Accreditation, Bidding Issues Crop Up at Open Door

BALTIMORE — Home medical equipment providers peppered CMS
officials with questions about hot button issues regarding
accreditation and DMEPOS
competitive bidding during an Open Door Forum on Wednesday, but
came away with little new  information.

Some 516 listeners were on the line for the teleconference,
which also covered hospice and home health agency issues, but the
bulk of their questions centered on DME.

A Dallas DME provider said her company has a surety bond but
would likely not be accredited by the mandatory Oct. 1 deadline.
“Will we have to opt out of Medicare billing, and, if so, for
how long?” she asked.

CMS’ Jim Bossenmeyer replied that providers who will not
be accredited by Oct. 1 have two options: to terminate voluntarily
or withdraw from the Medicare program, or simply to wait until
their billing privileges are revoked.

“If your billing privileges are revoked, you would not be
able to bill the Medicare program for one year,” he said. If
providers withdraw voluntarily, they will not be able to bill
Medicare until they have met the program requirements and are
re-established with the National Supplier Clearinghouse, though
they would not necessarily have to wait out the one-year revocation
bar.

“So it would be better if I opt out?” the provider
asked.

“I think each business needs to make its own decision
given their fact set and when they started the accreditation
process,” Bossenmeyer answered.

That exchange led to a question about beneficiary
service.

“Let’s say you are not accredited but you have a bed
out to a patient that’s been out there for eight months and
you know after 13 months it’s patient-owned. What would
someone do in that circumstance?” the provider asked.
“No other company is going to pick them up at month nine.
It’s just not feasible; it won’t even pay for the
equipment itself. What is that patient going to
do?”

Joel Kaiser, deputy director of DMEPOS policy and a CMS veteran
of 21 years, said that historically, CMS has left such issues to
providers to work out among themselves.

Added Kaiser, “We’re going to really be very
intensely monitoring the situation with this one-time transition
where we have the implementation of these new requirements to see
if beneficiaries are caught in this situation and having difficulty
finding suppliers.”

Regional CMS staff, Kaiser said, “will work to address
those situations as they come up.”

One provider questioned whether suppliers would be allowed to
subcontract billing services under competitive bidding
rules.

“Lots of suppliers have billing services,” Kaiser
responded. “I don’t know why that wouldn’t be
allowed.”

But the caller said just that morning, the CBIC had told him he
couldn’t contract out that aspect of his business.

Kimberly Rogers Bowers of Apria Healthcare corroborated the CBIC
stance, reading to CMS officials from a CBIC presentation that
indicated subcontractors are not allowed to submit claims on behalf
of beneficiaries.

Kaiser said he did not believe that meant providers
couldn’t subcontract with billing services and said that he
would follow up with the CBIC.

Another caller identified a problem with the competitive bidding
registration process. Under the process, providers must identify
and register an “authorized
official” if they intend to place a bid.
That person must use his/her name and Social Security number. The
system, however, would only allow a single use of that AO, the
caller said; he was unable to register for another of his locations
using the same AO.

CMS officials said they would look into that.

One caller from an oncology clinic dialed in to comment on
CMS’ recent change of the rules governing
consignment closets.
Under the new rules, he said, physicians would now have to purchase
their own DME and do the billing.

“Our contention is that physician-owned facilities
aren’t in a position to go out and purchase this equipment
not only because of the capital expense but also because they
don’t have the staff necessary to do these types of DME
billings, and I was wondering what the take on this was,” he
said.

Bossenmeyer noted the
effective date for the
new policy has been changed to March 1, 2010. “We are
continuing to analyze and review the comments we have received but
at the moment there is nothing more I can add,” he
said.

Bowers brought up another tripping point for providers.
According to MLN article 6421, as of Jan. 1, 2010, DMEPOS claims
will be denied if the authorizing physician is not in the Provider
Enrollment, Chain and Ownership System, or PECOS. Bowers wondered
if providers would have some access to a list or somehow be able to
check to see if the physician is in PECOS before delivering
equipment.

CMS representatives on the call had no definitive
response.

They did, however, issue a series of reminders and some
clarifications:

–In response to e-mails she had received, the agency’s
Sandra Bastinelli addressed the issue of giveaways to
beneficiaries. “The provision of free supplies to a
beneficiary who purchased other covered items or drugs implicates
the civil monetary penalty statute that prohibits inducements to
beneficiaries as well as the anti kick-back statute,”
Bastinelli said. 

She referred providers with questions to the Office of Inspector
General advisory bulletins (http://www.oig.hhs.gov/fraud/fraudalerts.asp) or the
OIG public call line (202/619-0335).

–Bastinelli also clarified that pharmacies must be accredited
in order to serve Medicare patients after the mandatory
accreditation date of Oct. 1.

“If you are a pharmacy and you are billing a DME MAC for a
covered product, you must be accredited by Oct. 1,” she said.
Pharmacies billing Medicare only for drugs and biologicals do not
need to be accredited, she said.

–Regarding subcontractor accreditation, Bastinelli said,
“We understand there is much confusion in the industry, thus
we will provide clarifying guidance in the very near future.”
She reminded listeners that “subcontract requirements are the
same for all DME programs, irregardless of the bidding
status.”

–Kaiser reiterated that providers interested in bidding must
first establish an AO for the bidding entity, followed by a back-up
official (BAO) and end user (EU).

“To ensure adequate time to then register the back-up
official and the end user, we strongly urge that all companies
interested in bidding for Round 1 have the authorized official
registered through the system no later than Monday, Sept.
14,” Kaiser said. BAOs should register by Oct. 9 and EUs
by Nov. 4.

He also encouraged providers to participate in the various
competitive bidding educational opportunities offered by the CBIC.
The third Special Open Door Forum on the Round 1 rebid will be from
3:30 to 4:30 p.m. ET on Wednesday, Sept. 16, and will cover
policies for change of ownership, grandfathering and traveling
beneficiaries, along with supplier responsibilities under bid
contracts.

For a replay of the Open Door, call 800/642-1687 and use
Conference ID 22139267. The replay will expire on Monday.