Andrea Stark & Angela Hayden

Almost four years after the public implementation of the PECOS project, CMS started the clock on the countdown to Phase 2.  This second phase will implement edits to deny claims dated on or after May 1, 2013 for claims with physician data that does not link to a valid PECOS record.  Claims for DME, Home Health and Part B lab and similar services prescribed by a referring physician will be affected by the new edits.  This has been in the works for quite some time; however, because of the repeated delays to implementation, the call to action has waned.  With larger scale issues on the docket such as Competitive Bidding, PECOS seems to have been all but forgotten.  As previously reported on our blog and in several editions of our signature Vista Notes publication, we believed it to be imminent that suppliers would be given a 60 day window, for the Phase 2 announcement. Now that we are proceeding to implementation, suppliers must ensure that physician records match the PECOS database before the edits go into place. Don’t expect any more delays… the official countdown has begun.

Phase 1 (the informational messaging phase) began in October of 2009 using claim rejection, warning messages to communicate that the ordering/referring provider submitted on a given claim was not PECOS certified.  This front-end warning system was used until the implementation of Version 5010 when these claims were allowed to proceed past the front-end system and warnings are now reflected in the form of a remark code N544 on Medicare remittance advices.  Until now, these N544 remark codes have served only as a warning to providers of denials to come if action is not taken on these flagged physicians. Beginning May 1, under Phase 2, these remittance warnings will become actual denials on future EOBs.

Providers need to act swiftly to identify which physicians in their billing system are problematic and cannot be validated in the PECOS database.  Affected claims will be denied and cannot be reprocessed until the data is corrected or the physician has been certified.   At this stage of the game, most of the N544 remark codes are likely tied to typographical errors, transposed NPI numbers, or incorrect use of group NPI numbers instead of individual practitioner NPI numbers.  There are still a select number of practitioners that are either new or not linked to PECOS, and these will be a bit more difficult to resolve.

Here are a few steps to help you identify which records can be fixed in your billing software and which physicians will require contact:

1. Start by verifying that the NPI from the physician record in your billing system ties back to the individual physician and not a group practice or facility by looking up the NPI in your system on the NPPES website. Make sure there are no spelling errors in the first or last name and that the NPI is correct for the doctor.
2. Next, compare your physician record to the PECOS database located here (in the Downloads section click the CSV version of the Medicare Ordering and Referring File) to verify that this physician is confirmed as PECOS certified.
3. When you do find a match (based on NPI), ensure that the first letter of the first name and the first four letters of the last name match exactly to the PECOS record.  If your record does not match the PECOS file, claims will be denied.
4. Identify and parse out those physicians that do not have a match in the PECOS database and begin contacting them to encourage the completion of the enrollment process.  In the case of long standing physicians they may need to send in a renewal of their Medicare enrollment information, so the PECOS record can be created.  Remind the doctor that none of their referrals for DME, Home Health or lab referrals will be payable after May 1 until this issue is resolved.

While it is in the hands of the physician to complete the enrollment process, there are some resources that providers can use to explain what PECOS is and why this update or enrollment is necessary. The most recent piece of information is provided in an MLN Matters article released by CMS (#SE1305), which is a consolidation of previous instruction and can be found here: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1305.pdf. Physicians should also be reminded that the PECOS database is used to populate the www.medicare.gov website and without enrollment, Medicare beneficiaries will not be able to validate or locate them for new business.

The bottom line is that real revenue is at stake if providers are not mindful of this deadline. By taking these steps and utilizing the resources available, PECOS Phase 2 Implementation can be a smooth transition for providers, but action must be taken now.  For additional guidance on navigating through this process you can attend our webinar on April 10th @2pm EST (registration details here) or contact our office to schedule a consult with reimbursement consultant, Andrea Stark at 803-462-9959 ext.246.

By: Michelle Hamel, Communications Specialist, MiraVista LLC

I like to stay abreast of the latest healthcare legislation being introduced in congress and have an RSS feed that sends me a weekly list of new Medicare related bills. As I scanned through today’s list of recently introduced bills – most of which have nothing to do with DME – one particular title caught my eye. On January 18^th, the “Health Care Paperwork Reduction and Fraud Prevention Act” was introduced into the House of Representatives. Intrigued by the name, I decided to take a closer look, and it wasn’t long before I was championing its cause.

Creating standardized healthcare claim forms that all Federal government agencies would be required to use.

Count me in.

Significantly reducing the numbers of billing codes for health care claims.

I can work with that.

Simplifying and updating CMS’ electronic forms.

Sounds great.

Ensuring that the Secretary does not target providers and suppliers attempting to properly submit Medicare claims for inadvertent billing errors.

Now we’re talking!

And when I reached section 5 “Overpayments Under the Medicare Program” the bill’s full potential became clear. While the protections under this section only apply to physicians (at least in the bill’s current state), there are several provisions here that suppliers should be championing as well. For example, if a carrier initiates a pre-pay audit, it must explain to the physician why they are being audited within 3 months. Also, auditors are prevented from targeting physicians based on self-disclosed overpayments. And auditors may not assume that just because a physician made an honest billing error that all of their claims are bad or incorrect.

And now for the crème de la crème.

“Following a post-payment audit, a carrier that is conducting a pre-payment screen on a physician service under the Medicare program may not delay reimbursements for more than one month and as soon as the physician submits a corrected claim, the carrier shall eliminate application of such a pre-payment screen.”

To strip it down to bare bones: If we make a mistake, and we’ve fixed it, the auditing contractor needs to move on.

While limited in nature, this is the first bill to offer any type of protection from pre-pay audits. However, it’s not the first time it has been introduced. In fact, Congressman William “Mac” Thornberry, R-TX introduced four previous versions of this same bill, all of which died in congress and had little to no support. But it’s a new year, and we have a new congress. And I say we take full advantage of it.

My vote is that we as an industry take this bill, champion its cause and use it as a vehicle to extend audit protections to DMEPOS suppliers. Aside from Congressman Thornberry, the bill currently has no co-sponsors. So we’re going to have to take action if we want it to succeed.

The bill is currently awaiting review by the House Ways and Means Committee, and the House Energy and Commerce Committee. The key to keeping the Health Care Paperwork Reduction and Fraud Prevention Act (H.R. 315) alive is to contact members of these committees and ask them to support the bill. Better yet, ask them to support H.R. 315 and amend it to include additional supplier protections under sections 3 and 5!

Right now H.R. 315 is just another number on the docket. But we can make it so much more than that. Contact your congressman and let them know your struggles. Tell them why supplier protections from unrestricted auditors are a must, and show your support for this legislation.

House Ways and Means Committee: Contact the Committee, Members

House Energy and Commerce Committee: Contact the Committee

(Republican) Members, (Democratic) Members

Contact Your State Representative!

Suppliers affected by Round 1 of Competitive Bidding have less than 2 weeks to make one of the most important business decisions of their lives – whether or not to grandfather DME. On Tuesday November 2, CMS posted information on the CBIC website notifying DME suppliers that they must inform both CMS and their patients of whether they will grandfather DME by November 17, 2010 (coincidentally, this date falls right in the middle of Fall Medtrade). This deadline leaves just 14 days for suppliers who haven’t been offered a contract to:

1. Evaluate their business and decide whether to continue providing products subject to Competitive Bidding, and
2. Send a written notification to each one of their patients and CMS.

Some grandfathering guidelines to keep in mind:

If you grandfather, you only get to keep patients that were setup on rentals prior to 1/1/2011. Grandfathering does not allow you to setup new patients or restart existing customers. If you grandfather oxygen you have to accept the standard payment amount awarded to contract suppliers and accept assignment. If you grandfather capped rental items you will continue to receive the regular fee schedule on the rental, but accessories are paid at the single payment amounts awarded under Competitive Bidding  (up to the purchase date of the equipment, at which time the patient will have to seek out a contracted supplier for ongoing supplies).

Sending notifications:

An interactive form for suppliers to notify CMS of their decision is available here.  CMS has also provided the following sample letters for suppliers to use when notifying patients of whether they will grandfather:

• Sample Letter to Beneficiary from Supplier that Chooses NOT to Grandfather
• Sample Letter to Beneficiary from Supplier that Chooses to Grandfather (Note: While this letter provides an option for patients to inform suppliers of whether they wish to continue renting from them in writing, patients may opt to call suppliers instead).

If a supplier opts not to grandfather DME, or if a patient decides to switch from a grandfathered to a contracted supplier, the original supplier must contact the patient two additional times: at 10-days and 2-days prior to the equipment’s pick-up date. The pick-up date should be the patient’s first anniversary date after the implementation of Competitive Bidding, and delivery must be coordinated with a contract supplier so there is no break in service for the patient.

In all cases, suppliers must maintain proof of delivery showing the required notification(s) were sent and must keep records of all attempts made to contact patients.

Lately there’s been some confusion surrounding the date that suppliers can begin billing for oxygen maintenance and service. Current regulations indicate that maintenance payments may begin “six months after the patient caps.” However, this is actually seven months after the last bill date.

To clarify, let’s say you receive your 36^th rental payment for a patient on December 1, 2010. This payment will cover the patient’s rental of the equipment until the following month (January 1, 2011), at which time the patient will cap-out. Under this scenario, the earliest you may bill for maintenance and service is July 1, 2011, which is 6 months from the cap date (January 1, 2011), but is 7 months from your last rental payment (December 1, 2010).

DME MAC A, NHIC, recently updated their Oxygen 36^th Month Calculator to show the earliest possible maintenance and service date for an oxygen patient. Just visit: http://www.medicarenhic.com/providers/billing/dme_billing_calc_oxygen_rental.html, enter the initial date of service and select “Calculate”. 

Sample Image:

By: Andrea Stark, DMEPOS Consultant, MiraVista LLC

There may soon be an increased cost to submit claims to Medicare. Suppliers, clearinghouses, third party billers and software vendors are currently able to connect and transmit information directly to Medicare via several free modem and FTP network connections.  However, during a vendor call on September 8, 2010, CEDI announced that all direct connections to their gateway will be shut down over the next several months, and all electronic Medicare transactions will need to be transmitted through one of six select network service vendors: ECC Technologies, IVANS, McKesson CareBridge, MedXpress, VisionShare or Nebo Systems, Inc. 

Effective November 1, 2010, all new vendors and suppliers who aren’t actively submitting claims to CEDI will need to go through one of the above network service vendors, or through a clearinghouse that provides this service. All free connections to CEDI will be shut down for everyone else effective April 30, 2011.

The premise behind the service change is driven by CMS’ security concerns. National Government Services currently operates the Common Electronic Data Interchange (CEDI) contract, which is the entity responsible for the front-end editing of all claims traffic and transactions with the DME MAC contractors. NGS is closing all free modem and FTP connections to the CEDI gateway in order to meet requirements put forth in the Medicare Claims Processing Manual, Chapter 24 and the Internet Only Manual, Pub 100-17.  The six network vendors mentioned above will be the only vendors allowed to transmit data between suppliers and CEDI via secure AT&T Global Network Service (AGNS) lines.

If you connect directly to the CEDI gateway to upload your claims, retrieve response reports, download Medicare ERNs or send claim status inquiries, you will likely be affected by the upcoming change in service. However, if you are already transmitting claims and other transactions to Medicare through a clearinghouse or one of the network service vendors above, you may not be affected by the transition.  Suppliers who are currently using free network connections can typically expect to pay a per claim fee to a clearinghouse, or pay monthly fees for bandwidth time through one of the approved network service vendors once the transition takes place.

It will still be possible to secure a direct line to CEDI by becoming a direct network service vendor, but this option will be cost prohibitive for most.  IVANS and McKesson also serve as CMS’ authorized AT&T resellers. 

On September 9, 2010, CEDI released a list serve announcement confirming the coming transition. A copy of the announcement and a list of vendor FAQs is available at: http://www.ngscedi.com/news/newsindex.htm. Contact information for CEDI’s select network vendors is available at: http://www.ngscedi.com/telecomm/teleindex.htm.

By: Michelle Hamel

We’ve all heard the saying, the numbers don’t lie. But almost every one of us knows how easy it is for statistics or figures to be manipulated or mis-interpreted. Take, for example, the latest Medicare Fee-For-Service Payments Report released by the Comprehensive Error Rate Testing (CERT) team, which shows that during fiscal year 2009:

• Medicare overpaid DME suppliers by $5.4 billion.
• 51.9% of all DME claims were improperly paid.

Looks bad, right? In a time when healthcare reform is front-and-center in congress and reducing Medicare waste is one of the biggest targets, these figures seem to paint a giant bulls-eye on an industry already suffocating under a chokehold of new billing regulations. In fact, we’ve all born witness to reports in the media showing how this DME product is overpaid or how easy it is for that DME product to be billed fraudulently.

But what if I told you the reason these figures are so high isn’t because Medicare is using poor judgment when paying claims, but rather the result of a regulation crack-down? I know… reason stands that if payments are being made more stringently, then the error rate should be lower, not higher, but bear with me here.

As any supplier in today’s DME industry can attest to, getting payments for legitimate claims is harder than ever before. With accreditation and surety bond requirements, increased scrutiny from CMS and the pending implementation of PECOS, many of today’s suppliers are struggling to stay afloat in a sea of ever-changing regulations. And if you’ve recently undergone an audit, you know firsthand that it’s a whole new ball game. (For an easy way to keep up-to-date on Medicare reimbursement requirements, see Vista Notes.)

So how does this impact the overpayment and paid error rate figures above?

Anyone who happens to do more than glaze over the initial statistics, will find that the CERT team attributes 2009′s high error rates directly to an increased enforcement of documentation requirements and a decrease in the allowance of contractor judgment.

“In the past, reviewers applied clinical review judgment to claims to fill in the gaps of knowledge where documentation was missing. Once CMS clarified that clinical review judgment may not override documentation requirements, more errors were found on DME items. Additionally, it is often more difficult for DME contractors to obtain the proper documentation because they request documentation from the supplier who billed for the item, not the medical professional who ordered the item. The supplier then is responsible for submitting documentation to CMS that they have collected from the ordering provider. The involvement of multiple parties can cause a delay in documentation receipt and incomplete documentation. CMS also recently clarified that documentation produced by the supplier alone is insufficient to warrant payment of the claim.”

As unfair as it may seem for a supplier’s claim to be denied due to the physician’s failure to dot all the i’s and cross all the t’s, suppliers are ultimately responsible for ensuring documentation requirements for the services they provide have been met.

The increased payment error rates are also partially attributable to a new policy (implemented by CMS at the recommendation of the OIG) that prevents audit contractors from looking at a claim’s billing history as an additional source of information. CERT provides the following example of how a once payable claim was denied during a review based on this new policy.

“CERT reviewed a claim for a bedside commode. The supplier provided the treating physician’s signed and dated order to the CERT Contractor indicating a 79 year old patient was recovering from a total knee replacement. A review of claims history showed the beneficiary had a Medicare covered inpatient hospital stay for total knee replacement with a comorbid diagnosis of urinary tract infection shortly before this claim. The policy states a commode is covered when the patient is physically incapable of using regular toilet facilities. The CERT Contractor would have previously determined that the total knee replacement combined with the urgency of urination associated with a urinary tract infection was sufficient to meet this requirement. Now, however, the CERT contractor may not use claims history as a basis for payment. CERT would not know the patient had urinary incontinence unless a medical record indicating the condition was also submitted.”

And to top it all off, previously paid claims with illegible physician signatures are now receiving requests for recoupment as well. This is a scary thought for suppliers, as virtually every claim is subject to denial based on this technicality. Let’s face it; have you ever been able to read your doctor’s handwriting, much less their signature?

“In the past, if the provider’s signature was missing or illegible, and there were no other reasons for denial of the claim, the CERT contractor did not deny the claim. After consultation with the OIG, CMS issued instructions to the CERT contractor directing them to strictly adhere to the CMS policy requiring a legible identifier.”

If one of your claims is being audited and the physician signature is illegible, we recommend that you proactively get an attestation statement from your physician certifying that the signature is indeed theirs. (For information on how to develop a thorough intake process, including physician signature and documentation requirements for general DME, download DME Billing 101.)

So what does all this say about 2009′s $5.4 billion in overpayments and the 51.9% error rate?

In a nutshell, legitimate payments that otherwise would not have been denied are now being audited and recouped based on technicalities. What these numbers show is not that Medicare is improperly paying claims where there is no true medical need. Rather, they represent the learning curve taking place as DME suppliers transition from a Medicare world with a “read between the lines” grey area, into a sink or swim world of only black and white.

(See: http://oig.hhs.gov/publications/docs/workplan/2010/Work_Plan_FY_2010.pdf)

The Office of Inspector General (OIG) has released its 2010 fiscal year Work Plan. The Work Plan outlines which areas within the Department of Health and Human Services (HHS) are currently on the OIG’s radar for assessment and audit. Per the OIG’s mission statement, the goal of their investigations is to “protect program integrity and the well-being of program beneficiaries by detecting and preventing waste, fraud, and abuse; identifying opportunities to improve program economy, efficiency, and effectiveness; and holding accountable those who do not meet program requirements or who violate Federal laws.”

Per the Work Plan, effective October 2009, the OIG will begin examining the following DMEPOS reimbursements, regulations and programs for compliance issues or areas in need of improvement: 

• Physician Self-Referral for DME Services
• Medicare Payments for Various Categories of DME
  • Includes: power mobility devices (scooters), hospital beds, oxygen concentrators and enteral/Parenteral nutrition.
• Medicare Payments for DME Claims with Modifiers
• Comprehensive Error Rate Testing (CERT) Program: DME Corrective Actions
• Appropriateness of DME Categorization
• Enteral Nutrition Therapy Services in Nursing Homes
• Medicare Pricing for Parenteral Nutrition
• Medicare Part B Payments for Home Blood-Glucose-Testing Supplies
• Medicare Payments for Power Wheelchairs
• Medicare Payments to DME Suppliers of Power Wheelchairs
• Repair and Servicing of Capped Rental Durable Medical Equipment
• Medicare Enrollment and Monitoring for Supplier of DMEPOS and Home Health Agencies

Upon completion of an investigation, the OIG has the authority to suggest improvements, impose civil monetary penalties (CMPs) and even impose administrative sanctions.

Specific details on what the OIG will be looking for in each of the above investigations, as well as any actions or audits implemented as a result of an investigation will be included in the December issue of Vista Notes.

Not yet a Vista Notes subscriber? Visit our Products page and add a subscription to your cart today, or contact info@miravistallc.com.

H.R. 3363 is a bill to effectively delay the accreditation deadline for pharmacies who supply DME until January 1, 2010. The bill was introduced to the House on 9/29/09 and quickly passed with a voice vote on 9/30/09. On 10/01/2009 the bill was received by the Senate and was subsequently passed on October 5, 2009.

Update: On October 7, 2009, the bill was presented to the President for signature. As of October 12, 2009 the bill has not yet been signed into law.

While the bill seeks to delay the accreditation deadline for most pharmacies, those that wish to participate in the Competitive Bidding program will still need to meet Medicare’s accreditation requirement prior to placing their bids. Also, the bill only applies to organizations registered with the NSC as a pharmacy dispensing DMEPOS and not DMEPOS providers in general (even if they have a pharmacist on staff).

On 10/05/09, an HME News article reported that CMS is allowing pharmacies who have requested a voluntarily termination of their billing numbers or who have submitted an amended CMS-855S indicating they will no longer provide DME to continue billing Medicare, so long as the NSC has not already processed their application. Per the article, CMS has also asked the NSC to stop processing any further pharmacy applications for voluntary termination.

The article, entitled “House delays accreditation requirement for pharmacies” may be read in its entirety here.

MiraVista sent an inquiry to both CMS and the NSC requesting verification of these statements and further clarification. As of this posting, we have received no response.

Update: On October 09, 2009, the NSC released instruction to the DME MACs regarding H.R. 3363 and those pharmacies that submitted a voluntary termination prior to the original October 1 deadline. Bulleted points from the instruction have been copied and pasted below. To read the instruction in its entirety, click here.

• Pharmacies that were not accredited prior to the October deadline are not subject to the revocation of Medicare billing privileges at this time.
• Any pharmacies that submitted a voluntary termination that now wish to withdraw this request, must submit a letter to the NSC signed by the authorized official.
• The letter MUST be received by the NSC no later than October 23, 2009.
• Letters may be faxed to the NSC by geographic location.

The NSC included a map in its instruction to help pharmacies determine the appropriate fax number for their location. A copy of that map has been posted below:

© National Supplier Clearinghouse, 10/09/2009

National Supplier Clearinghouse Jurisdiction Map

 

Pharmacies on the East coast (Red) should fax termination withdrawal letters to: 803.382.2405.

Pharmacies in the Central region (Yellow) should fax termination withdrawal letters to: 803.382.2408.

Pharmacies on the West coast (Blue) should fax termination withdrawal letters to: 803.382.2406.

To read the full text of H.R. 3363, as well as track its progress, please visit this link:

http://www.washingtonwatch.com/bills/show/111_HR_3663.html#toc0.

Updates will be posted as they become available.

On August 17, 2009, CMS opened the registration window for competitive bidding. Providers who wish to place a bid will need to register with CMS’ Individuals Authorized Access Computer Services (IACS) system.  To register, please visit www.dmecompetitviebid.com, click on the Suppliers tab and then select Registration.

When registering, providers must appoint one authorized official (AO) and are encouraged to appoint one back-up authorized official (BAO) to manage their account. Both the AO and BAO must be listed as an AO on the provider’s CMS-855S enrollment form. AOs should register no later than September 14, 2009 and BAOs should register no later than October 9, 2009.

Any additional registrants beyond the provider’s AO and BAO are known as end users (EUs).  EUs have limited capabilities, such as filling out electronic bid forms, and may register until the close of the registration window on November 4, 2009 at 9:00pm EST. After this time, AOs may update company information, but no additional registrants will be accepted.

Prior to registration, it’s important that providers ensure their information is up-to-date and on file with the NSC and SSA. Information entered into IACS will be compared against information in the NSC (physical address, supplier number) and SSA (legal name, DOB, SSN) databases and must match exactly.

In most cases, the NSC is allotted up to 45-days to process all change of information (COI) requests. Per CMS, providers must wait 5 additional days after receiving confirmation from the NSC that their COI has been processed to update their information in the IACS system. However, the NSC has recently agreed to allow expedited faxed processing of sections 6 and 15 of the CMS-855S, when used to update AO information only. If you are only updating sections 6 and 15 of the 855S form, fax it to: 803.387.2407. For all other updates, the form must still be sent via standard postal mail.

For complete details on the registration process, bid forms, documentation requirements and bid rules, we invite you to attend Andrea Stark’s “Competitive Bidding: What to Expect this Time Around” webinar on August 27, 2009 at 2:00pm EST. You may register for the event or purchase a digital recording via the Seminars/Webinars page of this website.

As published in the August (Volume 1, Issue 3) edition of Vista Notes.

(See: Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions for Part B for CY 2010; Proposed Rule, p.637)

Background

Under Round 1 of Competitive Bidding in 2008, providers who were not awarded a bid contract were allotted the option of grandfathering-in, or keeping, the patients they were renting to prior to the program’s implementation.

Under those provisions, providers were given the option of choosing which products they wished to continue furnishing in each bid category. They were then required to grandfather-in all patients who wished to continue renting those products from them.

For DME items that the provider opted not to continue furnishing, beneficiaries were required to rent equipment from a contracted provider.

All or Nothing

On July 1, 2009, CMS issued a proposed rule that would modify the definition of a “grandfathered item” to include “all rented items within a competitive bid product category that the provider currently rents to beneficiaries.”

The new definition would no longer allow providers who do not win bid contracts the option of grandfathering-in DME based on specific HCPCS and would require them to furnish either all or none of the products that they provide in each bid category.

Notifying Patients

The proposed rule would also require providers to mail a written notification to each of their patients informing them of whether they will grandfather-in (continue to furnish) DME. The letter must be sent at least 30-days before the implementation of Competitive Bidding in each patient’s location.

According to the rule, each letter would need to include the following:

• The DME the provider is currently furnishing to the patient (prior to Competitive Bidding).
• A list of DME the provider will grandfather-in (continue to rent to the patient post Bid).
• The state(s) in which the provider is offering to continue furnishing the DME.
• A statement that the patient has the option of staying with them (their current provider) or renting from a contract provider.
• Contact information for the patient to ask the provider questions and notify the provider of their choice.
• The www.medicare.gov website and 1-800-MEDICARE phone number for the patient to obtain more information.

Providers would be required to keep proof of delivery for all notifications sent and keep a record of attempts made to contact beneficiaries regarding their rental decisions.

Should a patient opt not to continue renting from a non-contract provider, the provider would also be required to provide the patient with two additional notices prior to picking up equipment.

A 10-day written notification would need to be sent to the patient explaining that their equipment will be picked up on a given date (the pick-up date must be clearly spelled out). Per CMS, equipment may be picked up no sooner than the patient’s first anniversary date after implementation of the Competitive Bidding program.) The notice would also need to state that they (the current provider) will be paid for equipment up to the pickup date and that the new contract provider cannot begin furnishing equipment until after this date.

The original provider would then need to call the patient two-days prior to picking up the equipment to remind them of the pickup date and time.

According to CMS, a provider would not under any circumstances be able to pick up equipment prior to receiving acknowledgment from the patient that:

1. They understand the date and time that the equipment will be taken away AND
2. Arrangements have been made with the contract provider to have equipment delivered on that same date.

It is CMS’ stance that since providers submit monthly claims for rental DME, they should have ongoing relationships with their patients and thus have minimal problems contacting them.

Notifying CMS

The proposed rule would also require non-contract providers who opt to grandfather DME to notify CMS of their decision in writing, at least 30-days prior to the implementation of Competitive Bidding. These notifications must include the following:

• That the provider will grandfather-in DME and the product categories they will continue to furnish.
• The provider’s name and address (providers with multiple locations may submit one notification to cover all stores).
• A statement that the provider agrees to abide by all grandfathering terms and conditions.

 Comment & Contact Information

The proposed rule is open for comment until August 31, 2009 and may be read in its entirety here (p.637). Comments may be submitted electronically here or by writing to the following address:

Centers for Medicare & Medicaid Services

Department of Health and Human Services

Attention: CMS-1413-P

P.O. Box 8013

Baltimore, MD 21244-8013