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 bidding and answers frequent beneficiary questions at www.medicare.gov/Publications/Pubs/pdf/11307.pdf.

And the agency will hold an April 22 conference call explaining bidding's impact on physicians and therapists who furnish DME.

The Fight Continues

The DME industry is combating bidding's implementation with sustained vigor. The American Association for Homecare issued releases in each bidding area with specific statistics and facts relevant to the region, as well as quotes from local DME leaders.

"Many beneficiaries will be surprised to discover their long-time provider may no longer be able to serve them effective July 1," Raul Lopez, director of operations at Miami-based Bayshore Dura Medical and president of the Florida Association for Medical Equipment Services, said in the release for Miami and Orlando. "Some patients will undoubtedly face confusion from new, multiple providers and multiple copays."

"In my two decades of involvement in the home medical equipment industry, this is the most severe and life-threatening issue this small, but vital segment of our nation's health care delivery system has faced," Kam Yuricich, executive director of the Ohio Association of Medical Equipment Services, said in the AAHomecare release for Cincinnati and Cleveland. "It threatens to unravel respectable organizations that have provided years, sometimes generations, of service to their communities in Ohio."

An average DME company receives about 40 percent of its business from Medicare, AAHome-care points out in the releases. "Loss of this business will result in layoffs and business failure for many DMEs," the trade group warns.

Lawsuit progress: The National Association of Independent Medical Suppliers continues to solicit funds for its legal defense fund. "The judicial review preclusion in the statute is broad enough to allow a suit," NAIMES contends.

AAHomecare continues to work on a lawsuit as well, it says.

But suppliers shouldn't rely on legal action to save them. "We must still work from the grassroots legislative side, regardless of the legal action taken," NAIMES urges. "It is imperative that we keep the Congressional pressure on."

At least part of the lawsuit rests on the errors made in the bid selection process. But CMS says it wants to rectify those errors.

"We have a process in place to review supplier concerns with the results of bid evaluations," a CMS staffer said in the forum. "If any supplier has any questions or concerns about its bid, you should contact [competitive bidding implementation contractor Palmetto GBA], who along with CMS has established a process for case by case review of all of the supplier concerns." Suppliers can call the CBIC at 1-877-577-5331.

Note: The new MLN Matters articles are at  www.cms.hhs.gov/MLNMattersArticles/downloads/SE0805.pdf and www.cms.hhs.gov/MLNMattersArticles/downloads/SE0806.pdf .