Medicare Compliance & Reimbursement

Suppliers disheartened by round one of Medicare's competitive bidding may want to take a look at a similar situation with laboratories. On April 8, U.S. District Court Judge Thomas Whelan ordered an injunction halting Medicare's bidding program for labs. The program is currently a demonstration project limited to the San Diego area, notes the American Association for Homecare.

"The law firm we are working with on potential competitive bidding challenges in the durable medical equipment program is reviewing the April 8 order," AAHomecare's Tyler Wilson says in a release. "Obviously, this is of great interest to the home care community and we will determine how this affects our ability to challenge round one of competitive bidding."

But suppliers aren't putting all their bidding eggs in one basket. Industry representatives continue to urge DME providers to contact their congressional representatives to argue against bidding.

AAHomecare has issued a five-page white paper for suppliers to use in their arguments. The paper notes the many errors made so far in the bidding system, including improper disqualifications and contracts awarded in areas where suppliers have no business presence.

Example: The Centers for Medicare & Medicaid Services disqualified a supplier as unaccredited who has had CMS-approved accreditation for 10 years, AAHomecare notes in the paper. After contacting CMS to correct the error, the supplier still received paperwork indicating it was not accredited.

More problems include the way CMS has handled the overall bidding process. "The entire implementation phase of the program has been shrouded in secrecy and in all aspects failed to meet customary standards of government transparency," the trade group charges.

CMS has offered no specifics on how it is resolving bidders' allegations of errors in round one bidding, AAHomecare notes. "We are alarmed that the first time we have heard about contract review efforts was upon questioning from the Association," the white paper says. "CMS has never made stakeholders aware of the specific program to assess aggrieved supplier complaints."

Not enough: CMS told suppliers in the April 2 home care Open Door Forum to contact competitive bidding implementation contractor Palmetto GBA with bid concerns. But CMS officials didn't get into specifics on the process for case-by-case review it says it's using.

AAHomecare has received 170 phone calls and emails with "serious complaints about improper disqualifications and other problems with round one," it says.

The white paper also emphasizes bidding's impact on beneficiaries. That includes reduced quality and disruptions in service as patients switch from sometimes long-standing relationships to suppliers they don't know.

No more one-stop shops: "A significant challenge for beneficiaries will be obtaining competitively bid products from multiple and unfamiliar contract suppliers, depending on the home medical equipment services and items they need," AAHomecare points out. "This situation stands in stark contrast with their ability today to receive many services from a single, local provider."

Getting members of Congress to listen in this election year may be a challenge. AAHomecare is holding a fly-in lobby day May 21 to focus lawmakers' attention on the matter.

"The congressional fly-in on May 21 will serve as just one element in a continuing effort to suspend round one of bidding," the trade group promises.

Round one, which takes place in 10 metro areas, is slated to begin July 1. CMS is gearing up to begin the bidding process for round two, which will expand to 70 more areas, this spring.

Note: AAHomecare's bidding white paper is available online at http://www.aahomecare.org.