BALTIMORE--A second CMS provider training call last week showed just how many questions about competitive bidding remain.
Among a barrage of detail-oriented queries, a range of topics included subcontracting, patient residency, what will happen in cases where contract winners are not licensed (if required) in states where they won bids and what exactly is being done to educate beneficiaries about the impending changes.
With just a few weeks left before round one is scheduled to take effect July 1, CMS allowed one-and-a-half hours for the May 27 session, designed to field questions about exactly how the bidding program will work. The time came and went with a ceaseless flow of calls--and not everyone got their questions addressed.
Following is a sample of questions from those who made it through the call-in queue.
--Jurisdiction: What to do when a patient's residence conflicts with his or her billing address
An Ohio caller asked about a patient who was being solicited by a winning bidder in Florida--but the patient resided in a nursing home in Detroit. The caller explained that the confusion in this situation derived from the fact that the patient's Power of Attorney is located in Florida.
In answer, CMS' Joel Kaiser, deputy director of DMEPOS policy, said, “If the beneficiary's permanent address is in a competitive bidding area but they are receiving services in an area outside of the competitive bidding area, then we would consider that beneficiary in 'travel status.'”
Kaiser's answer actually raises more questions, according to industry consultant Sylvia Toscano of Professional Medical Administrators in Boca Raton, Fla.
“If a patient resides in Wisconsin, let's say, but their sibling or son or daughter handles their Medicare affairs and that relative resides in a CBA, the permanent address with Medicare is listed as the relative's address,” Toscano, who listened in on the conference call, explained. “The item of DME such as oxygen would need to be provided by a contract supplier but there are no contract suppliers in Wisconsin because they are not in round one. How does the patient receive their equipment? How would a local supplier be paid under the Medicare program in this instance?”
--Licensure: What happens when bid winners are not properly licensed to serve a bidding area?
Rob Brant, a Miami provider and president of Accredited Medical Equipment Providers of America (AMEPA), asked Kaiser what would happen with those companies--at least eight of them in the Miami CBA alone, according to Brant--that won bids but do not have an oxygen license in the state of Florida.
“The contract suppliers were accredited to furnish the items they have been awarded a contract for,” answered Kaiser. “If you have information about a specific contract supplier where you think they were accredited for something inappropriately then you should send an email to us and we will research it.”
Kaiser's answer, which addressed accreditation, confused Brant.
“[Kaiser] kept saying 'We put the responsibility on the accrediting body.' But he is not even answering the question as to whether they checked the licensure,” Brant said. (For more, see "Oxygen Licensure Is Issue for Some Bid Winners" in this issue.)
--Subcontracting: Can we or can't we?
Toscano asked Kaiser the following question: “The article off of the [National Supplier Clearinghouse] Web site states that CMS interprets [section] 1834 of the Social Security Act to mean 'A supplier receiving payment from Medicare must be the entity furnishing and billing for the items or services, specifically a supplier cannot contract with other entities to provide essential services.' Are we allowed to subcontract for competitive bidding if we did not have an agreement in place at the time that this was filed?”
Kaiser's response: “Yes, you may subcontract. The contracted supplier is the one who will be submitting the claims for reimbursement. The contracted supplier is the one who is responsible for meeting the terms of the contract and ensuring that the items and services that are paid for under the DME benefit are provided. It is the contractor who is doing the billing. They may subcontract with other entities to provide various services for DME.”
Toscano then pointed out that Palmetto GBA's Web site states that “suppliers may not contract with other entities to provide essential services as the supplier is the entity receiving payment for Medicare, and therefore must be the one providing the items or services.”
Kaiser said he would have to consult with CMS' Office of Financial Management to get clarification on the issue.
“Can you explain 'essential services'?” Toscano persisted.
”I think we need to wait and get that answer from our supplier enrollment, supplier standards experts, who are not here today,” Kaiser said.
--Grandfathering: What should providers be doing?
Kaiser noted that CMS' new Chapter 36 of the Internet-only claims processing manual includes a section on grandfathering. “This relates to individuals who are receiving oxygen and oxygen equipment, or rented DME, from a supplier currently,” he told listeners. “We provide guidelines for the supplier regarding their decision to remain as a grandfathered supplier, giving the beneficiary that option, or what they should be doing if they elect not to be a grandfathered supplier. And that goes along with the whole transition issue.
“We're expecting current suppliers, who obviously have to notify the beneficiary if they are not going to grandfather, when they are going to pick up the equipment. There are obviously rules on when they can pick up the equipment, so they will have to be making arrangements with the supplier about that. They will have to be communicating with beneficiaries to make those arrangements and supply that information as to whether they are going to continue to provide services to the beneficiary.
“And if they are not, then the guidelines provide for them to refer the patient to a contracted supplier and to go through the channels to locate a new contract supplier,” Kaiser said.
--Beneficiary Outreach: What has been done and what is allowed?
Several callers expressed confusion over the proper procedures for beneficiary outreach. One caller asked whether current Medicare rules governing the methods of direct contact between a provider and a beneficiary still apply under competitive bidding.
“My related question is that now that these contracts are announced, are the winning bidders free to advertise and communicate with the marketplace subject to those preapproval rules?” he asked, noting that some of his customers had been contacted by contract winners and told they would have to change providers because his company had not won a contract.
A CMS official responded, “We are not establishing special marketing guidelines for contract suppliers under this program. All of the current DMEPOS supplier guidelines that apply as far as marketing continue to apply. For example, the current prohibitions on cold-calling Medicare beneficiaries when there is no prior history of service and also prohibition against misusing the word Medicare and Medicare symbols continue to apply.”
Another caller asked what CMS has been doing to ensure beneficiaries are ready for round one.
“What type of communication is going out to the beneficiaries directly? The thousands of patients that are on service right now today--how are we communicating with them? Who is going to help them in transitioning if a supplier is not going to grandfather? Who is taking the lead on helping that patient that's laying in their bed, unable to get the mail or anything?” the caller asked.
The response: “We don't have representatives here from the communications staff … but [we're] using every avenue we can. We have organizations of the state health insurance programs who are helping to reach beneficiaries. There is going to be a mailing to beneficiaries in bid areas. [We have an] extensive network of advocates for beneficiaries who are going to be helping us with education.”
The caller pressed, “Who is helping the patients who don't go out of their homes? Who don't go to meetings? I just don't understand how CMS is going to reach those patients to tell them what is going on.”
The response: “We don't have the beneficiary outreach people here so it's hard to give you, really, specifics. We'll try to have someone here next time.”
During the conference call, agency representatives referenced two tip sheets--one on grandfathering and another for referral agents--that would be posted to the CMS Web site. They also said providers should notify beneficiaries of their decision on grandfathering by June 1.
“According to the teleconference," said Toscano, "a non-contracted supplier that elects not to become a grandfathered supplier must provide notification to the beneficiary. So they are asking in the next 30 days [that providers] notify every single rental patient that has a piece of rental equipment. If the patient chooses to switch, the supplier must pick up the equipment.
“We're supposed to notify each beneficiary, get the letters back and arrange for pickup if necessary and tell them to visit the Web site or make the phone call all within the next 30 days. I think that's an undue burden on a lot of suppliers, especially if they have thousands of rental patients,” Toscano continued, adding she believes that “no beneficiary education has been done [by CMS] to date.
“They promised intensive outreach and education. None to our knowledge has been provided,” she said.
For more on the agency's new tip sheets, see "CMS Issues Tip Sheets for Grandfathering, Referral Agents" in this issue.
To hear a complete replay of the CMS teleconference, which will be available through June 4, call 800/642-1687 and enter access code 47261135.