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:
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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.
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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.
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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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