BALTIMORE--In back-to-back teleconferences last week, CMS unleashed a veritable tidal wave of information for providers preparing for the implementation of competitive bidding--well, almost.
The May 13 teleconferences began with a national provider training call that was designed to “address some of the situations [providers] may encounter” before the implementation of round one on July 1. Using a PowerPoint outline, CMS and CBIC officials discussed contracts, payment rules, payment policies, mail-order diabetic supplies, use of the ABN, grandfathering and more.
But asked when round one contract winners will be announced and what the timeline for round two will be, the answers were that information would come “in the near future.”
Additionally, despite six pages of information on various policies for grandfathering, complications including the oxygen rental cap caused confusion among listeners, as did instructions on mail-order diabetic supplies.
“If a contract supplier did not win, can that uncontracted supplier hand deliver the [diabetic] supplies to the patient? Would that be a mail order or not a mail order type of arrangement?” one caller asked.
Joel Kaiser, deputy director of DMEPOS policy, answered this way:
“The reason we separated mail orders from non-mail orders is that we were basing it on concerns and comments that competitive bidding was going to impact beneficiaries’ abilities to go to local storefronts and pharmacies … to receive their diabetic care,” Kaiser said. “We are applying competitive bidding to mail order only."
Pointing out a definition in a new chapter of its claims processing manual that deals with competitive bidding, Kaiser said in "Chapter 36 in the Internet home manual [that] 'mail order' refers to items ordered remotely, that is by phone, email, Internet or mail and delivered to the beneficiaries’ residence by common carriers … and does not include items obtained by beneficiaries from local supplier storefronts.”
But when the caller responded that the definition was “a little foggy,” Kaiser conceded.
“We probably could and should further define what we mean by local storefront so that there is no question about it,” Kaiser said. “You may be right. There may be a little ambiguity there, so we’ll be looking into it to see if maybe we can further define what we mean by ‘local storefront.'"
Questions also arose concerning competitive bidding’s effects on beneficiary services.
One caller, a physical therapist who services beneficiaries in two separate round one CBAs, said she and other therapists have “concerns” about beneficiary care in the realm of complex rehab.
“The concerns amongst a lot of the therapists are that some of the companies that appear to be the ones who are going to be getting the bid for our areas are companies who have never provided complex rehab in the past and don’t have the basis to do it,” she said. “They don’t understand the complexity of it. And I know that that’s not fraud, but is there someone we can contact to say when companies are being given the bid who clearly, from a clinical perspective, can’t provide the services that the clients need?”
CMS’ Sandra Bastinelli responded, advising the caller to contact either the OIG Fraud Hotline, the accrediting organizations for the companies in question or CMS, at which time she said the concerns would be investigated.
During an Open Door Forum immediately following the training call, Kaiser outlined basic information on grandfathering and clarified the differences between MSAs and CBAs--information critical to those providers who may be involved in round two.
Kaiser advised providers to access the Medicare Claims Processing Manual’s new Chapter 36 for more information on grandfathering, which includes policies on grandfathered providers and items, transfer of title of capped rental items and oxygen equipment. “Suppliers need to make these grandfathering decisions in the very near future, and they need to start informing beneficiaries about what their plans are regarding grandfathering,” he said.
“If you elect to become a grandfather supplier for an item, you must be a grandfather for all beneficiaries in a competitive bid area. It is not a decision made by the supplier on a beneficiary-by-beneficiary basis. It is a decision made by a supplier on an item-by-item basis.” Kaiser said. “You can pick and choose among the items that are subject to competitive bidding but you cannot pick and choose whether to be a grandfather supplier on a beneficiary-to-beneficiary basis.”
Non-contract suppliers are responsible for notifying Medicare patients of their plans to furnish grandfathered items--or not--that beneficiaries have been receiving from the supplier, CMS said.
On the subject of MSAs and CBAs, Kaiser offered this clarification:
“An MSA is an area that is defined [by] a series of counties. You can clearly identify whether an area is part of an MSA or not part of an MSA by looking to see what counties are part of the MSA, so there’s really no question about whether an area is part of an MSA or not.
“You don’t need to know what zip code you are in,” Kaiser continued. “If there’s a county and it’s part of an MSA, it’s part of an MSA. There’s no ifs, ands or buts.
“As far as CBAs are concerned, they may differ from the actual boundaries of the MSAs, and the reason is because the law gives us the authority to exempt or carve out low population-density areas of an MSA. So we’re not talking about huge, massive parts of an MSA … what we’re really talking about is areas on the fringe …
“It’s not where the supplier is located, it’s whether you furnish items to beneficiaries in an MSA,” Kaiser said. “If you are furnishing items to beneficiaries in a given MSA on a routine basis, you’re probably furnishing those items to people who live in the more populated areas … There’s not much chance that those will not be part of the CBA.”
To see which counties are included in the round two MSAs, Kaiser said to visit the Census Bureau Web site.
Bastinelli also took the opportunity to say that CMS is still reviewing comments on proposed revisions to its accreditation quality standards, for which the comment period ended March 18.
“We hope to have the final of those quality standards posted soon,” she said.
Kaiser offered a similar statement with regard to announcing the winners in round one.
“Contracting for round one will be announced in the near future,” he said. “We are very close to finishing up the contracting process for round one and will be announcing them in the near future.”
CMS has announced its next educational call on competitive bidding for May 27. For information and to register for the call, visit www2.eventsvc.com/palmettogba052908.