Surprises on Bid Winners, PECOS on Open Door

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.

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