Home Health & Hospice Week

CMS releases more information on how bidding will work.

You may have to start grilling new patients about where they've come from before furnishing them with durable medical equipment. That's because if they usually live in a competitive bidding area, you'll receive only the bid amount from that area for the item of DME.

If a beneficiary permanently lives in a CBA and travels to an area not covered by the bidding program, she "may get items from any Medicare-enrolled DME supplier, and the supplier will be paid by Medicare as if it were in the beneficiary's competitive bidding area," the Centers for Medicare & Medicaid Services explains in a new MLN Matters article about round one bidding (SE0805).

If a bene travels from an area not under competitive bidding to a CBA, he must get bid items from a contract supplier, CMS adds in the article. "Medicare will not pay for competitively bid items furnished by noncontract suppliers," the agency maintains in the article.

Article SE0805 gives providers an overview of the bidding program, while another new article (SE0806) reviews bidding details such as grandfathering and repair and replacement procedures.

Bottom line: Beneficiaries can continue to obtain DME items from their existing suppliers if they started renting the items, including oxygen, before bidding commences, CMS explains in the second article.

And beneficiaries can go to any supplier for repair or a replacement part, although CMS will pay for the replacement part only at bid price. If a client needs a whole new piece of equipment to replace the broken one, however, he must obtain it from a contract supplier.

Enteral nutrition will not be a grandfathered item, CMS pointed out in the April 2 Open Door Forum for home care and DME providers. CMS soon will issue more information on how to transition beneficiaries to their new supplier for bid items, a staffer said.

Patients won't have too long to choose their new suppliers, since CMS plans to announce the contract suppliers in May.

Red flag: CMS will be watching out for suppliers who try to claim that their mail-order diabetic supplies are just regular diabetic supplies.

Only mail-order diabetic supplies are subject to bidding. "It is solely up to the beneficiaries to decide whether or not they wish to obtain their diabetic testing supplies on a mail order basis," CMS notes in the MLN Matters article.

But suppliers who try to still get paid for mail-order items by misleading billing will be playing a dangerous game. "Suppliers that furnish diabetic testing supplies on a mail order basis and do not attach the mail order modifier could be subject to significant penalties under the False Claims Act," CMS threatens in the article.

CMS also issued a patient fact sheet that explains [...]