CBIC Conference Call: Confusion Still Reigns

BALTIMORE — As part of the continuing countdown to the
Jan. 1 implementation date for competitive bidding, CMS’
Competitive Bidding Implementation Contractor held part two of its
educational teleconference for contract suppliers yesterday, and it
soon became apparent that there is a lot more education for CMS to
do.

The teleconference, the first part of which was presented Nov.
10, focused on the broad categories of contract supplier
obligations and payment policies. (See “Congratulations,
You’re a Winner?,” Nov. 11.) Cindy Dreher, CBIC manager,
policy and content, whipped through a span of information on such
subjects as breach and remedies, transitioning to a contract
supplier, change of ownership, grandfathering, traveling
beneficiary and modifiers. (View the slide presentation for the
call on the CBIC website at www.dmecompetitivebid.com/.)

Of all the issues, Dreher spent the most time on
grandfathering, the provision that allows beneficiaries to
maintain a relationship with their current supplier to minimize any
disruption in services, a topic that also garnered the most
attention on last week’s call.

“This is another policy that has been discussed at length on
calls and at workshops, but we are still receiving calls and
e-mails about this provision, so we wanted to review it again
today,” she said.

Dreher explained that the grandfathering provision applies only
to oxygen equipment, capped rental DME and such items as walkers.
It is not applicable to enteral nutrition or mail-order diabetic
supplies and the item must be under rental agreement at the time
the program is implemented, Dreher said.

Grandfathered suppliers must grandfather all products in the
product category, she reminded listeners, and they must offer to
grandfather all eligible beneficiaries in that product category.
“Grandfather suppliers must accept assignment on all competitive
bid items,” Dreher said. “If the supplier chooses not to become a
grandfather supplier, then that supplier has to notify the
beneficiary of this decision and has to coordinate the pick up of
the equipment with the beneficiary and with the new contract
supplier,” she added.

Dreher reminded providers that Wednesday (Nov. 17) was the day
for grandfathered suppliers to provide written notification to both
CMS and beneficiaries that they would continue to provide oxygen or
capped rental items.

It was also the date for non-contract suppliers that do not
become grandfathered suppliers to provide initial written notice to
beneficiaries. In addition, today (Nov. 18) is the deadline for
contract suppliers to disclose subcontracting arrangements, and
Friday Nov. 19) is the cut-off date for bid losers to make
inquiries to the CBIC about why they lost.

But it was the 10 minutes of questions at the end of the
hour-long call that eloquently painted a picture of confusion
within the industry — and within CMS itself — about
some of those policies and the real price that some providers will
have to pay for the project:

• There was the non-contract provider located within a competitive
  bidding area, but whose vast majority of patients — 95
  percent — reside outside. Could the provider still service
  those patients, the caller asked?

  Dreher said that would be interpreted as servicing a traveling
  patient and traveling patients in a CBA must work with a contract
  supplier.

  Caller: Are we able to service those patients within their
  home?

  Dreher: Because you are within a CBA, you cannot provide bid
  items at all to anybody.

  That’s when Joel Kaiser, CMS deputy director of DMEPOS policy,
  intervened.

  Kaiser: We’d like to jump in and clarify that issue. We have a
  policy where if you travel into a CBA you must obtain an item from
  a contract supplier, but in this situation it sounds like the
  supplier is in the CBA and is traveling outside the CBA to furnish
  an item. In that case, we wouldn’t consider this a competitively
  bid item since the patient is not residing in the CBA, they are
  outside the CBA. Even if they are outside the CBA and the supplier
  is in the CBA, it is irrelevant. They are furnishing it to a
  patient who has not traveled to a CBA, so I think they will be
  fine.

  Caller: So we can provide it in the patient’s home?

  Kaiser: If they are outside the CBA and are not residing in the
  CBA.

  Caller: Even though we are within the CBA?

  Kaiser: Yes.

• Another caller queried Dreher on provisions for mail-order
  diabetes products.

  Caller:  My question is whether there are any different
  provisions for mail-order and for a quick example, diabetic
  supplies if the permanent address of the beneficiary is not in the
  CBA but they travel on vacation into a CBA. Do they have to obtain
  their diabetic supplies from a winning contractor in the CBA they
  are traveling to or can they continue to get their mail-order
  supplies from their original supplier?

  Dreher: Mail-order diabetic supplies are not under the traveling
  beneficiary policy since they are provided through the mail so if
  the beneficiary travels, the beneficiary would continue to receive
  their mail-order diabetic supplies from a diabetic supplier for the
  CBA where the beneficiary resides. In that case you do not affix
  the KT modifier to those claims.

  Caller: Just a quick FYI for you: The individuals on your phone
  lines at the CBIC have a different interpretation of that, so you
  might want to make sure they are educated. 

  Replied Dreher: We’ll follow up with them. Thank you.

• The last call was a stark example of the non-contract supplier’s
  dilemma. The caller wanted to know how to keep a Medicare number if
  her company was unable to bill Medicare.

  Caller: Are we still considered a Medicare supplier in our
  non-contract areas?

  Dreher: Oh sure, as long as you’re enrolled in the Medicare
  program.

  Caller: So what happens if we don’t bill Medicare for a certain
  amount of time. Aren’t our numbers automatically deactivated?

  Dreher: That’s [a National Supplier Clearinghouse] question, but
  I do believe it is a certain period of time. But I can’t tell you
  exactly what that time frame is, but if you don’t bill within a
  certain amount of time, your number is inactivated.

  Caller: So if we’re not able to bill, how do we keep our numbers
  from being deactivated?

  Dreher: You can certainly bill for items that are not
  competitively bid items.

  Caller: We don’t provide any of those items. We only provide
  CPAPs and bi-levels.

  Dreher: OK, if you don’t provide any other items and you can’t
  bill, then of course your number will be deactivated.

  Caller: But we need those numbers activated in order to obtain
  other contracts like Tri-Care, Blue Cross-Blue Shield. So how do we
  keep our numbers from being deactivated?

  Dreher: You’re going to have to bill Medicare.

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