BALTIMORE — A CMS Open Door Forum Oct. 14 confirmed what HME providers suspected: The list of contract winners for Round 1 of competitive bidding will have to wait.
According to an agency timeline, names of the winners were to have been announced in September before implementation of the program in January 2011. When September came and went, stakeholders had speculated that CMS was having trouble filling contracts for the nine-city rebid or that the agency was delaying release of the names for political reasons.
But during the Open Door call, CMS gave another explanation.
As reported in a HomeCare Monday Special Alert, the agency's Michael Keane delivered the following announcement on the call: "We wanted to provide an update on all the current information we have at this time concerning the announcement of the final list of the contract suppliers. In testing a new program integrity tool on the list of potential competitive bidding suppliers, a number of red flags were raised that require further examination before CMS announces the final list.
"Given the past history of fraud in the DME arena, especially in Miami, CMS believes it is prudent to take the time to review these issues to ensure the program is best positioned to serve Medicare beneficiaries. We expect to move forward with the implementation of the program very soon, beginning with the announcement of the contract suppliers and continuing our aggressive education and outreach activities for beneficiaries and other stakeholders. Again, this is all the information we have to report on today, and we thank you."
The Florida-based Accredited Medical Equipment Providers of America took exception to the jab at Miami providers and immediately responded in an electronic newsletter to members. "They cannot accept the blame themselves, because they did not release and have no timeline to release bid winners, so they blame it on fraud in Miami," said one AMEPA member. "If that is the case, why did they offer contracts to fraudulent companies? How low did those 'fraudulent' companies bid?"
The 1-hour forum revealed nothing else about competitive bidding, but two other callers asked about the Provider Enrollment, Chain and Ownership System (PECOS). The partial exchanges below reveal a likely implementation date of July 2011 instead of January 2011. But John Spiegel, director of the Medicare Program Integrity Group, would not unequivocally confirm the date for when the agency will begin rejecting claims whose prescribers are not registered in the online system.
Caller #1: I want to confirm that the implementation date of phase 2 of PECOS is being postponed until July 2011.
Spiegel: I don't think we have established a date by which time we would turn on our automated edits that would otherwise deny claims automatically merely for not having someone enrolled in PECOS. We are working on cleaning up the backlog of individuals trying to enroll, so I do not think we have established a date when we would turn on those automated edits.
Caller #2: On the new target date for the PECOS claim edit denials ... please tell us what the date is for DMEPOS suppliers at this point.
Spiegel: Well, I will reiterate what I said earlier. Because of the way we do business, we have to plan out a number of months in advance our dates or targets that we are looking at. Nothing is established in final yet as to the specific date when we would actually deny something for somebody not being enrolled in PECOS, or otherwise enrolled in Medicare.
As you know, there were a number of problems we encountered in making sure that the lists were right and the backlog of people trying to enroll was reduced or eliminated. Until we make sure that all those problems are addressed, and everybody that wants to get in has an opportunity to do so — and it is never going to be down to zero at any particular time — until all those things are resolved we are not going to turn on those automatic denials.
Caller #2: Can DMEPOS suppliers assume that, as you have announced today for home health agencies, that it will not be before July 5, 2011?
Spiegel: It is not likely that it would be before July. I did not say that it will not be before July. I don't think it will be before July, but you can never tell. Criterion for when it is, is when we are sure the files are right.
View more competitive bidding stories.