INDIANAPOLIS — National Government Services, the Jurisdiction B DME MAC, has posted a summary of questions and answers from its Ask-the-Contractor teleconference on Dec. 7.
At the time of the conference call with only days until implementation of national competitive bidding Jan. 1, many of the questions providers asked were about the bidding program. Subjects ranged from claims filing and traveling beneficiaries to rules for furnishing Group 2 power wheelchairs, CPAP, oxygen and mail-order diabetic supplies.
A sampling of questions from the teleconference follows, with answers given by representatives from CMS' Competitive Bidding Implementation Contractor (CBIC). For an audio playback or transcript of the teleconference, along with the entire Q&A summary, see the NGS website.
When competitive bidding is implemented, should suppliers continue to file claims to the DME MAC jurisdiction based upon the beneficiary's address on file with the Social Security Administration (SSA)?
Yes. Claim filing will continue to be based upon the beneficiary's permanent address on file with the SSA. For suppliers filing electronically, submit claims with the beneficiary's correct address — as indicated on file with the SSA — through the Common Electronic Data Interchange (CEDI). As is the current process, the CEDI will forward the claim to the appropriate DME MAC jurisdiction based upon the beneficiary's address indicated on the claim. Suppliers that have a valid Administrative Simplification Compliance ACT (ASCA) waiver on file and are permitted to file paper claims, must mail their CMS-1500 paper claim to the appropriate DME MAC based upon the jurisdiction in which the beneficiary resides.
Is it true that if a supplier is located in a competitive bidding area (CBA) and is one of the contract winners for the Group 2 power wheelchairs, the supplier will still be able to offer the purchase option when competitive bidding is implemented on [Jan. 1], but suppliers outside of a CBA may only rent standard power wheelchairs effective [Jan. 1]?
Yes, that is correct. The changes to the power wheelchair payment rules made by section 3136 of the Affordable Care Act do not apply to payment made for items furnished pursuant to competitive bidding contracts entered into prior to Jan. 1, 2011 or for power wheelchairs in which the first rental month occurred before Jan. 1, 2011. Therefore, under the Round 1 rebid competitive bidding program, contract and grandfathered suppliers furnishing rented power wheelchairs will continue to be paid under the capped rental payment methodology using 10 percent of the single payment amount for the first three months and 75 percent of the single payment amounts paid in the first three rental months for months 4 through 13.
Similarly, the elimination of the lump sum purchase option for standard power wheelchairs, as required by the section 3136 of the Affordable Care Act, does not apply to standard power wheelchairs furnished by contract suppliers under the Round 1 rebid program. Payment for standard power wheelchairs will continue to be made to Round One Rebid contract suppliers on either a lump sum purchase or rental basis.
If a beneficiary who resides in a non-CBA (permanent address on file with the SSA) temporarily relocates to a CBA, is the home supplier in the noncompetitive bidding area allowed to ship CPAP supplies to the beneficiary in the competitive bidding area?
No. When a beneficiary travels from a noncompetitive bidding area to a competitive bidding area, the beneficiary must obtain any competitively bid item or services — except for mail order diabetic supplies — from a contract supplier within the competitive bidding area.
When a beneficiary travels from a non-CBA in which they reside to a CBA, but the beneficiary does not change their address on file with the SSA, are the beneficiaries allowed to call their home supplier (within the non-CBA) and request that CPAP supplies be mailed to their temporary residence within the CBA?
No. If a beneficiary travels to a competitive bidding area from a non-competitive bidding area, the beneficiary would have to get their competitively bid item or service from a contract supplier. However, the contract supplier's reimbursement will be based upon the beneficiary's address on file with the SSA. Therefore, if the beneficiary's permanent address on file with the SSA is not within a CBA, the contract supplier in the travel location will be reimbursed based upon the fee schedule amount for the state in which the beneficiary resides.
This rule applies to all competitively bid items except for mail order diabetic supplies.
If a beneficiary residing in a non-CBA is within the 13-month rental period for CPAP equipment and they travel to a CBA (snowbird), is the beneficiary required to return the CPAP machine to the home supplier in the non-CBA and rent the CPAP equipment from a contract supplier in the CBA or can the home supplier continue to bill for rental of the CPAP?
The home supplier that provided the CPAP to the beneficiary may continue to rent the CPAP equipment and submit claims for the remainder of the rental period. However, supplies and accessories must be obtained from a contract supplier within the competitive bidding area to which the beneficiary travels.
Please explain the rules for mail-order diabetic supplies for both traveling beneficiaries that reside in a CBA and for traveling beneficiaries that do not reside in a CBA.
If a beneficiary's permanent residence is in a competitive bidding area, the beneficiary must get the mail-order diabetic supplies from a contract supplier. If they are traveling, even if they travel to a noncompetitive bidding area, they must still obtain mail order diabetic supplies from a contract supplier since the item is furnished by mail. So as long as the beneficiary's permanent address or permanent residence is in a competitive bidding area, then the mail order diabetic supplies, regardless of where the beneficiary is, must be provided by a contract supplier.
However, because diabetic supplies purchased from a storefront are not subject to competitive bidding, the beneficiary may purchase diabetic supplies from any Medicare supplier that furnishes these items. If the beneficiary does not reside in a competitive bidding area, the beneficiary may obtain their mail-order supplies from any Medicare supplier.
If the beneficiary's permanent residence is in a noncompetitive bidding area, and he/she travels into a competitive bidding area, the noncontract supplier from that noncompetitive bidding area (the beneficiary's place of residence) may continue to furnish the mail order diabetic supplies. So, a beneficiary that resides in a noncompetitive bidding area and travels to a competitive bidding area, does not have to obtain their mail order diabetics supplies in a competitive bidding area from a contract supplier. That is an exception to general competitive bidding rules for beneficiaries who travel or temporary relocate.
During the 36-month rental cap for oxygen equipment, if a beneficiary travels or temporarily relocates from a non-CBA to a CBA, who is responsible for providing the oxygen equipment, contents, and related supplies and accessories?
During the 36-month rental period for oxygen, when a beneficiary temporarily travels or relocates to a competitive bidding area, the home supplier may continue to furnish the oxygen equipment as well as any contents, supplies and accessories directly, or the supplier may assist the beneficiary in locating a contract supplier in the beneficiary's new service area.
If a beneficiary travels or temporarily relocates out of our noncompetitive bidding service area before the 36-month rental cap is reached, and we assist them in finding a new supplier in their new location, what is our obligation to that beneficiary if/when they return to our service area?
Since you are a non-contract supplier in a noncompetitive bidding area, you are under no obligation to provide oxygen services to the beneficiary upon their return to your service area. The supplier in the travel location is responsible for working with the beneficiary to locate a supplier in their home location. If the supplier in the travel location receives the 36th rental payment, they will be responsible for providing all necessary oxygen equipment, contents, supplies, and accessories directly or under arrangements with another supplier throughout the reasonable useful lifetime of the equipment.
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