CMS Posts Tip Sheets for Grandfathering, Referral Agents

BALTIMORE–On Wednesday, CMS posted two new tip sheets related
to competitive bidding, one on grandfathering and another for
referral agents.

Along with clarifications on questions about picking up
equipment if necessary and special payment and billing rules, the
tip sheet on grandfathering includes a link to a sample notice that
can be used to let beneficiaries know about a provider’s decision
to become (or not become) a grandfathered supplier.  

According to CMS, providers should notify their Medicare
patients of this decision in writing “at least 30 days prior to the
start date of the competitive bidding program” (in other words,
now) in order to give beneficiaries adequate time should they elect
or need to transition to a contract supplier by July 1.

According to the tip sheet for referral agents, HME providers,
physicians, discharge planners, pharmacists and home health
agencies may be a beneficiary’s first contact with the competitive
bid program, and they may need to direct those patients to a
contract supplier. The tip sheet answers a number of FAQs about how
to do that.

A DME MAC notice about the referral agent tip sheet gave two
examples:

“Medicare patients in the 10 CBAs who use oxygen will need to
take action to either transition to a new contract supplier, or, in
the case where their current oxygen supplier elects to become a
grandfathered supplier, continue services with their current
non-contract supplier.”    

The notice also said “Medicare patients in the 10 CBAs who use
enteral nutrients, supplies and equipment must transition to a
contract supplier as of July 1, 2008. If they reside in a Skilled
Nursing Facility (SNF)/Nursing Facility (NF) that is not a contract
supplier, the SNF/NF will have to make new arrangements with a
contract supplier to furnish items to their residents. If they live
at home, the beneficiary must make new arrangements with a contract
supplier.”

Both tip sheets can be found on the CMS competitive bidding Web
site at www.cms.hhs.gov/DMEPOScompetitivebid. Click on
the “Provider Educational Products and Resources” tab and scroll
down to the “Downloads” section.