.

When competitive bidding is implemented, should
suppliers continue to file claims to the DME MAC jurisdiction based
upon the beneficiary’s address on file with the Social Security
Administration (SSA)?

Yes. Claim filing will continue to be based upon the
beneficiary’s permanent address on file with the SSA. For suppliers
filing electronically, submit claims with the beneficiary’s correct
address — as indicated on file with the SSA — through
the Common Electronic Data Interchange (CEDI). As is the current
process, the CEDI will forward the claim to the appropriate DME MAC
jurisdiction based upon the beneficiary’s address indicated on the
claim. Suppliers that have a valid Administrative Simplification
Compliance ACT (ASCA) waiver on file and are permitted to file
paper claims, must mail their CMS-1500 paper claim to the
appropriate DME MAC based upon the jurisdiction in which the
beneficiary resides.

Is it true that if a supplier is located in a
competitive bidding area (CBA) and is one of the contract winners
for the Group 2 power wheelchairs, the supplier will still be able
to offer the purchase option when competitive bidding is
implemented on [Jan. 1], but suppliers outside of a CBA may only
rent standard power wheelchairs effective [Jan. 1]?

Yes, that is correct. The changes to the power wheelchair
payment rules made by section 3136 of the Affordable Care Act do
not apply to payment made for items furnished pursuant to
competitive bidding contracts entered into prior to Jan. 1, 2011 or
for power wheelchairs in which the first rental month occurred
before Jan. 1, 2011. Therefore, under the Round 1 rebid competitive
bidding program, contract and grandfathered suppliers furnishing
rented power wheelchairs will continue to be paid under the capped
rental payment methodology using 10 percent of the single payment
amount for the first three months and 75 percent of the single
payment amounts paid in the first three rental months for months 4
through 13.

Similarly, the elimination of the lump sum purchase option for
standard power wheelchairs, as required by the section 3136 of the
Affordable Care Act, does not apply to standard power wheelchairs
furnished by contract suppliers under the Round 1 rebid program.
Payment for standard power wheelchairs will continue to be made to
Round One Rebid contract suppliers on either a lump sum purchase or
rental basis.

If a beneficiary who resides in a non-CBA (permanent
address on file with the SSA) temporarily relocates to a CBA, is
the home supplier in the noncompetitive bidding area allowed to
ship CPAP supplies to the beneficiary in the competitive bidding
area?

No. When a beneficiary travels from a noncompetitive bidding
area to a competitive bidding area, the beneficiary must obtain any
competitively bid item or services — except for mail order
diabetic supplies — from a contract supplier within the
competitive bidding area.

When a beneficiary travels from a non-CBA in which they
reside to a CBA, but the beneficiary does not change their
address on file with the SSA, are the beneficiaries allowed to call
their home supplier (within the non-CBA) and request that CPAP
supplies be mailed to their temporary residence within the
CBA?

No. If a beneficiary travels to a competitive bidding area from
a non-competitive bidding area, the beneficiary would have to get
their competitively bid item or service from a contract supplier.
However, the contract supplier’s reimbursement will be based upon
the beneficiary’s address on file with the SSA. Therefore, if the
beneficiary’s permanent address on file with the SSA is not within
a CBA, the contract supplier in the travel location will be
reimbursed based upon the fee schedule amount for the state in
which the beneficiary resides.

This rule applies to all competitively bid items except for mail
order diabetic supplies.

If a beneficiary residing in a non-CBA is within the
13-month rental period for CPAP equipment and they travel to a CBA
(snowbird), is the beneficiary required to return the CPAP machine
to the home supplier in the non-CBA and rent the CPAP equipment
from a contract supplier in the CBA or can the home supplier
continue to bill for rental of the CPAP?

The home supplier that provided the CPAP to the beneficiary may
continue to rent the CPAP equipment and submit claims for the
remainder of the rental period. However, supplies and accessories
must be obtained from a contract supplier within the competitive
bidding area to which the beneficiary travels.

Please explain the rules for mail-order diabetic
supplies for both traveling beneficiaries that reside in a CBA and
for traveling beneficiaries that do not reside in a
CBA.

If a beneficiary’s permanent residence is in a competitive
bidding area, the beneficiary must get the mail-order diabetic
supplies from a contract supplier. If they are traveling, even if
they travel to a noncompetitive bidding area, they must still
obtain mail order diabetic supplies from a contract supplier since
the item is furnished by mail. So as long as the beneficiary’s
permanent address or permanent residence is in a competitive
bidding area, then the mail order diabetic supplies, regardless of
where the beneficiary is, must be provided by a contract
supplier.

However, because diabetic supplies purchased from a storefront
are not subject to competitive bidding, the beneficiary may
purchase diabetic supplies from any Medicare supplier that
furnishes these items. If the beneficiary does not reside in a
competitive bidding area, the beneficiary may obtain their
mail-order supplies from any Medicare supplier.

If the beneficiary’s permanent residence is in a noncompetitive
bidding area, and he/she travels into a competitive bidding area,
the noncontract supplier from that noncompetitive bidding area (the
beneficiary’s place of residence) may continue to furnish the mail
order diabetic supplies. So, a beneficiary that resides in a
noncompetitive bidding area and travels to a competitive bidding
area, does not have to obtain their mail order diabetics supplies
in a competitive bidding area from a contract supplier. That is an
exception to general competitive bidding rules for beneficiaries
who travel or temporary relocate.

During the 36-month rental cap for oxygen equipment, if
a beneficiary travels or temporarily relocates from a non-CBA to a
CBA, who is responsible for providing the oxygen equipment,
contents, and related supplies and accessories?

During the 36-month rental period for oxygen, when a beneficiary
temporarily travels or relocates to a competitive bidding area, the
home supplier may continue to furnish the oxygen equipment as well
as any contents, supplies and accessories directly, or the supplier
may assist the beneficiary in locating a contract supplier in the
beneficiary’s new service area.

If a beneficiary travels or temporarily relocates out of
our noncompetitive bidding service area before the
36-month rental cap is reached, and we assist them in finding a new
supplier in their new location, what is our obligation to that
beneficiary if/when they return to our service area?

Since you are a non-contract supplier in a noncompetitive
bidding area, you are under no obligation to provide oxygen
services to the beneficiary upon their return to your service area.
The supplier in the travel location is responsible for working with
the beneficiary to locate a supplier in their home location. If the
supplier in the travel location receives the 36th rental payment,
they will be responsible for providing all necessary oxygen
equipment, contents, supplies, and accessories directly or under
arrangements with another supplier throughout the reasonable useful
lifetime of the equipment.

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