Medicare Compliance & Reimbursement

The feds continue to move forward with the July 1 implementation date for competitive bidding, even though the start date is under intense debate.

Medicare beneficiaries with DME have received the bidding notification letters the Centers for Medicare & Medicaid Services has issued, and the result is mass confusion, contends the National Association of Independent Medical Suppliers.

"The letters ... prompted over 50 calls to one supplier with questions about what the program was about and wanting to know why they had to switch suppliers," NAIMES' Wayne Stanfield recounts. "Many were confused by their current supplier not being on the list."

The problem: Benes think they have to get all their DME from bid suppliers, not just the items up for bidding. The letters will "push confused patients to competitors because of the failure to explain the program," NAIMES predicts.

Even patients that don't receive any bid items will be swayed to switch to contract suppliers because they received a list of them from CMS, the trade group worries.

Other topics: CMS also issued information on the bidding ombudsman, zip code files for bidding areas, grandfathering requirements, and transmittals regarding bidding-related Medicare summary notices and remittance advices, and bidding implementation.

CMS additionally pointed out that the exception for physical and occupational therapists to furnish orthotics under bidding won't apply yet, because orthotics are not a round one bid item.

Lawsuit derailed: A June 19 decision in a Washington, DC federal lawsuit over competitive bidding didn't favor providers. In the suit, Carolina Medical Sales Inc. and Americare Health Systems argued that bidding was improper because it singled out mail-order diabetic supplies for bidding based on its delivery method.

"The selection of items and services for inclusion in competitive bidding ... necessarily includes relevant distinctions such as delivery method," says Judge Ricardo Urbina in the opinion (07-1298).