The AMA and other stakeholders had been urging CMS to revise many of the proposed requirements, which would disrupt access to care for Medicare patients, interrupt legitimate payments and care coordination, and cause other administrative hassles.  While CMS has been working to update the PECOS database with complete enrollment information, the process has been cumbersome for physicians and other health care providers.

CMS stopped short of enforcing those requirements, because as many as 200,000 doctors and other health care professionals out of about 750,000 did not have enrollment records in PECOS. This would potentially result in a denial of claims for DME and many other services.  The effect to DME and other services:  the potential “edits” (denials) were put on indefinite hold.

Update:

 CMS has released a final rule detailing the requirements for “ordering and referring” in Medicare.  As noted above, in 2009 CMS began issuing warnings for Medicare claims that failed to meet CMS’s ordering and referring criteria, including the requirement that the ordering/referring provider have an updated enrollment record in PECOS.  This rule finalized requirements that have been in development for three years.

The final rule includes these changes to some of the previous requirements:

• CMS changed the regulatory language from requiring an enrollment in PECOS to “requiring enrollment in Medicare” — including PECOS or other legacy Medicare enrollment systems.
• CMS removed specialist services from those that are required to list the ordering or certifying provider on the claim and meet the other criteria. This change resulted in CMS replacing the term “refer” with “certify” for the applicable items and services. The requirements in this final rule apply to ordered or certified items and services including DMEPOS, clinical laboratory and imaging services, and home health claims billed by Medicare Part B suppliers. For these claims, ordering or certifying providers must be eligible to order or certify in Medicare, their legal name and NPI must be listed on the claim, and they must have an enrollment record in Medicare. The requirements vary slightly for medical interns and residents who order or certify these items and services.
• Residents in an accredited graduate education program also could enroll in Medicare to order services. The interim rule had excluded residents.

CMS will continue to issue warnings for claims that fail to meet these criteria, but at this point CMS will not deny claims that do not meet the criteria. In the future, CMS will begin to deny claims, but has not indicated when this will occur.

Background:

In 2010, Congress required the use of national provider identifiers for ordering and referring physicians on claims for medical equipment or services from laboratories, imaging providers and suppliers. CMS later issued an interim regulation requiring all physicians who order supplies or refer services, including those from specialists, to be enrolled in PECOS by July 2010, but CMS delayed enforcement of that rule as the agency worked to validate and update enrollment records. Enforcement would have meant that claims for items or services would be rejected unless the ordering or referring physician also was in the enrollment system, not just the physician who provided the care.

Bottom line:

• Medicare contractors will continue to use legacy systems, not just PECOS, to determine if an ordering physician has a valid record. Both PECOS and legacy systems collect enrollment data.
• The Medicare agency has not activated automatic edits that would deny payment for noncompliant claims from physicians and other health professionals. CMS is delaying activation indefinitely and will not turn on the edits without 60 days of advance notice.
• The rule continues to require physicians and other professionals to use national provider identifiers on applications to enroll in Medicare and Medicaid. This allows CMS and state health agencies to link claims for services and supplies to the referring professional and check for suspicious activity. CMS expects that changes in the final rule will save the system $1.6 billion over 10 years

“CMS officials have said the enrollment and billing changes are needed to fight Medicare fraud and protect patients. Through the enhanced enrollment process, CMS will be able to verify the credentials of health professionals who order or certify equipment and supplies — a major hub of fraudulent activity.”

 Submitted by Mark Higley

<a href=”http://www.homecaremag.com/features/acos-hme” target=”_blank”></a>

HMEs who serve patients in any of the original Round 1 CBAs (see states affected above) are reminded that CMS has announced a “recompete” bid for the same areas.  The current fee schedules from Round 1 bidding expire 1/1/2014; this program will update and replace the reimbursement for bid items.  The bid window opens this fall!   Six months allows minimal preparation time…and CMS has emphasized increased scrutiny on determining the array of eligible bidders.   Importantly, HMEs should note that CMS is adding new products to the recompete (e.g., external infusion pumps, TENS devices, patient lifts, etc.) and combining several product categories into single larger groupings.   Licensing and other potentially troubling issues to the independent/niche provider may exist and will be reviewed.   Each attendee will receive a complete CD “toolkit” and checklist applicable to the new bidding program.  This program is included within your Heartland tuition, but space is limited.  Round  1 servicing HMEs may sign up today at www.vgmheartland.com.

Please send us an email with the names of any companies that you believe may have:

1. Gone out of business in R 1
2. Sold business in R1
3. Gone out of business outside R1
4. Sold business outside R1

(include the town and state in which they were located)

We need to hear from you by Friday, May 18. If you have any questions or need additional information, please contact Jamie Blomme (Jamie.blomme@vgm.com) or Brittany Terrell (Brittany.terrell@vgm.com) at 800-642-6065.

Continue to Contact Your Members of the House Ways and Means Health Subcommittee

It is important for providers and beneficiaries to follow up with their representatives on the House Ways and Means Health Subcommittee to continue to ask questions about competitive bidding and beneficiary access to quality care and equipment.

(A list of the Ways and Means Health Subcommittee members is below.)

VGM encourages all providers to contact their representatives, as well as to bring forth their patients who have had access issues because of competitive bidding. Providers are asked to reach out to People for Quality Care who may assist with making videos of their patients so that their stories can be heard by members of Congress. Visit People For Quality Care’s Youtube Channel to view videos of patients sharing their stories.

Ways and Means Subcommittee on Health

**NOTE: Each member of the Health Subcommittee represents a district that falls in Round 2 of the competitive bidding program.

• Wally Herger, CA, Chairman
• Fortney Pete Stark, CA Ranking Member
• Mike Thompson, CA
• Ron Kind, WI
• Earl Blumenauer, OR
• Bill Pascrell, Jr., NJ 
• Sam Johnson, TX
• Paul Ryan, WI
• Devin Nunes, CA
• Dave Reichert, WA
• Peter Roskam, IL
• Jim Gerlach, PA
• Tom Price, GA
• Vern Buchanan, FL

Some people are already doing this because of other issues they face getting quality care. They understand competitive bidding  is one more obstacle that will make their lives difficult.  They get it.  The minute I mention low bids they fire back with “great, cheap equipment and poor service”  They follow this up with “what can I do to help”

Please help them help you!  Provide them information every chance you get.  Invite them to your store for a informative meeting, take them with you when you make visits to your local government.  Involve them, involve them, involve them.  They understand and they will help. 

THIS FIGHT IS NOT OVER YET,  PLEASE TAKE THE PLEDGE.  www.peopleforqualitycare.org/fight

“The Lunch Bucket was developed as another way for providers to connect with us,” said Gallagher. “The idea came from Van [Miller], who wanted to offer our members a means to sit down with either Mark or me, and to hear the latest legislative and regulatory information,” he added. “Understanding our vigorous travel schedules, we also wanted to give our members another opportunity to talk with us as well.”

On May 3, hundreds of providers logged on to the 90-minute webinar to listen to both Gallagher and Higley. The two talked about the most concerning issue the industry is currently facing: competitive bidding. Higley discussed his predictions for Round 2 bidders, as well as the need to get more providers to fill out his anonymous survey. Higley’s survey may be found on his blog through the VGM website here:

http://www.vgm.com/blog/index.php/2012/04/preliminary-round-2-bidding-survey-results-and-request-for-survey-completion/

Meanwhile, Gallagher discussed CMS’ recent and timed propaganda promoting the competitive bidding program. Gallagher called out the agency for its misleading data that was included in a 16-page report CMS provided immediately following the announcement of the Round 1 “recompete.” Gallagher noted that the report claimed a savings of 42 percent since the implementation of Round 1 in January 2011.

“CMS initially claimed an average savings of 32 percent,” said Gallagher during the webinar. “Now they are claiming with a larger savings.”

Gallagher also discussed the importance of getting involved in the fight against CMS and competitive bidding, stressing many times the need to get the face of Medicare beneficiaries in front of members of Congress. He called on all providers to bring forth their patients who have had access issues because of competitive bidding. Gallagher also asked providers to contact People for Quality Care who may assist with making videos of their patients.

“CMS says there is no problem with access to equipment,” said Gallagher following the webinar. “We need to provide faces of beneficiaries that convey otherwise.”

VGM plans to host more “Lunch Buckets” in the near future. Dates and times of these events will be announced through The VGM Group, Inc. through Legislative Updates and on John Gallagher’s blog. In the meantime, a recording of the May 3 webinar may be found here:

https://vgmservices.webex.com/vgmservices/lsr.php?AT=pb&SP=EC&rID=46257307&rKey=b5ffaee76dd4cf46

The claims range from $16 up to the full $50,000 face value of the bonds.  While the smaller dollar amount claims seem insignificant the real concern is that even these smaller amounts could jeopardize a providers billing privileges and if this process continues it will most definitely impact the underwriting, rates and ability of providers to obtain surety bonds in the future.

In a recent email VGM Insurance shared 3 important tips that I would like to share with you:

• Make certain that your Medicare billing and overpayment staff (or company) understand that all overpayments must be settled before they hit 100 days. The DME MACs may submit a claim against your surety bond for any overpayment amount, so don’t let a $16 claim jeopardize the future of your business.

• A bond is not insurance. A bond is more like an advance from a bank or credit card. If the bond company pays a claim for you, they will treat that claim like a debt and use all available tools to collect that debt plus interest. Also, when a claim is paid by the surety, renewal of your surety bond may be jeopardized. Most surety bond companies will not write a bond for a provider who had a claim on a previous bond.

• If you are notified of a claim please contact VGM Insurance’s Medicare Bond Hotline immediately.

For questions please contact VGM’s Bond Hotline at 866-497-0472.

To join John for “lunch:”

1. Log onto: https://vgmservices.webex.com/vgmservices/onstage/g.php?t=a&d=746053032 
2. Enter your name
3. Enter your e-mail address
4. Event password: lunchbucket

No need to register. Simply log on today (May 3) at 12:30 pm CDT (1:30 pm EDT/10:30 am PDT).

Please contact Jamie Blomme at 800-642-6065 or Jamie.blomme@vgm.com if you have any questions.

Go to: www.competitivebiddingconcerns.com

See below to view the summaries from KHN. Click in the name of the news source to view the whole article.

Once again, CMS’ recent PR blitz was neither coincidental nor an accident. The agency is aware of the traction the Market Pricing Program (MPP) is gaining with our members of Congress, as well as the impending CBO score of the proposal (see John Gallagher’s blog here). As most are aware, the MPP would require CMS to make fundamental changes to ensure a financially sustainable program. It uses a state-of-the-art auction system to establish market-based reimbursement rates around the country.

Providers need to ensure that they stay in front of CMS’ efforts to curb support for stopping and replacing the current bidding program. Please be sure to contact your local media to inform them of how this program affects small businesses and patient access to quality care and equipment. You should also continue communicating with your members of Congress on this issue.

IT IS ESPECIALLY IMPORTANT TO GET BENEFICIARIES AFFECTED BY ROUND 1 INVOLVED IN EFFORTS TO CALL CMS OUT ON ITS CLAIMS! If you know of any Medicare beneficiaries who have experienced access issues, encourage them to get involved and to speak up! People for Quality Care, which is part of the VGM Family, may be able to assist with getting your patients’ voices heard.

The following videos from People for Quality Care may be used when reaching out to your local media and legislators. The videos feature real Medicare beneficiaries, referral sources, and/or providers who discuss patient-access issues because of competitive bidding.

http://www.youtube.com/watch?v=Fris3PKnkQs&list=UUP6e0Mmdt-b4AAeXLdDZr

http://www.youtube.com/watch?v=j2GobUh9ze4&feature=relmfu

http://www.youtube.com/watch?v=pXsuCWebZb0&feature=relmfu

http://www.youtube.com/watch?v=GB6zRgdX4Eg&feature=relmfu

http://www.youtube.com/watch?v=T2JXc1kEwro&feature=relmfu

http://www.youtube.com/watch?v=w-KPPB0eBDo&list=UUP6e0Mmdt-b4AAeXLdDZr

http://www.youtube.com/watch?v=VjD48-QGq-g&feature=youtube_gdata_playe

Click here for a packet of information to use with your local media and legislators. It includes the Cramton Analysis and the Dr. Brown Study on rural access.

The following is the summary from Kaiser Health Network regarding CMS’ PR.

Obama Administration Will Expand Use Of Competitive Bidding In Medicare

A year-long experiment found that the competitive bidding approach saved money without harming beneficiaries. It also made inroads against waste and fraud.   

The New York Times: In A Shift, Medicare Pushes Bids
The Obama administration said Wednesday that it would vastly expand the use of competitive bidding to buy medical equipment for Medicare beneficiaries after a one-year experiment saved money for taxpayers and patients without harming the quality of care (Pear, 4/18).

The Associated Press: Competition Cuts Down Medicare Fraud
A yearlong experiment with competitive bidding for power wheelchairs, diabetic supplies and other personal medical equipment produced $200 million in savings for Medicare, and government officials said Wednesday they are expanding the pilot program in search of even greater dividends. The nine-city crackdown targeting waste and fraud has drawn a strong protest from the medical supply industry, which is warning of shortages for people receiving Medicare benefits and economic hardship for small suppliers. But the shift to competitive bidding has led to few complaints from those in Medicare, according to a new government report (Alonso-Zaldivar, 4/18).

CQ HealthBeat: Medicare Officials Say Equipment Bidding Program Saved $200 Million
A controversial competitive bidding program to supply medical equipment to Medicare patients in nine markets netted $202 million in savings in its first year, the Centers for Medicare and Medicaid Services announced Wednesday. Contrary to the claims of critics, the program hasn’t led to disruptions in access to products such as wheelchairs, hospital beds, and oxygen supplies, Deputy CMS Administrator Jonathan Blum said in a telephone press briefing. Nor has it led to adverse health effects requiring more hospital, doctor, or skilled nursing care, added Blum (Reichard, 4/18).

The Hill: Obama Administration Claims $42.8 Billion In Savings From Health Law Bidding Program

The healthcare reform law’s competitive bidding program for durable medical equipment such as hospital beds and wheelchairs is projected to save $42.8 billion over the next 10 years, the Medicare agency said in a report Wednesday. Competitive bidding, an effort to replace Medicare’s standard fees with market competition among providers, was created by the 2003 Medicare reform law and began on Jan. 1, 2011 in nine pilot metropolitan areas (Pecquet, 4/18).

California Healthline: A Second Opinion on Medicare ‘Double Counting’
[T]he ACA’s budget impact — and its Congressional Budget Office score — are making headlines again, sparked by a new study from conservative scholar Charles Blahous. Blahous has a prominent perch: He’s one of two White House-appointed trustees for Medicare. And he’s made an eye-catching contention: The CBO wonks are wrong, and ObamaCare could add as much as $527 billion to the U.S. deficit across the next decade. But this latest debate doesn’t expose anything new about the health law. What it does illustrate is the flawed approach to Medicare accounting — and how easy it is to gin up another fight over health spending (Diamond, 4/18).

I’m concerned that many providers have become complacent or too willing to accept what CMS dishes out. You CANNOT be either of those! We are closer than we’ve ever been to effecting a positive change to this program. Those of you that have gone to D.C. and talked to your congressmen and senators know that when you talk about CMS the majority roll their eyes because they don’t believe what information comes out of it. HME IS THE SOLUTION to lower costs in healthcare. YOU DO provide vital services to your patients. The industry HAS OFFERED a more fair (to the provider AND the American taxpayer) and cost neutral alternative to this ill conceived and ill managed program. NOW more than ever our voices AND more importantly, your patients voices NEED TO BE HEARD.

VGM is here to help. We WON’T GIVE UP! If I sound like I’m mad, it’s because I AM and you should be too!

1).  An example of the “composite bid” and “capacity” methodology via a faux bidding category of one HCPC code and 75 potential bidders.  

2). The initial survey results of two sampling populations of bidders:  33 large HMEs that are VGM members, and 123 respondents to the survey request that attended one or more VGM competitive bidding seminars. 

Open the file here:  http://www.vgm.com/files/PDF/Round-2-Predications-and-Projections.pdf

Caveat and Disclaimer: These are preliminary overall results that have not undergone stratified sampling and testing/variance analysis.  VGM will offer subgroup analysis (e.g., by CBA, by region, by metro population, etc.) in the near future. 

YOU can help improve the reliability of this data!  If you completed a Round 2 bid, PLEASE complete a survey!  Here is a reprint from a prevous Blog: 

——————

Almost immediately after CMS announced the Round 1 Recompete, press releases from the agency seemingly poured out of several news outlets. Once again, CMS touted taxpayers’ savings and also indicated that beneficiary access to suppliers was not compromised. In other words, “Lies, damned lies, and statistics” (as made famous by the great Mark Twain). CMS continues to say the program is running smoothly, without any problems. It also released a 16-page report highlighting its claims. Meanwhile, the entire industry knows such claims are untrue.   

Using diabetic patients as an example in its report, CMS states that it addressed the declines in the use of mail-order diabetes test strips and CPAP supplies in competitive bidding areas (see page 5 of the report). CMS states that its staff “randomly identified” 100 diabetic beneficiaries who indicated they had not made Medicare claims for 2011 because they had “more than enough supplies on hand.” The agency goes on to say: “This would suggest that beneficiaries received excessive replacement supplies before they became medically necessary. CMS concludes that the competitive bidding program may have curbed inappropriate distribution of these supplies that was occurring prior to implementation.”

View the entire report here.

Time to “Pony Up!”

Make no mistake – CMS’ timely press releases were not by accident. The agency is aware of the traction that the Market Pricing Program (MPP) is gaining on the Hill and the impending CBO score that the DME industry is working to achieve. In response to the traction of the MPP, CMS is doing all it can to portray a smooth-running, flawless program. The claim above is only one sample of the false data that CMS has released as part of its propaganda to curb support for the MPP. But we should regard this as a gift that the agency has given the industry. The industry has always known the program has had a number of issues with patient access to quality care and services. We should use examples of Medicare beneficiaries who are facing real issues with the competitive bidding program to contradtict CMS’ false data. 

Rather than chasing CMS’ endless PR campaigns, we need to ensure that we stay in front of the agency’s false information. Rally your beneficiaries and get them involved. Let them speak for themselves to inform local media and your members of Congress that they are having access issues! Start contacting your media now! This flawed program will affect all areas, including rural regions.

• Round 1 providers should report on the issues they have already seen or experienced in their areas.
• Round 2 providers should let their local media know what’s coming and how it will affect their local Medicare beneficiaries.
• Rural area providers should convey how the program will affect their beneficiaries (see Dr. Brown’s study below).

Begin contacting your local media and legislators now!

As an industry, we need to be sure we stay ahead of CMS. Reach out to your local media and members of Congress and make this an issue. Convey to them that competitive bidding is flawed and will affect local jobs as well as access to quality care and supplies. Once again, this is the time to get involved!

Remember: It’s not over until WE, AS AN INDUSTRY say it’s over! It’s time to stop asking: “What are they doing to fight competitive bidding.” We need to ask, “What am I doing to fight competitive bidding?

Below are some handouts and videos that may be used with your local media and legislators conveying the real issues involved with competitive bidding. Please use this information to forward to both. Contact both the local media and your members of Congress by using the VGM DC Link (www.vgmdclink.com). Click on “Find Media Contacts” to connect with your local media. Enter your ZIP Code and click on “Find your Official” to connect with your legislators.

Let’s take action and fight this together!

Below are some videos from People for Quality Care. The videos feature real Medicare beneficiaries, referral sources, and/or providers who discuss patient-access issues because of competitive bidding.

• http://www.youtube.com/watch?v=Fris3PKnkQs&list=UUP6e0Mmdt-b4AAeXLdDZr
   
• http://www.youtube.com/watch?v=j2GobUh9ze4&feature=relmfu
   
• http://www.youtube.com/watch?v=pXsuCWebZb0&feature=relmfu
   
• http://www.youtube.com/watch?v=GB6zRgdX4Eg&feature=relmfu
   
• http://www.youtube.com/watch?v=T2JXc1kEwro&feature=relmfu
   
• http://www.youtube.com/watch?v=w-KPPB0eBDo&list=UUP6e0Mmdt-b4AAeXLdDZr
   
• http://www.youtube.com/watch?v=VjD48-QGq-g&feature=youtube_gdata_playe
   

Click here for a packet of information to use with your local media and legislators. It includes the Cramton Analysis and the Dr. Brown Study on rural access.

• Respiratory Equipment and Related Supplies and Accessories
• Includes oxygen, oxygen equipment, and supplies; continuous positive airway pressure (CPAP) devices, respiratory assist devices (RADs), and related supplies and accessories; and standard nebulizers
• Standard Mobility Equipment and Related Accessories
• Includes walkers, standard power and manual wheelchairs, scooters, and related accessories
• General Home Equipment and Related Supplies and Accessories
• Includes hospital beds and related accessories, group 1 and 2 support surfaces, transcutaneous electrical nerve stimulation (TENS) devices, commode chairs, patient lifts, and seat lifts
• Enteral Nutrients, Equipment and Supplies
• Negative Pressure Wound Therapy Pumps and Related Supplies and Accessories
• External Infusion Pumps and Supplies

CMS is conducting the Round 1 Recompete in the same competitive bidding areas (CBAs) as the Round 1 Rebid.

A list of the specific items in each product category is available on the Competitive Bidding Implementation Contractor (CBIC) website.  The specific ZIP codes in each Round 1 Recompete CBA are also available on the CBIC website.

To ensure that suppliers have ample time to prepare for the competition, CMS announced the following next steps for the program:

• Spring 2012
• Summer 2012
• Fall 2012

• CMS begins pre-bidding supplier awareness program

• CMS announces bidding schedule
• CMS begins bidder education program
• Bidder registration period to obtain user ID and password begins

• Bidding begins

If you are a supplier interested in bidding, prepare now – don’t wait.

• Update your contact information:  The following contact information in your enrollment file at the National Supplier Clearinghouse (NSC) must be up to date before you register to bid.  If your file is not current, you may experience delays and/or be unable to register and bid.  DMEPOS suppliers should review and update:
• The name, Social Security number, and date of birth for all authorized official(s).  If you have only one authorized official listed on your enrollment file, consider adding one or more authorized officials to help with registration and bidding; and
• The correspondence address.

DMEPOS suppliers can update their enrollment file via the internet-based Provider Enrollment, Chain and Ownership System (PECOS) or by using the Jul 11, 2011 version of the CMS-855S enrollment form.  Suppliers not currently using PECOS can learn more about this system by accessing the Internet-Based PECOS  page on the CMS website or reviewing the PECOS fact sheet.  Information and instructions on how to submit a change of information via the hardcopy CMS-855S enrollment form may be found on the NSC website.

• Get licensed:  Contracts are only awarded to suppliers that have all required state licenses at the time of bidding.  Therefore, if you are bidding for a product category in a CBA, you must ensure that all required state licenses for that product category are either on file with the NSC or received by the NSC by close of bidding.  Every location must be licensed in each state in which it provides services.  If you have only one location and are bidding in a CBA that includes more than one state, you must have all required licenses for every state in that CBA.  If you have more than one location and are bidding in a CBA that includes more than one state, your company must have all required licenses for the product category for every state in that CBA.   Make sure that current versions of all required licenses are with the NSC before you bid.  If any required licenses are expired or missing from your enrollment file, your bid(s) may be rejected.
• Get accredited:  Suppliers must be accredited for all items in a product category in order to submit a bid for that product category.  If you are interested in bidding for a product category and are not currently accredited for that product category, take action now to get accredited for that product category.  Your accreditation organization will need to report any accreditation updates to the NSC.  CMS cannot contract with suppliers who are not accredited by a CMS-approved accreditation organization.

More information about the DMEPOS accreditation requirements, including a list of the accreditation organizations and those who are exempt from accreditation, may be found on the DMEPOS Accreditation page on the CMS website.

Visit the DMEPOS Competitive Bidding page on the CMS website for more information about the DMEPOS competitive bidding program.

——-

Our law firm has continued to receive phone calls and emails from
suppliers about Agape.  It appears there have been many people affected
by the situation.

If you feel that you are interested in pursuing a law suit against
Agape, our law firm remains available to assist you with that.  It is
important to note, however, that such litigation could be costly, and
there is no guarantee of recovery.  This is not meant to discourage you
from pursuing litigation; rather, it is meant to remind you of the
realistic challenges that litigation presents.

At this time, our law firm does not plan to make an appeal to the CBIC
or CMS on behalf of affected suppliers.  Rather, we suggest you continue
your efforts of pursuing that potential avenue of relief.  The CBIC’s
telephone number is 877-577-5331, and the emails can be sent using the
following link:
http://www.dmecompetitivebid.com/cbic/cbicforms.nsf/ContactUs?OpenForm.
We also suggest you contact your local United States Congressman’s
office to appeal for his or her help.  It is possible that an elected
official could put pressure on CMS to provide you with relief.

Lastly, you may wish to consider contacting the following entities to
ascertain whether they have a desire to investigate the situation:

*    County of Riverside District Attorney’s Office
Special Prosecutions Unit
3960 Orange Street
Riverside, CA 92501
(951) 955-5491

*    United States Attorney’s Office
Central District of California
Major Frauds Section
312 North Spring Street
Los Angeles, CA 90012
(213) 894-3868

*    State of California Department of Justice
Office of the Attorney General
(916) 322-3360
The following link leads to an online complaint form you can fill out:
Ag.ca.gov/contact/complaint_form.php?cmplt=CL

Please let us know if we can assist you further with this.

Jeffrey S. Baird, Esq.
Board Certified-Health Law
Texas Board of Legal Specialization
Brown & Fortunato, P.C.
P.O. Box 9418
Amarillo, Texas  79105
(806) 345-6320
(806) 345-6363 Facsimile
jbaird@bf-law.com
www.bf-law.com

Beth will also be available at the VGM booth if you need to order some more informational literature for your customers.  Please keep the fight going by including your customers, family members, advocacy organizations and referral sources.  Keep them updated on the issues.  They can help us make our message clear.  Home care is the most cost-effective, patient preferred, safe health care delivery system available!

With that said, I believe it is appropriate to attempt to estimate what the HME community has actually submitted in bids.  By that I mean not only category discounts, but bid prices on the key items in each product category, as well as the nefarious “capacity” issue which confused so many HMEs – and decimated the fee schedule – in the original Round and the Round One rebid. 

The industry deserves an attempt to obtain a preview now that the bid window is over.

 Our education has created an Internet survey requesting your input. 

http://www.vgm.com/files/PDF/Round2SurveyLinks.pdf

Responses are compiled through an independent third party electronic survey.  VGM will not and cannot identify the respondents.  You will NOT be prompted to offer any identifiable company information.   

After you select your CBA, please review the survey. 

PLEASE complete it.  We need you…

• Here is the link:  http://www.vgm.com/files/PDF/Round2SurveyLinks.pdf
• This includes ALL 100 CBAs AND THE NATIONAL MAIL ORDER PROGRAM.
• PLEASE SELECT ONLY THE CBA OF WHICH YOU BID.  You may return to this URL and select another CBA if you submitted more than one bid.
• Select, then “Ctrl + click”; please ensure the link is the correct CBA!

Note:  VGM has also requesting this data from other HMEs that attended certain seminars or other functions.  If you have previously completed a survey, please do NOT duplicate your survey submission a second time. 

The industry needs to be prepared.  You can help!  Please submit your non-identifiable information today.

Thank you!

http://www.vgm.com/files/PDF/Round2SurveyLinks.pdf

No!

Now we reenergize. Now we reassemble. Now we persevere.

Now we continue the fight to STOP the flawed competitive bidding program.

In the next few months, providers need to come together and join in efforts to repeal competitive bidding. It is especially important that the industry conveys the same message to ensure that it is heard, loud and clear by our legislators. If you haven’t joined in the fight, we need your voice, now more than ever. If you’ve been fighting, we need you to keep it up.

“It’s not over until WE, AS AN INDUSTY say it’s over!”

Whether in a competitive bid area or not, this fight is everyone’s fight. If not repealed and fixed, this program will affect the entire industry, as well as Medicare beneficiaries. We urge all providers to mobilize once again to bring awareness to the competitive bidding issue. The following is CMS’ projected timeline of what is to come in Round 2. It is up to our industry to make use of the time between now and when CMS announces the Round 2 single payment amounts this fall.

Fall 2012
CMS announces single payment amounts, begins contracting process

Spring 2013
CMS announces contract suppliers, begins contract supplier education campaign

Spring 2013
CMS begins supplier, referral agent, and beneficiary education campaign

July 1, 2013
Implementation of Medicare DMEPOS Competitive Bidding Program Round 2 and National Mail-Order Competition contracts and prices

In the coming weeks, VGM will send out “take action” tasks that you may do to help with the fight and to get your voice heard. Please continue to check your legislative updates and be sure to TAKE ACTION. Instead of asking, “What are they doing to fight competitive bidding?” Ask, “What am I doing….?”

THIS WEEK’S “TAKE ACTION” TASK

Congress is on a recess from April 2 to April 16. Legislators will be in their home states and districts hosting town hall meetings and/or campaigning for this year’s elections. They will likely be discussing issues such as the health care law, gas prices and the economy. While they are home, be sure to attend their public events. Below are steps that you can take:  

1. Visit your legislators’ website or call your legislators’ local offices to find out when/if they are hosting any upcoming public events. Go to www.vgmdclink.com if you need to find your legislators’ contact information.
2. Form a group with your colleagues, employees, patients, family members, etc. to attend your legislators’ town hall meetings. As they discuss issues like health care and the economy, voice your concern about competitive bidding and express how it will affect your local community.
3. Consider bringing homemade “push back” signs with phrases like, “Don’t let the government take my job!”
4. Following your attendance to your legislators’ town hall events, be sure to follow up with their local offices. It will be important to push for a CBO score of the Market Pricing Program (MPP). Remember: in order to move the MPP forward, we must get it scored by the Congressional Budget Office.

VGM stands ready to continue the industry’s fight. Will you be a part of that fight?

If you need any assistance with contacting your legislators, please feel free to contact the VGM Government Relations department at 800-642-6065 or e-mail jamie.blomme@vgm.com.

With the exception of diabetic supply bidders (who were required to submit a “50%  form” ), those suppliers who had completed letters of intent, and those who opted to submit updated financials or credit reports…there is nothing “hardcopy” to send to the CBIC.

“Nothing” means not a copy of your electronic bid worksheets, not a copy of your expansion plan, not a copy of your licenses…you get the idea.  You are done. 

Note:  If you submitted financial documents by the covered document review date (CDRD) February 29, 2012 – you will receive an e-mail about your financial documents from the CBIC by May 14, 2012.  If you did not submit all of the required financial documents, the e-mail will alert you to expect a letter notifying you of the specific missing financial document(s).  This letter will be mailed to your organization’s authorized official.  You will be required to submit the indicated missing financial document(s) within 10 business days of the notification.  If you submitted all required financial documents, the e-mail will confirm that the CBIC received all required financial documents and that no further action from you is required.  If you did not submit any financial documents by the CDRD, you will not receive an e-mail or a letter about your financial documents.

And one more time, a reprint from one of our members that pretty much sums it up:

ACCORDING TO “JENNA” AT CBIC (MARCH 23 AT 12:20 PM)… ONCE ALL THE BIDDING CATEGORIES THAT YOU WISH TO BID ON ARE MARKED “COMPLETE AND CERTIFIED” AND THE FORM A IS MARKED “COMPLETED AND APPROVED” AND DOCUMENTATION STATUS SHOWS THAT IT WAS RECEIEVED “YES”, THEN THERE IS NOTHING LEFT TO DO TO “FINALIZE” WHAT IS THERE… IT JUST STAYS THERE UNTIL THE MARCH 30TH DEADLINE.  BIDS CAN BE CHANGED UP UNTIL THE DEADLINE, BUT THE CHANGES HAVE TO BE RECERTIFIED BY AN AUTHORIZED OFFICIAL BY USING THEIR “LOGIN” ID.  THERE IS NO FINAL “MAGIC BUTTON” TO CLICK ON ONCE YOUR STATUS SCREEN SHOWS THESE THINGS.

I couldn’t have said it better. 

I’m probably taking Monday off.  I’ve got a 36 Carver on the Mississippi and it’s be in the 80′s in Iowa this weekend.  Time to boat.  I’ll toast to the bidding window finally coming to an end.  Many times…good luck all.

All suppliers bidding in the Round 2 or national mail-order competitions must submit the required hardcopy documents stated in the Request for Bids (RFB) instructions. All required hardcopy documents that must be included as part of the bid package must be RECEIVED by the Competitive Bidding Implementation Contractor (CBIC) on or before March 30, 2012. If your hardcopy documents are not RECEIVED on or before March 30, 2012, your bid(s) will be disqualified. If you have not already submitted your hardcopy documents…

DO NOT SUBMIT YOUR ELECTRONIC FORMS A AND B!! – This is referencing the credit report and score, the financials, any completed LOIs and so on.  NOT your bid worksheets. 

Most of you have nothing to send as you submitted prior to the CDRD on 2/29/2012.

After you certify there is nothing else to do.  Yes, the CBIC is behind on updating its electronic receipt records.  You can call them if you are worried…

Hope this helps

HME SERVICES

DURABLE MEDICAL EQUIPMENT COMPANY

PROUDLY SERVING SINCE 2009

1234 Governor’s Road

Kansas City, Kansas 47525

555-555-5555

LETTER OF INTENT TO SUBCONTRACT

March 1, 2012 

§ 1 – Preamble

HME SERVICES Durable Medical Equipment Company (“HME SERVICES” and/or “Contractor”) and ABC MEDICAL EQUIPMENT Subcontractors (“ABC MEDICAL” and/or “Subcontractor”) hereby execute this letter of intent to enter into a subcontracting relationship and provide services under the Centers for Medicare and Medicaid (“CMS”) DME Round Two Competitive Bidding Program.

Proposed Contractor:

HME SERVICES Durable Medical Equipment Company – NPI # 2221479630/ Tax ID# 36558977745

Proposed Subcontractor:

ABC MEDICAL Equipment Subcontractors – NPI # 2325891240 / Tax ID# 55899987445

 HME SERVICES and ABC MEDICAL are entering into this arrangement specifically to contract for supply and provision of Oxygen and Oxygen Equipment in the Bridgeport-Stamford-Norwalk, CT MSA, as defined by CMS. Exhibit “A”, listing all products specifically covered by this agreement, is attached hereto and fully incorporated as if fully set forth herein.

 § 2 – Purpose

The Contractor has chosen to enter into this arrangement with Subcontractor for the purposes of receiving product line support and personnel support. Both the Contractor and Subcontractor expressly warrant and represent that its agreement is solely for lawful and legitimate business purposes and is in no way an attempt to circumvent the policies and procedures outlined by CMS. Nor does this agreement intend to bind the parties to undertake any actions that violate 42 U.S.C. § 1320a-7b, the Anti-Kickback Statute.

 § 3 — Conditions Precedent to Serving as Authorized CMS Supplier

 The Subcontractor expressly warrants and represents that it meets all of the conditions precedent to being an authorized subcontractor. This includes, but is not limited to: accreditation, financial solvency, requisite state licensing, and all other requirements articulated in 42 CFR § 414.414.

 The Subcontractor further warrants and represents that it has never been excluded from Medicare or any state run health services program. Subcontractor also expressly warrants and represents that it has never been sanctioned by Medicare or any state run health services program for violations of any applicable rules. Subcontractor agrees to notify Contractor immediately to any material changes in Subcontractor’s status as an eligible CMS provider.

 § 4 – Fee Schedule

Contractor and Subcontractor agree to be bound by the terms of the Fee Schedule, attached hereto as Exhibit “B” and fully incorporated as if set forth herein.

 § 5 – Cooperation with Bidding Program

Subcontractor fully agrees to cooperate with Contractor throughout the entire DMEPOS Competitive Bidding Program. This includes, but is not limited to, disclosing additional information, providing documentation, and taking any other such measures which CMS may require of competitive bidding winners and subcontractors.

 § 6 – Term of Agreement

The term of this agreement shall not exceed three (3) years, which is the term of the contracts awarded by CMS.

Contractor further expressly reserves the right to terminate this agreement at any time as long as Contractor provides Subcontractor with ninety (90) days notice.

 § 7 – Proof of Insurance

Subcontractor covenants and expressly warrants that Subcontractor maintains the requisite amount of insurance required by CMS, which is currently at least $300,000.00 in comprehensive liability insurance covering Subcontractor’s place of business, employees, and customers.

Subcontractor further warrants to maintain to stay abreast of CMS’s insurance requirements and to remain compliant throughout the total duration of the contract period.

Subcontractor also agrees to provide Contractor with proof of sufficient insurance within ten (10) days of any request by Contractor.

§ 8 – Indemnification

Both parties agree that they will indemnify the other in the event of a lawsuit or other liability that arises out of the party’s breach of this Agreement or other acts of negligence.

Both HME SERVICES Durable Medical Equipment Company and ABC MEDICAL EQUIPMENT Subcontractors fully execute and agree to be bound by the terms and conditions stated above.

Signed this ______________ day of ____________________,2012

 ________________________________________________________________________

HME SERVICES Representative

 ________________________________________________________________________

ABC MEDICAL Representative

———-

IMPORTANT CAVEAT AND DISCLAIMER; NO WARRANTY:   This template is not a VGM Group, Inc. work product.  This template is distributed in the hope that it will be useful, but WITHOUT ANY WARRANTY; without the implied warranty of FITNESS FOR A PARTICULAR PURPOSE. THERE IS NO WARRANTY FOR THE TEMPLATE, TO THE EXTENT PERMITTED BY APPLICABLE LAW.   VGM GROUP, INC. PROVIDES THE TEMPLATE “AS IS” WITHOUT WARRANTY OF ANY KIND, EITHER EXPRESSED OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF FITNESS FOR A PARTICULAR PURPOSE. THE ENTIRE RISK AS TO THE QUALITY AND PERFORMANCE OF THE TEMPLATE IS WITH YOU. IN NO EVENT UNLESS REQUIRED BY APPLICABLE LAW OR AGREED TO IN WRITING WILL VGM GROUP, INC BE LIABLE TO YOU FOR DAMAGES, INCLUDING ANY GENERAL, SPECIAL, INCIDENTAL OR CONSEQUENTIAL DAMAGES ARISING OUT OF THE USE OR INABILITY TO USE THE TEMPLATE (INCLUDING BUT NOT LIMITED TO FAILURE TO SECURE A ROUND TWO DMEPOS COMPETITIVE BIDDING CONTRACT OR LOSSES SUSTAINED BY YOU OR THIRD PARTIES OR A FAILURE OF THE TEMPLATE TO OPERATE AS IT IS INTENDED) EVEN IF SUCH HOLDER HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.

The following is the message from CMS regarding the bid submission deadline:

The Centers for Medicare & Medicaid Services (CMS) is currently accepting bids for the Round 2 and national mail-order competitions of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. All bids must be submitted in DBidS, the online bidding system, by 8:59:59 p.m. prevailing Eastern Time on Friday, March 30, 2012. All required hardcopy documents that must be included as part of the bid package must be RECEIVED by the Competitive Bidding Implementation Contractor (CBIC) on or before March 30, 2012.

Here are some important reminders:

– The Round 2 and national mail-order competitive bidding areas, product categories, DBidS information, bid preparation worksheets, educational materials, and complete Request for Bids (RFB) instructions can be found on the CBIC website at www.DMECompetitiveBid.com. You should review this information prior to submitting your bid(s).

– You must submit your bid in DBidS using the user ID you received during registration. If you have not already logged in to DBidS, we strongly recommend that you do so NOW to have plenty of time to complete your bid. If you have forgotten your user ID and/or password, you may recover them by using the “Forgot Your User ID?” and “Forgot Your Password?” buttons located on the Individuals Authorized Access to the CMS Computer Services (IACS) login page.

– Your authorized official or backup authorized official must approve your Form A and certify your Form B before the close of bidding. If you modify your bid after it has been approved or certified, it will need to be reapproved or recertified. If Form A is not approved or Form B is not certified, your bid cannot be evaluated, and you will not be considered for a contract. You can verify the status of your forms by logging into DBidS and checking the status screen.

– All bidders must submit certain required hardcopy documents as specified in the RFB instructions. It is very important that you review the hardcopy documents section and the sample financial statements in the RFB instructions to ensure your documents include the required information. We also encourage you to use the Hardcopy Document Package Checklist, which may be found in Appendix B of the RFB. If you have already submitted your financial documents, you may still amend those documents as long as they are RECEIVED by the CBIC on or before March 30, 2012. We cannot accept faxed or e-mailed documents, so you must mail your documents to the CBIC at the address in the RFB instructions.

– All bidders participating in the national mail-order competition for diabetic testing supplies must complete and submit the National Mail-Order 50 Percent Compliance form on the CBIC website. Only one form should be submitted per bidder number. You must not change the printed form in any way. Please ensure that all pages of the form are included in the hardcopy document package. If the form is not RECEIVED on or before March 30, 2012, your bid for the national mail-order competition will be disqualified. Please refer to the instructions on the form or to the National Mail-Order Competition for Diabetic Supplies fact sheet on the CBIC website for additional information.

– If you submitted financial documents by the covered document review date (CDRD) – February 29, 2012 – you will receive an e-mail about your financial documents from the CBIC by May 14, 2012. If you did not submit all of the required financial documents, the e-mail will alert you to expect a letter notifying you of the specific missing financial document(s). This letter will be mailed to your organization’s authorized official. You will be required to submit the indicated missing financial document(s) within 10 business days of the notification. If you submitted all required financial documents, the e-mail will confirm that the CBIC received all required financial documents and that no further action from you is required. If you did not submit any financial documents by the CDRD, you will not receive an e-mail or a letter about your financial documents.

– If you did not submit any hardcopy financial documents by the CDRD, you are still required to submit all required hardcopy documents specified in the RFB instructions on or before Friday March 30, 2012.

If you have any questions, please contact the CBIC customer service center at 877-577-5331 between 9 a.m. and 9 p.m. Eastern Time.

• Form B requests your potential increase in business in the applicable category.  It does NOT affect your bid quality (competitiveness), nor does it prompt the software to require completion of an “expansion plan”.
• The next section, which offers three “key” category codes, requests input of total patients served, how many of these are Medicare, and to what percentage increase could your company add to this amount (and this number can be greater than 100%)…also does NOT affect the quality of your bid, but WILL prompt the software to require completion of an expansion plan.

IF you are bidding in your own service territory (versus a distant CBA) you are under no obligation to indicate an increase in business re the first two bullet points above.  In reality, it is arguable that you will not gain any new business; this was certainly not the norm in Round 1.  And, many of you will attempt to reduce your Medicare dependency by promoting enrollment in exempt Medicare Advantage Plans, taking less FFS Medicare business in these categories, and so on.  Hence, I strongly suggest you input ZERO increase within both these areas.  Again:  There is NO penalty or a limit on future reimbursements.  There is no “spy” analyzing this flatline and suggesting something to the effect of “this company doesn’t want to grow such they should be disqualified”…and, finally, it does not prompt the expansion plan software.  Expansion plans ARE reviewed by humans…expansion plans ARE scrutinized.  If you fall within the parameters above (i.e., bidding in your own territory) please consider this. 

Next:  The actual bid amount per code and indicated capacity.  Yes…THIS counts.  Please keep your capacity modest.  There is no advantage or basis to increasing your current patient census by 100% for the numerous reasons we have explained in previous seminars and posts.  Current patient census counts are just fine.  Once more:  There is no penalty or limit in your future reimbursements.  Lower industry capacities increase your chances of being awarded a contract and keep the allowables at a higher median bid price.  BTW — this is NOT “cheating” or “gaming”…it reflects the realities of Round 1 in that it is unlikely additional business may be gained through this program for many suppliers. 

This is important folks — read through the rest of the blogs here: http://www.vgm.com/blog/index.php/category/regulatory/

Good luck to everyone…

PS:  Once more…  If you have suggestions, corrections, questions or compliments to the VGM NCB Round 2 offerings, please post them (not to me…thanks) to vgmbidding@vgm.com.

Thank you!

 VGM cannot offer financial, operational or legal advice in this regard. 

 However, one VGM member has allowed us permission to forward HIS generic “sample plan”. 

 IMPORTANT – READ THIS –

 •IMPORTANT CAVEAT AND DISCLAIMER; NO WARRANTY:   This is not a VGM work-product.  This reprint of an actual supplier’s “expansion plan” is distributed in the hope that it will be useful, but WITHOUT ANY WARRANTY; without the implied warranty of FITNESS FOR A PARTICULAR PURPOSE. THERE IS NO WARRANTY FOR THE DOCUMENT TO THE EXTENT PERMITTED BY APPLICABLE LAW.   VGM GROUP, INC. PROVIDES THE DOCUMENT “AS IS” WITHOUT WARRANTY OF ANY KIND, EITHER EXPRESSED OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF FITNESS FOR A PARTICULAR PURPOSE. THE ENTIRE RISK AS TO THE QUALITY AND PERFORMANCE OF THE DOCUMENT IS WITH YOU. IN NO EVENT UNLESS REQUIRED BY APPLICABLE LAW OR AGREED TO IN WRITING WILL VGM GROUP, INC BE LIABLE TO YOU FOR DAMAGES, INCLUDING ANY GENERAL, SPECIAL, INCIDENTAL OR CONSEQUENTIAL DAMAGES ARISING OUT OF THE USE OR INABILITY TO USE THE DOCUMENT (INCLUDING BUT NOT LIMITED TO LOSS OF DATA OR DATA BEING RENDERED INACCURATE OR LOSSES SUSTAINED BY YOU OR THIRD PARTIES OR A FAILURE OF THE DOCUMENT TO OPERATE AS IT IS INTENDED) EVEN IF SUCH HOLDER HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.

————————————————–

 Staff Current

Currently we do not have staff in the (appropriate CBA).  All of our product management, inventory, customer service and billing takes place out of our __________________ headquarters which is located __________ miles from the (appropriate CBA). 

 Staff Expansion

We are hiring intake and delivery personnel to handle new patients in this CBA, as well as sales representatives to work with referral sources.  Our delivery personnel will handle patient education at the time of delivery.

 Finance Current

We are properly capitalized with the personal commitment of the owners to fund our growth.  We have two lines of credit at different banks.  We have open account status at over 24 different manufacturers that suffice for our cash flow needs.

 Finance Expansion

We anticipate our current financing will be sufficient to handle our growth into this CBA.  Additional credit line increases could be obtained by suppliers and our banks if needed.  Our owner’s net worth was too great to qualify for an SBA loan, and he is committed to finance our future growth in this CBA.

 Facilities Current

Our current facilities are located in ______________, which includes our headquarters, retail location, billing, customer service and warehousing operations.

 Facilities Expansion

We believe our current facilities can handle the growth of this CBA, particularly with the availability of vendor drop ships.  As growth dictates, we would eventually add a regional warehousing operation to insure timely availability of product.

 Inventory Control Current

We use _________________________ software to manage all aspects of billing, inventory control, and patient care.

 Inventory Control Expansion

We will use the additional location feature of (Software) to manage any remote inventory needed in this CBA.

 Distribution Current

We currently drop ship all items into this CBA from the manufacturer or our headquarters

 Distribution Expansion

We will continue to drop ship items into this CBA, and add a regional distribution facility when necessary and cost effective.

 Additional Information Current

We have developed our internal processes so that we have developed a smooth patient experience with excellent customer care, and have streamlined the paperwork and billing processes through training personnel in (Software) and the CMS system.  We have grown beyond simply being a regional supplier, and have obtained licensing to be approved in ____ states for Medicare.  We have assembled a team of veteran HME and medical office experienced staff, with over ___ years of combined experience in the industry.

 Additional Information Expansion

We plan to leverage the talent we have assembled in our headquarters to continue to grow our customer base through providing excellent patient care and customer service.  Our growth will depend in part on the ability of our sales representatives to develop relationships with referral sources, and the marketing presence we develop in the CBA.  We have developed an extensive training website to assist with developing and training new personnel to effectively grow this business.

 ACCORDING TO “JENNA” AT CBIC (MARCH 23 AT 12:20 PM)… ONCE ALL THE BIDDING CATEGORIES THAT YOU WISH TO BID ON ARE MARKED “COMPLETE AND CERTIFIED” AND THE FORM A IS MARKED “COMPLETED AND APPROVED” AND DOCUMENTATION STATUS SHOWS THAT IT WAS RECEIEVED “YES”, THEN THERE IS NOTHING LEFT TO DO TO “FINALIZE” WHAT IS THERE… IT JUST STAYS THERE UNTIL THE MARCH 30TH DEADLINE.  BIDS CAN BE CHANGED UP UNTIL THE DEADLINE, BUT THE CHANGES HAVE TO BE RECERTIFIED BY AN AUTHORIZED OFFICIAL BY USING THEIR “LOGIN” ID.  THERE IS NO FINAL “MAGIC BUTTON” TO CLICK ON ONCE YOUR STATUS SCREEN SHOWS THESE THINGS.

 A copy of the official final recommendations from the CBIC follows:

 All bids must be submitted in DBidS, the online bidding system, by 8:59:59 p.m. prevailing Eastern Time on Friday, March 30, 2012. All required hardcopy documents that must be included as part of the bid package must be RECEIVED by the Competitive Bidding Implementation Contractor (CBIC) on or before March 30, 2012.

 Here are some important reminders:

 •The Round 2 and national mail-order competitive bidding areas, product categories, DBidS information, bid preparation worksheets, educational materials, and complete Request for Bids (RFB) instructions can be found on this website, www.DMECompetitiveBid.com. You should review this information prior to submitting your bid(s).

•You must submit your bid in DBidS using the user ID you received during registration. If you have not already logged in to DBidS, we strongly recommend that you do so NOW to have plenty of time to complete your bid. If you have forgotten your user ID and/or password, you may recover them by using the “Forgot Your User ID?” and “Forgot Your Password?” buttons located on the Individuals Authorized Access to the CMS Computer Services (IACS) login page.

 •Your authorized official or backup authorized official must approve your Form A and certify your Form B before the close of bidding. If you modify your bid after it has been approved or certified, it will need to be reapproved or recertified. If Form A is not approved or Form B is not certified, your bid cannot be evaluated, and you will not be considered for a contract. You can verify the status of your forms by logging into DBidS and checking the status screen.

 •All bidders must submit certain required hardcopy documents as specified in the RFB instructions. It is very important that you review the hardcopy documents section and the sample financial statements in the RFB instructions to ensure your documents include the required information. We also encourage you to use the Hardcopy Document Package Checklist, which may be found in Appendix B of the RFB. If you have already submitted your financial documents, you may still amend those documents as long as they are RECEIVED by the CBIC on or before March 30, 2012. We cannot accept faxed or e-mailed documents, so you must mail your documents to the CBIC at the address in the RFB instructions.

  •All bidders participating in the national mail-order competition for diabetic testing supplies must complete and submit the National Mail-Order 50 Percent Compliance form on the CBIC website. Only one form should be submitted per bidder number. You must not change the printed form in any way. Please ensure that all pages of the form are included in the hardcopy document package. If the form is not RECEIVED on or before March 30, 2012, your bid for the national mail-order competition will be disqualified. Please refer to the instructions on the form or to the National Mail-Order Competition for Diabetic Supplies fact sheet on the CBIC website for additional information.

 • If you submitted financial documents by the covered document review date (CDRD) – February 29, 2012 – you will receive an e-mail about your financial documents from the CBIC by May 14, 2012. If you did not submit all of the required financial documents, the e-mail will alert you to expect a letter notifying you of the specific missing financial document(s). This letter will be mailed to your organization’s authorized official. You will be required to submit the indicated missing financial document(s) within 10 business days of the notification. If you submitted all required financial documents, the e-mail will confirm that the CBIC received all required financial documents and that no further action from you is required. If you did not submit any financial documents by the CDRD, you will not receive an e-mail or a letter about your financial documents.

 •If you did not submit any hardcopy financial documents by the CDRD, you are still required to submit all required hardcopy documents specified in the RFB instructions on or before Friday March 30, 2012.

 If you have any questions, please contact the CBIC customer service center at 877-577-5331 between 9 a.m. and 9 p.m. Eastern Time.

 For most of you, the only item to physically forward to the CBIC will be a LOI, if applicable.  Diabetic mail order bidders should include the compliance form noted above.  Hard copies of your bidding worksheets are NOT to be sent.  If you have had an increase in credit score or updated financial documents, these also may be updated.  Please include your bidder number on all documents and, in the case of updated financial information, a date on each page. 

 Good luck to all. 

 Please read all posts for additional information here http://www.vgm.com/blog/index.php/category/regulatory/

These signatures along with a letter will be sent to key contacts in Washington.  Remember, we do not want them to forget that we are still fighting for what is right.  We’re still fighting, how about you?

These are a sampling of the 250+ actual email inquiries we received this week. 

As you will note, some questions are timely and most suitable.  Others are, well…we must just hope that these companies do not make serious errors or offer unsuitable bids. 

The purpose of this email is not necessarily “instruction” or “guidance” as previous Blog updates were intended.  Rather, I’d like to share with our VGM members and affiliated companies a sampling of the issues that appear to remain unclear to many HMEs. 

Lastly, before I begin the reprint, many replies have been shortened and/or edited for space purposes.  If any appear “curt” or blunt, it was certainly not my intention. 

Please click here: http://www.vgm.com/files/PDF/RoundTwoNCBLastMinuteFAQs.pdf

The supplier can send the license to the NSC with a signed cover letter by the authorized or delegated official. (this is if just updating current license)The full 855s is not necessary.
Now if they are ADDING a new state where they will be providing services, they will need to complete the appropriate sections of the 855S including the products/services in section 2 and section 4 requesting the state(s) they intend to serve.

Feb 16, 2012

Today, the White House announced that it will offer a time for senior administration officials to answer questions about the Affordable Care Act (ACA) during its “White House Office Hours.” The announcement was posted in the White House blog here: http://www.whitehouse.gov/blog/2012/03/16/white-house-office-hours-health-care

The blog encourages constituents to ask their questions about the ACA on Twitter (which only allows 140 characters per submission). Cecilia Munoz, Director of the Domestic Policy Council, will answer questions beginning at 2 PM EDT on Friday, March 23. The following are the directions that the White House provided on how you can join:

• Ask your question on Twitter with the hashtag #WHChat
• White House officials answers your questions from the @WHLive account https://twitter.com/whliveFollow the Q&A through the @WHLive Twitter account and the hashtag #WHChat
• If you miss the live event, the full session will be posted on WhiteHouse.gov and Storify.com/WhiteHouse http://Storify.com/WhiteHouseThe White House also included:

“As the provisions in the law start to take effect, millions of Americans are seeing a noticeable difference in the cost and quality of their health care. How has healthcare made a difference for you and your family? We want to hear from you: http://www.whitehouse.gov/mycare.”

PLEASE TAKE A MOMENT TO TALK ABOUT COMPETITIVE BIDDING ISSUES!

VGM encourages providers to join in the “White House Office Hours” on Friday, March 23 to raise concern about the competitive bidding issue. Remember, Twitter will only allow 140 characters per post submission.

Some questions you may ask include:  

• What is the White House doing to repeal the DMEPOS competitive bidding program, which restricts access to quality patient care? #WHChat
• DMEPOS competitive bidding restricts patient access to quality care and services. Why are we letting CMS go forward with this flawed program? #WHChat
• Why are we letting CMS implement a program that will close 1,000+ small, home medical equipment businesses across the U.S restricting patient access to quality care? #WHChat
• Medicare will implement a job-killing competitive bidding program for DME that will cost over 100,000 jobs, restricting patient access to quality care and services. Why? #WHChat

We discussed the matter with the healthcare law firm of Brown and Fortunato.  A reprint follows below:

 All:

 Jeff asked that I look at and respond to the email below regarding estimated capacity.

 I looked through all of the guidance I could think of (regs, RFB, fact sheets, DBidS Reference Guide), and the only explanations of or guidance regarding estimated capacity that I could find mirrored that in #2 below. Page 40 of the DBidS Reference Guide states that total estimated capacity “indicates the number of units per HCPCS code that [the supplier] estimates [it] can provide throughout the entire CBA for this product category for one (1) year. . . . To determine capacity for each HCPCS code, calculate the number of units that you currently furnish on a yearly basis and add any additional number of units or capacity you would be capable of providing annually at the start of the contract period.”

 After looking at the written guidance, I called Elena Armstrong (Dallas area CBIC Ombudsman), and she told me that it was perfectly fine to report an estimated capacity lower than the level historically provided. However, we also discussed the contract term which states that suppliers must agree to furnish covered items under their contracts to any beneficiary who maintains a permanent residence in or visits a CBA and requests those items from the contract supplier. See 42 C.F.R. § 414.422(e)(1). Therefore, it is not as though reporting a lower estimated capacity will enable a contract supplier to turn away excess beneficiaries.

 Elena told me that she would be glad to provide me with something in writing that states it is okay to report an estimated capacity lower than that previously provided. If you would like me to get that and forward it on to you, let me know.

 Regards,

 Todd A. Moody

905 S. Fillmore, Ste. 400

Amarillo, TX 79101

(806) 345.6343 (direct)

(480) 695.5487 (mobile

(806) 345.6363 (fax)

tmoody@bf-law.com

1.    – from Form B- the bidding sheet

It is anticipated that suppliers will be capable of sustaining the same level of estimated capacity throughout the entire contract period. Please refer to the Bidding Information Chart titled “Estimated Capacity and Bid Amount Worksheet” at www.dmecompetitivebid.com/bic for the definition of a unit for each item.

• Fee Schedule – This indicates the fee schedule amount for the HCPCs code in this CBA. For items included in

 2.      Request for Bid- page 15

Total Estimated Capacity – Requires suppliers to provide their expected capacity. The total estimated capacity indicates the number of units per HCPCS code you estimate you can furnish throughout the entire CBA for one (1) year. The bid preparation worksheet on the CBIC website contains the unit by product category definitions. To determine your expected capacity, calculate the number of units you currently furnish in the area on a yearly basis and add units you would be capable of providing annually as of the start of the contract period. It is anticipated that suppliers can maintain this level or greater throughout the contract period.

————————————————————————————————————————-

More issues to follow later today.  And remember…Do NOT overestimate capacity (please…)  There are no limits to what you may be reimbursed in a particular product category.  Round one rebidding companies that offered a double or triple capacity bid compared to their current patient census resulted in lowering the allowable by up to five additional percentage points. 

The response:  She indicated that HMEs should submit a letter of disclosure regarding current contracts with these vendors (such as LifeGas or Air Gas) that will perform future subcontracting duties under the program guidelines.  She directed us to the Contract Suppliers section of the website and then to Subcontractors.  This is the applicable paragraph:

Contract suppliers must identify the name of the subcontractor, the address of the particular location that will perform the subcontracting service (corporate headquarters’ addresses are not acceptable), the services to be provided by the subcontractor, and whether the subcontractor is accredited, as applicable. For your convenience, we have provided a sample subcontractor disclosure form. Please submit the required information to the Competitive Bidding Implementation Contractor (CBIC) as directed on the sample form.

HMEs may submit a completed disclosure form (included on the website).  She also indicated that suppliers should send “a letter of explanation” to the CBIC, and “someone from LifeGas should sign the letter as well”. 

I have not been aware of this issue and it arguably has been under the radar.  There are hundreds of HMEs currently using these services, and I will fathom that very few eligible for the Round Two program have considered this and/or completed these steps as advised by the CBIC above.

FYI…

In any case, please do not contact me regarding this issue at this time, as I have no authority to comment or advise.  Please contact the CBIC directly at 1-877-577-5331.

Thank you

That brings me to this. Do you see fraud in the industry by someone or some company? If you do, you owe it to yourself and every honest HME provider (the vast majority) to point it out. Usually I hear that you fear reprisal from the offender. VGM started years ago FEAT (Fraud Eradication Action Team) where you can report, confidentially, suspected fraud and our people will relay that information to CMS and into Congress. You can view the information at our website (www.vgm.com) or directly at http://www.mymedicarefraudreporting.com/default.asp

If you see fraud, do us all a favor and report it!

According to AAHomecare, the briefing on the House side will only be for staff members of Congresspersons on either the House Ways and Means Committee or the House Energy and Commerce Committee. The House briefing will be at 11:00 AM in the Rayburn House Office Building, Room B-318. 

The Senate briefing will be at 2:00 PM in the Dirksen Senate Office Building, Room SD-430. All Senate staff are invited to attend.

Once again, please be sure that your Senators and Representative are aware of these hearings and urge them to have their staff members attend. Ensure that their staff asks CMS tough questions about the flawed bidding program and that they request additional information about the program. In the briefing, CMS will likely convey that the program is running smoothly, with no issues. We must be sure that our members of Congress are aware of the problems in the current bid program!

 Here is an example that is representative of others:

Mark,

I think we now better understand how the discount and the weighting affects the composite bid.  But I think everyone’s misunderstanding is more specifically the capacity that we have to enter on the Bid Sheet.   Several HCPCS codes we have never billed before.   I understand it has to be 1 or more for the form to be accepted.  When we all compare the Bid Prep worksheets that shows the capacity for each CBA, I believe we all get more confused because we all feel that we have to be able to provide at least 1% capacity which in most case is more than 1 unit which is required to be in the capacity on the bid sheet.

To read my reply and comment, click here: 

http://www.vgm.com/files/PDF/TheBiddingCapacityIssue.pdf

As always, email me with questions!!

 With that said, I’d like to offer a step-by-step guide with commentary as to some nuances of the program. 

Click here and email with questions!  http://www.vgm.com/files/PDF/Round-Two-Bidding-Help_Bid-Calculators.pdf

My question: Under Support Surfaces the HCPC code E0193 refers to Low Air Loss beds that as far as I can tell are products we can’t supply because they are exclusive to Hill-Rom and KCI. Any suggestions about this code?

VGM has posted the following at http://campaign.r20.constantcontact.com/render?llr=nx4vybeab&v=001Kq5KIUlW9l2d6wldkavioBbGXsre09gmUAPmRNhKbLqHY5d4X4ybdJsWRn30BhzaNgIAPSA4sBtziJsfAkUQHbia8poY81HGIR73b6lEaR7S8xcmBDIz9mx1wfXspqw5vrPBOWDikMx4634jwTrLO1jBkSG9_Q5ZwxB-RjfdEalAWBhQSQOdhdoMluBGLa5j3wF-T5ViEwL_uR6_XcN6u116xBAyfy_JqZ54f3pcGEA%3D

Blue Chip Medical Products, Inc.
Offering Competitive Bidding Solutions!

E0193 is considered an “integrated low air loss bed system.” That would be a powered bed with a low air loss mattress built into the bed frame. The odds of ever using this code are slim, however, Blue Chip now has an E0193 product.  Call us for pricing.

The submission deadlines for competitive bidding are rapidly approaching! Blue Chip Medical Products is here to help you WIN.

One of our goals as a manufacturer is to give VGM members the ability to compete in all areas of health care. Blue Chip can provide VGM members with the products and clinical expertise that will allow you to grow your business in this very precarious marketplace.

Our program consists of educating you on how to effectively go after the therapeutic support surface business in your service area.

If you are looking to aggressively pursue profitable areas of business for 2012, Blue Chip has the right program for you.

Pressure mapping provides accurate, valuable insight to help determine and implement optimal seating solutions. Blue Chip, in conjunction with Vista Medical, is pleased to offer a new stretch seat, back and bed sensing mat.

Order your stretch sensing back and get a  FREE tablet computer. No other therapeutic support surface measures up to Blue Chip. Affordable, reliable, effective.

Blue Chip Medical Products, Inc.

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tel: 800 795-6115
fax: 845 369-7633
sales@bluechipmedical.com

 I met Senator Tom Harkin and Charles Grassley and most of the Iowa’s Congressman.  I also attended a few fundraisers in between. When meeting with them I highlighted the stories from Earl & Helen, Joe & Beverly, Lowell, Sara, Cathy, Kelly, and many more.  It felt right to be there and tell them what is wrong with this system the way it is set up now.  It was great to speak out passionately for something that is so important to me. 

 But as every trip to Washington D.C. ends, I’m left with a major question.  Did they really hear us when we were talking?  Was our information compelling enough for them to remember and act on?  Everyone we talked to said they would push for a CBO score on the MPP replacement program, a process important to the progress of our work. I want to believe that their answers to us were genuine. I have a good vibe about this year’s visit.

 However, your legislators still need to hear from you. Please contact them and ask them to help push the CBO for a score on the MPP replacement program.  They are very busy people who listen to numerous agendas every day.  Help them remember what they said they would do.  It is our duty to call them, see them and ask them to act.  Speak out, because it feels so good.

 Go to our site www.peopleforqualitycare.org  and enter your zip code at the bottom of the page next to the green arrow. We have pre-written an email message that explains the technicalities of the request. All you have to do is enter your information and send.

Senator Lugar is asking for an investigation of the contradictory claims between CMS and the HME community that Round 1 of the program is successful and sustainable.  He also supports the effort of “seeking a Congressional Budget Office (CBO) score of this industry-developed alternative” which is the urgent “ask” today in order to proceed with a legislative fix.

Click here to view the letter.

VGM would like to thank both George Kucka (Fairmeadows Home Health Center) and Wayne Knewasser (Premier Home Care) for their work with Senator Lugar’s office to educate both the Senator and his staff on the issues and problems that providers and Medicare beneficiaries are facing with the flawed bidding program. Both Kucka and Knewasser are VGM and AIHMES members.

Keep Up Pressure for MPP Score and Enactment!

It is important for the industry to keep up the pressure to get a CBO score and the enactment of the MPP. Please contact your senators and request that they send a similar letter to the Senate Finance Committee leadership.

THE MPP IS NOT DEAD! In the immortal words of John Belushi from “Animal House,” “Nothing is over until we decide it is!” Providers need to keep up and persist.  Continue to pressure members of both the House and the Senate. Ask them to reach out to their party leaders and urge for a CBO score of the MPP. Republican House members should contact House Speaker John Boehner (R-Ohio), and Democratic House members should contact House Minority Leader Nancy Pelosi (D-Calif.). In the Senate, Republicans need to contact Senate Finance Ranking Member Orrin Hatch (R-Utah), and Democrats need to contact Senate Majority Leader Harry Reid (D-Nev.).

For more information on the MPP, click here.

For more information on the “Doc Fix”, see the San Francisco Chronicle article below…

Obama celebrates win on payroll tax cut extension

Associated Press

Wednesday, February 22, 2012

Washington –

Relishing a political victory, President Obama said Tuesday that Congress “did the right thing” by extending payroll tax cuts for millions of Americans. He urged lawmakers to push forward on more measures, from assistance to struggling homeowners to increased taxes on the wealthy, saying the looming election is no excuse for inaction in Washington.

“Don’t stop here. Keep going,” Obama said during a White House event marking the passage of the tax cuts.

“Keep taking the action that people are calling for to keep this economy growing. This may be an election year, but the American people have no patience for gridlock,” he said.

Obama was celebrating a tax cut that is already in place, but due to expire at month’s end. He said the extension of the tax cut for the rest of the year will have a spillover effect: More people will spend money and more businesses in turn will be prodded to hire workers, and so “the entire economy” gets a boost.

Congress overwhelmingly passed the $143 billion measure Friday. The bill extends a two-percentage-point reduction in the tax that funds Social Security and extends jobless benefits for the long-term unemployed. The measure also averts a big cut in the reimbursements doctors get for treating Medicare patients.

But Tuesday’s event was not a bill-signing because the bill is not yet in Obama’s hands. Not knowing when the legislation will come down from Capitol Hill, the White House decided to go ahead and hold its event now, while the victory is still fresh in people’s minds. No major event is planned for the actual bill-signing.

The payroll tax cut was a centerpiece of the jobs plan Obama unveiled last year – and of a re-election strategy that seeks to cast his GOP foes as protectors of the rich out of touch with the worries of working families.

Obama never mentioned that a real driver of the deal Congress approved Friday was the political fallout on Republicans if they didn’t give ground. Having endured a debacle in December, when they were seen as holding up the tax cut before caving, Republicans this time went along without demanding that the cost be paid for.

The White House said the average family would have lost $40 per paycheck had the tax cut not been extended.

These are plane crash and shark attack stories. They don’t happen very often, but when they do…BOOM… instant headline! These stories can very easily give off the message that all HME dealers are crooks who are just out to make a buck. We like the sensational headlines. We like to see the guilty get what they have coming. But we can easily forget that this is just one guy in one business. These headlines don’t tell the whole story and this is not the norm. The norm in the HME/DME business is just the opposite. The majority of HME/DME owners are hardworking people with a real love for what they do and their customers. These are people in small family businesses who have worked hard to make an honest living by helping people get the care they need. They answer the beeper 24 hours a day and help people in the most need at their worst times. They often work with patients for many years and get to know them and their families very well. Their work prevents hospitalizations and further injuries and may either extend lives or at least make them better while they live.

Medicare’s competitive bidding won’t get rid of the bad apples; it will just cause hardship for patients and their “good apple” caregivers. Be careful reading these stories because, while they may be all too true, they are also the exception to the rule.

By the way, the odds of dying in a plane crash? 1 in 11 million. More people are killed by donkeys annually than are killed in plane crashes. The odds a person will die from a vending machine accident in a year are 1 in 112,000,000, while the odds that a person will die from a shark attack in a year are 1 in 251,800,000. Beware of headlines.

There are other opportunities to network and remain as up to date as possible on this continuing battle. MEDTRADE Spring in Las Vegas and our own HEARTLAND Conference here in Waterloo. I urge you to take full advantage of these opportunities. VGM is not giving up and NEITHER SHOULD YOU! I hope to see you in Las Vegas and again in Waterloo.

In all 100 CBA worksheets the oxygen category (only) includes 5 “payment class” cells in which potential bidders can enter a fixed “desired” bid amount in column G, or a bid discount percent in column H. 

Column M indicates the percentage of the overall composite bid that the five payment categories represent.  The software will sum the input and indicate a discounted composite bid in cell L20 and the overall category discount in cell L21. 

The bug exists in that the category discount did not reflect Payment Class “B”, the Portable Equipment Only class.  The composite bid amount was accurate (and hence there are no issues of an erroneous dollar amount)…but the overall category discount appeared less than the input data.

We are correcting all 100 files now. 

If you would like to manually correct a downloaded copy, it is easy: 

Unhide Column F.  This may be done by shifting and putting your cursor over columns E and G.  Hold the shift and right click the “Unhide” option.  Column F will appear!  The second of the five weighted bid limits (Portable Only) in this column is blank.  Simply copy the function of d7 * e7 and then the correction will take place.  Resave the file (or simply download the updated one from the link above; these will be complete by 1:00 CST today).

Thank you.

Whether it was a coincidence or not, this should make each provider say, “Enough is enough!” CMS continues to tout the program, ingoring the number of issues that have arisen because of this flawed program. We need to make our voices louder that CMS. We need our providers to speak up. 

If you haven’t yet, we need you now to join in efforts to put a stop to the flawed competitive bidding program. Call your representative and senators. Insist that they support the MPP and put a stop to the train wreck that is competitive bidding. We need your help in echoing that which is being discussed on the Hill today.

Today or tomorrow, call the U.S. Capitol Switchboard at 202-224-3121. Additional instructions may be found here: http://www.vgm.com/blog/index.php/category/government-relations/

To counter CMS’ claim (see statement below), be sure to point out:

1. The analysis done by Dr. Peter Cramton. A summary of his analysis can be seen here: http://www.thecre.com/blog/2012/01/data-energizes-industrys-bid-fight/
2. The Wall Street Journal article that says the competitive bidding program “designed for failure.”
   http://online.wsj.com/article_email/SB10001424052970204740904577193224024421442-lMyQjAxMTAyMDAwNjEwNDYyWj.html?mod=wsj_share_email#articleTabs%3Darticle

We need everyone to take action on this one! Don’t let CMS get the last word! The following is the CMS statement released yesterday, Feb. 15:

New DMEPOS Competitive Bidding Program Analysis Shows No Changes in Health Outcomes

On Sat Jan 1, 2011, the Centers for Medicare & Medicaid Services (CMS) launched the first phase of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program in nine different areas of the country.  Since the program’s implementation, CMS has used real-time claims analysis to track groups of Medicare beneficiaries potentially affected by the program.  This analysis has consistently shown that the competitive bidding program preserves beneficiary health outcomes.

CMS has now released a broad-view analysis that compares the impact of the program on the general Medicare population as well as Medicare beneficiaries likely to use competitively bid equipment based on their health conditions.  For these groups, it compares rates of health outcomes (such as hospitalizations, length of hospital stays, and number of emergency department visits) in the competitive bidding areas to rates in regions without competitive bidding.  The new analysis enables an easier comparison between subpopulations and between areas with competitive bidding and without competitive bidding.  This results in a clearer depiction of the effect of the DMEPOS competitive bidding program on Medicare beneficiaries’ health outcomes.  Consistent with prior analyses, we find that beneficiary health outcomes are stable in competitive bidding areas.  To view the results, please visit http://www.CMS.gov/DMEPOSCompetitiveBid.

http://www.dmecompetitivebid.com/Palmetto/Cbic.Nsf/files/R2_Financial_Documents_Chart.pdf/$File/R2_Financial_Documents_Chart.pdf

Need additional help?  Click below and start reading!

http://www.dmecompetitivebid.com/palmetto/CBIC.nsf/DocsCat/CBIC~Bidding%20Suppliers%20Round%202%20National%20Mail-Order~Bid%20Evaluation~8P2KRU4147?open&navmenu=Bidding^Suppliers^Round^2^National^Mail-Order||||&navmenu=Bidding^Suppliers^Round^2^National^Mail-Order||

Remember to ship your hard copy package prior to February 29.

(If you don’t know why then you didn’t read the info in the links above…)

But the information within the links doesn’t necessarily answer the plethora of questions with regard to multi-state bidding.  Many of the CBAs cross state lines.  Some states require specific licensure; some none.  Some states do NOT require an out of state entity to obtain a license to service patients within the state.  And so on and so on. 

With that said, let me de-identify an actual bidder who expressed frustration with unclear direction from the CBIC regarding multiple state/CBA bidding and the associated “Form A”.  Below this section  I will then reprint certain clarifications from Palmetto’s Elaine Hensley.  Elaine is a great asset to VGM for her timely responses to our concerns; she is Chief Ombudsman of the CBIC. 

Let’s start with this reprint

———

Mark,

Not real sure how to explain problems with Form A but will try to give you’re the short version.

I am bidding in 4 CBA’s, and have 6 Locations that will service patients. TN requires an HME license, AL requires the HME and Pharmacy License and Augusta is in GA and SC and SC requires Non-Resident Med Gas/DME licenses.

I have set up my corporate location as the primary identifying information and business organization (the PTAN that was used to register), commonly owned or commonly controlled, multiple locations, corporation, licensed in 4 States, bidding 8 categories excluding mail order, and bidding 4 CBA’s (Atlanta, Augusta, Chattanooga, Birmingham).

Everything was good until I tried to add additional locations that would serve all CBA’s. The first real problem I had was that when I got to the “add license for additional location” that you are required to enter, there is a drop down screen where you choose “licensure state” and all 4 states drop down for choice. I selected the state for the location that was appropriate and added the appropriate license info and added licensure and saved as prompted, then went to next locations.

When I had completed all locations the status for primary PTAN indicated COMPLETE and all additional locations status was INCOMPLETE . When I tried to modify the individual locations it indicated no license information available although there was licensing information populated on the screen and when printed appeared on paper as well.  After calling the CBIC for help I was told that the licensure for each state that was indicated on the primary had to be completed for each additional location before it would allow to “complete”. I added all licensure info for all 4 states for each additional location and sure enough all 5 additional locations status indicated COMPLETE.

I called the CBIC again and after about 40 minutes trying to describe situation was finally told to add licensure for all 4 states for all additional locations.  I also started thinking that the licensure info I had just entered would not match if copies of licenses were requested (ie: TN license attached to TN address and PTAN and not Atlanta, Birmingham etc. same with Alabama license and SC license). I called CBIC again  this morning and was directed to go back into modify form A and the licensing requirement for additional Locations and simply choose each state but to put NA if there was no requirement or it was not required for that state for that location… which also worked and status stayed PENDING APPROVAL. I am still NOT sure if I need to indicate only state required licensure info or if I need to indicate all city, county and state business licenses as well. Needless to say I have 999 characters and plenty of room so I went ahead and put everything in.

 I am told I can still go back and MODIFY form A up until 3/31/2102 so not to panic.

One other thing that I realized is that all licenses have to of file with the NSC and updated in PECOS too.

———-

(Response from Elaine…)

Mark,

My questions for this HME is do they intend to service every CBA with every location they’ve listed on their bid or will each location only service the state in which it exists?  Let’s use the Chattanooga CBA as an example:  Tennessee locations service only Tennessee beneficiaries and Georgia locations service only Georgia.

In DBidS, bidders are only required to indicate the applicable license(s) for the product categories and CBAs (states) in which they bid.  Suppliers do not need to enter the city, county, and state business licensure information for bidding purposes.  However,  that information is required in order to comply with Standard #1 of the Medicare DMEPOS Supplier Standards, which reads, “A supplier must be in compliance with all applicable federal and state licensure and regulatory requirements.”  Per page 3 of the Round 2 Request for Bids:

Bidding suppliers must ensure that copies of all applicable state licenses are RECEIVED by the NSC on or before May 1, 2012. Bids will be disqualified if a bidder does not meet all state licensure requirements for the applicable product categories and for every state in a CBA. Every supplier location is responsible for having all applicable license(s) for each state in which it provides services. For a multi-state CBA, the bidder must collectively have all applicable license(s) for every state in the CBA. Each location is not required to have licenses for every state in the CBA as long as each state has a bidding location licensed for the product category.

 Please let me know if there are additional questions.

 Elaine

 Elaine Hensley, Chief Ombudsman Palmetto GBA DMEPOS Competitive Bidding Implementation Contractor

Elaine.Hensley@PalmettoGBA.com

———

Hope this helps some!

1).  “PECOS” — Does a DME supplier have to have an enrollment record in internet based
PECOS in order to place a bid for round two?

Reply:  The PECOS application is not a competitive bidding application. However, a supplier has to still have its information updated in PECOS whether it be through entering the data into PECOS itself or submitting a revised CMS 855-S enrollment form. In the Request for Bids (RFB), it says, “Suppliers should ensure that their enrollment file is up-to-date in the Provider Enrollment, Chain and Ownership System (PECOS) and with the National Supplier Clearinghouse (NSC) as information in the enrollment file will be verified during the registration and bidding process.”

For more information about registering with External User Services (EUS) to view your enrollment file in PECOS, please refer to the EUS website at www.eushelpdesk.com or you may contact EUS at 866-523-4759. If you have additional questions, please contact the CBIC Help Desk at 1-877-577-5331.

2).  DBidS glitches?  AAHomecare spoke with senior CMS staff about problems that some HME providers are encountering when submitting bidding information in the competitive bidding DBidS system.  CMS is instructing all HME providers who are encountering problems to either call the CBIC or fill out a “trouble ticket” with the CBIC.   Our experience has been that the CBIC is very responsive to e-mail.  There is a daily senior CMS staff meeting at 9:30 am ET, which includes CMS’ IT contractor and CBIC staff, where they review all issues related to the bidding program. 

3).  E0193 (and other low utilization codes in the Support Surfaces (Group 2 Mattresses and Overlays) category:  Yes, for this code (and many others) you will likely not find a major manufacturer and model number.  That is OK!  It’s an issue most bidders are facing in at least some cases, and one that we have made the CBIC aware of.  The reality, for the time being, is that you must bid on all codes.  Two points here: a)  you only need list the manufacturer and model number for top (high utilization) codes  — and, according to the CBIC bidding worksheet…

Hence — it is extremely rare and you’d likely never have to supply it, and MOST importantly…this and similar codes have such low utilization rates (bid weight) that they are virtually inconsequential to your chances of being awarded a contract.  Bid a penny under the fee schedule/bid limit and move on.

 More to follow…

Join your Fellow Providers; Call your Legislators!

 ACTION NEEDED NOW!
This week, members of the DME industry will be at the Capitol urging their legislators to replace the current flawed competitive bidding program with the Market Pricing Program (MPP).  They will ask to have the proposal included into the upcoming “doc fix,” which looks to be near, according to the National Journal.

Now is the time urge your legislators work to include the MPP Proposal into the upcoming “doc fix.”  Even if you could not attend this week’s AAHomecare Conference, you can still participate in tomorrow’s “fly-in” by calling your legislators and sharing the same message that those on the Hill will be using: Competitive bidding must be stopped and replaced with the MPP!

IT’S TIME TO GET MAD! Don’t ask, INSIST that your representative and senators support the MPP! Remember: Continue to be respectful, be persistent!

The following are instructions on how to contact your representative and senators:

1.    Dial the U.S. Capitol Switchboard number: 202-224-3121 and ask to be directed to your legislator’s office. NOTE: Three calls will need to be made to reach your representative and your two senators.

OR

Call your legislator’s office directly. Numbers to your legislators may be found via the VGM DC Link: www.vgmdclink.com Enter your ZIP Code under “Find Your Officials.”

2.    Once connected to your legislator’s office, ask to speak with the Health Legislative Assistant (Health LA).  Share your message/concerns with the Health LA. If he/she is not available, be sure to leave a message. Be sure to give your name and your company’s name.

3.    Use some of the talking points provided below:

• Medicare competitive bidding for DME in its current form will prove harmful to the Medicare patients we serve, and (my/our) company by causing reduced beneficiary choice and access to home medical equipment items and services.
• Please support the repeal and replacement of DMEPOS Competitive Bidding with the industry supported Market Pricing Program.
• The current flawed CMS program is failing.
• Claims volume in the initial bid areas in Round 1 is down due to reduced access to medical equipment suppliers.
• This resulted because more than 80% of accredited DME suppliers in these areas can no longer provide the competitively bid items and services.
• This reduced access to home medical equipment will cause more ER visits, hospital admissions, and longer hospital stays, actually increasing Medicare’s costs.
• The program is predicted to cause over 6000 DME companies to close and more than 80,000 Americans to lose their jobs.
• The market pricing program will replace competitive bidding with a more sustainable program that will preserve beneficiary access to DME. It will be implemented on the same timeline as the current bidding program and include the same items and services, and it addresses flaws in the current bidding program.
• Please call your Party’s leadership and ask that the market pricing program be included in the Conference Committee’s pending legislation to address the payroll tax and physician payment issues.

4.    Be sure to thank the Health LA for his/her time.

5.    FOLLOW UP! Continue to persist until you get an answer from your legislators. You may also follow up by using the VGM DC Link. Use the featured alert to send a message to your legislators. 

Your phone call and/or e-mail will only take a few minutes, but can leave a large impact with the efforts to stop the flawed bidding program. TAKE ACTION NOW!

The following is from the National Journal:

DOC FIX DEAL LOOKS NEAR. The conference committee battling over the payroll-tax package struck a tentative deal for a 10-month “doc fix” Tuesday night, which would prevent a 27.4 percent Medicare pay cut for doctors for the rest of 2012, according to sources on K Street. To cover the nearly $20 billion cost of the 10-month patch, negotiators are pulling money from a fund earmarked for preventive medicine in the 2010 health reform law and cutting Medicare “bad debt” payments to hospitals when seniors fail to pay their co-pays. Both of those items were included in the payroll bill passed by House Republicans at the end of last year.

 The New England Medical Equipment Dealers Association (NEMED) has reported that since the petition went live on Feb. 10, a steady rise in signatures has been seen. The petition now has over 3,000 signatures, but we need more! VGM urges all providers to sign on if they have not and to urge their family members, friends, colleagues, clients, referral sources and other interested organizations to sign on. The link is below:

http://www.change.org/petitions/stop-competitive-bidding

Friends of Braley may attend for $50! 

Take advantage of a chance to meet with the congressman to convey industry concerns about competitive bidding. Congressman Braley has been a supporter of the durable medical equipment (DME) industry and has signed on H.R. 1041. Continued support, as well as continued communication on idustry concerns must come from you, the provider! Please join us for this opportunity.

When:

Wednesday, February 15

6:30 – 8:00 p.m.

Where:

407 A. Street, SE

Washington, D.C.

Suggested Contributions:

PAC Host: $2,500

Individual Host: $2,500

PAC Supporter: $1,000

Individual Supporter: $1,000

Friends of Braley may attend for $50!

For additional information, you may view the reception invitation here.

If you would like to attend, please contact VGM Government Relations immediately at 800-642-6065 or jamie.blomme@vgm.com.   

6,600 Philadelphia Area Beneficiaries Join Town Hall

On Consequences of Competitive Bidding Program

Philadelphia – Thousands of concerned seniors and caregivers in Philadelphia joined a town hall teleconference call to learn how Medicare’s competitive bidding program will impact access to quality home medical equipment and timely service.

The call was hosted by Last Chance for Patient Choice, a Non-Profit 527 affiliated with the VGM Group in conjunction with People for Quality Care (PFQC), an advocacy organization formed by The VGM Group to advocate on behalf of those who utilize durable medical equipment, and the Pennsylvania Association of Medical Suppliers. The call brought consumers and health care professionals together to discuss the consequences of Medicare’s program that eliminates local home medical equipment suppliers from providing service to beneficiaries.

6,600 residents answered the call to listen to the panel discussion, ask questions and participate in periodic polling throughout. Of those who participated in the poll questions, 100 percent were unaware in the upcoming changes in Medicare in the Philadelphia region. Ninety-five percent said that the government should not be allowed to choose their provider for them and 95 percent desired to stay in their own homes as they age. One hundred callers opted to “press-through” and connect with Congress members who represent the Philadelphia competitive bidding area. House members were asked to support H.R. 1041 and senators to create a companion bill, which would repeal competitive bidding.

Participants heard from panelist Ann Eubank, the Executive Director of Users First, a program of the United Spinal association that advocates for Americans to have access to the wheeled mobility that allows them to live the lives they choose. She warned that the competitive bidding program is devastating to wheelchair users, because it threatens access to local providers and products that are necessary for activities as simple as crossing the threshold of a door. She stressed that every single part of a wheelchair needs to match the function and lifestyle of the user and worried that low-quality equipment and service will cut off access to an individual’s own community.

Kelly Booth, the author of the blog Trials and Tribulations of Being a Type 1 Diabetic, stressed the importance of high-quality diabetic testing strips that match the need of individual users. Her readers from competitive bidding areas complain of not receiving their choice diabetic strips. Instead they are receiving inferior brands. She highlighted that consistent testing results are a major concern for people with diabetes, and when being forced to change testing strips, consistency is compromised.

In current competitive bidding areas, beneficiaries are experiencing a number of problems. Kelly Turner of People for Quality Care discussed how one beneficiary in Texas purchased a hospital bed from Craig’s list when he learned his new provider was located hours away. She highlighted the importance of telling these stories to legislators so that they understand the unintended consequences of Medicare’s flawed program. She also told of a gentleman with Multiple Sclerosis in Kansas City who waited a month for a new wheelchair battery as well as an oxygen user who complained that his new providers were located in states far away from his home.

The three call sponsors, the VGM Group’s Last Chance for Patient Choice and People for Quality Care and the Pennsylvania Association of Medical Suppliers Services united in effort to educate Medicare beneficiaries about the competitive bidding program for durable medical equipment, set to arrive in Philadelphia in 2013. The partnership is in response to a Congressional request for information about how beneficiaries are fairing after the Medicare policy changes.

About People for Quality Care

Our mission is to educate people with disabilities, their families and senior Medicare beneficiaries about health policy changes that affect their freedom of choice. We work with advocacy groups to effect positive change and to ensure that quality, innovation and service remain part of the health care continuum.

Here is an extract from an actual CBIC inquiry…

From: “CBIC.ADMIN@bcbssc.com” <CBIC.ADMIN@bcbssc.com>
To: Cc: CBIC.ADMIN@bcbssc.com
Sent: Wednesday, January 25, 2012 2:16 PM
Subject: RE: Financials for Competitive Bid
DCN 12025I03000xxxxx

Dear ==========

We are responding to your e-mail inquiry regarding accrual vs. cash basis.

We are not asking that you convert your cash accounting to accrual, because a cash basis is acceptable.
For consistency, we have provided some direction by requesting that the three required financial statements be prepared on the accrual or cash basis of accounting.  Although the financial statements must be in accordance with GAAP, certain departures such as depreciation, variable interest entities, or sale leaseback of medical equipment is acceptable.

If you have additional questions, please contact the CBIC Help Desk at 1-877-577-5331.  Please note that the Help Desk hours of operation have been extended for the registration and bidding periods to 9:00 a.m. until 9:00 p.m. prevailing Eastern Time, Monday through Friday.

Please continue to monitor the www.dmecompetitivebid.com website for information regarding the DMEPOS Competitive Bidding Program. If you have not done so, please register to receive e-mail updates and alerts. To register, please click the following link:

http://www.dmecompetitivebid.com/cbic/cbicregistration.nsf/profile?OpenForm.

Sincerely,

Competitive Bidding Implementation Contractor
Palmetto GBA

http://www.PalmettoGBA.com/disclaimer

Suppliers that do not register cannot bid and are not eligible for contracts.  Don’t wait – go to the Competitive Bidding Implementation Contractor (CBIC) website at www.DMECompetitiveBid.com and register TODAY!

 Registration is typically a quick and easy process if you follow the step-by-step instructions in the “Individuals Authorized Access to CMS Computer Services (IACS) Reference Guide” posted on the CBIC website.  To register, visit the CBIC website and click on “REGISTRATION IS OPEN” above the Registration Clock on the homepage.  You will also find a registration checklist and Quick Step guides on the CBIC website.  Please note that suppliers with multiple locations typically must register only one Provider Transaction Access Number (PTAN) that will submit the bid for all locations. 

 The target registration dates have passed for authorized officials (AOs) and backup authorized officials (BAOs).  End users (EUs), as well as any AOs and BAOs who have not yet registered, should register NOW.  Suppliers may wish to register multiple EUs to help enter bid data in Form B of DBidS, the online bidding system.  You will need to complete a Form B for each product category/competitive bidding area (CBA) on which you are bidding.  Multiple users (AO, BAOs, EUs) may be in the Form B section of DBidS at the same time as long as each user is entering information for a different product category/CBA.  Only suppliers that have registered and received a user ID and password will be able to access the online bidding system and submit bids.

 If the AO for your company has not already registered, CMS cannot guarantee that he or she will be able to complete the registration process before registration closes.  This is especially a concern if your files with the National Supplier Clearinghouse (NSC) are not current and accurate.  If your AO does not register, you cannot bid and will not be eligible for a contract.  In addition, suppliers whose AOs have not registered are at risk of experiencing delays in accessing the online bidding system to get a bidder number and thereby missing the opportunity to submit financial documents by the Covered Document Review Date (CDRD). 

 If you have registered an AO but not a BAO, CMS strongly recommends that a BAO register NOW.  The establishment of a BAO is encouraged to avoid any disruption in the bidding process.  The individual in the BAO role can assume the AO role if for some reason the AO can no longer fulfill his or her bidding responsibilities.  If there is no BAO for a company and the AO leaves the company, all end users associated with the company will lose access to the bidding system. 

 Remember, the AO and BAO must be listed on the CMS-855S enrollment form as an AO.  After an AO successfully registers, the AO may designate other authorized officials on the CMS-855S to serve as BAOs; the AO and BAOs can then designate other supplier employees as EUs.  BAOs and EUs must also register for a user ID and password to be able to use the online bidding system.  The name, date of birth, and social security number of the AO and BAOs must match exactly with what is on file with the NSC to register successfully.

 The CBIC is the official information source for bidders.  All suppliers interested in bidding are urged to sign up for email updates on the homepage of the CBIC website.  If you have any questions about the registration process, please contact the CBIC Customer Service Center at 877-577-5331.

NEW DEADLINE: Bidding suppliers must now ensure that copies of all applicable state licenses are RECEIVED by the NSC on or before Tue May 1, 2012. 

Bids will be disqualified if a bidder does not meet all state licensure requirements for the applicable product categories and for every state in a competitive bidding area (CBA).  Every supplier location is responsible for having all applicable license(s) for each state in which it provides services.  For a multi-state CBA, the bidder must collectively have all applicable license(s) for every state in the CBA.  Each location is not required to have licenses for every state in the CBA as long as each state has a bidding location licensed for the product category.

Please note that the extension of the licensure deadline does NOT change any other deadlines.  All bids must be submitted in DBidS, the online bidding system, by 8:59:59pm (prevailing Eastern Time) on Fri March 30, 2012.  All required hardcopy documents that must be included as part of the bid package must be RECEIVED by the Competitive Bidding Implementation Contractor (CBIC) on or before Fri March 30, 2012.

A licensure directory for each state, the District of Columbia, and the territories may be found on the NSC website at www.PalmettoGBA.com/NSC.   Licensure requirements vary from state to state.  The NSC licensure directory provides a good starting point to assist in identifying the licenses you need.  State licensure requirements change periodically and may have exceptions, so the NSC’s licensure directory serves only as a guide.  It remains the bidding supplier’s responsibility to ensure compliance with the most current state and federal laws and regulations.

For more information on licensure requirements, you may refer to the Licensure for Bidding Suppliers Fact Sheet and the Request for Bids (RFB) Instructions.  If you have any questions, please contact the CBIC customer service center at 877-577-5331 between 9am and 9pm (Eastern Time) during the registration and bidding periods. 

Please note that the RFB instructions initially posted on the CBIC website contained the original licensure deadline.  These instructions have now been updated to reflect the new licensure deadline shown in this announcement.

This step-by-step guide is designed to walk Round 2 bidders through the competitive bidding process. VGM receives 100+ calls per day regarding the bidding program, and recognizes that many members are being courted by consulting groups suggesting they’ll help with the bidding process. While we certainly would never suggest anything that would be detrimental to any VGM member, we suggest you review this “3 Easy Steps” guide, and recognize the details of the bidding process before making any decisions. You might find that this guide is just what you need to ease the burden and walk you through the process, ensuring you don’t miss any key steps along the way.

Click here to download “DMEPOS Competitive Bidding in 3 Easy Steps.” (NOTE: Your username and password are required.)  

 Additionally, and as always, feel free to call VGM’s team of competitive bidding experts at 800-642-6065.

We are receiving dozens of calls today relative to the credit reporting issue.  Now that we have settled the issue of “when must I obtain it?” (Answer — before the bid window is closed — but don’t wait that long — submit it to the CBIC before the February 29 covered doc review date)…here are two important observations and tips. 

1). You must use a reporting agency listed on the official Fact Sheet page http://www.dmecompetitivebid.com/Palmetto/Cbic.Nsf/files/R2_Fact_Sheet_Required_Financial_Documents.pdf/$File/R2_Fact_Sheet_Required_Financial_Documents.pdf. 

They are: 

Dun & Bradstreet, Experian, Equifax, TransUnion, or Standard & Poor’s.   All offer business reports.  Google any of these to obtain contact information and call them regarding any questions, concerns or pricing.  They ALL are aware of the DMEPOS program…so you won’t be starting from scratch explaining your needs. 

Credit reports MUST include a numerical score.  These agencies, are, again, most aware of this.  (The only exception is an alpha score from Standard & Poor’s.) Any other forms of gauging credit other than a numerical score(such as arrows indicating relative value of credit or the number of days beyond term) are NOT acceptable.  Again — the agencies know this.  Call them!

2).  May I use my owner’s (s’) credit report(s)?  Maybe…The CBIC states that if no credit report is available for the business, a personal credit report and numerical score for the principal business owner is acceptable as long as it is prepared by an acceptable bureau.  However, a personal credit report and score is NOT acceptable from bidders filing a regular ‘C’ corporation tax return (Form1120), except in cases of newly formed corporations.  My take:  If the owner(s) has/have excellent credit and your company is a Sub S or an LLC, consider using the personal credit report and score.

But first, here is an example of the releases distributed during the past several days:

—-

Round 2 Bidders Must Have Credit Report Dated Before Jan 30, 2012 Or Bid Will Be Disqualified.

CMS documentation on CBIC website requires bidding suppliers to have a credit report with a numerical score from one of the credit reporting agencies.  This report and score must be dated PRIOR to the opening of the bid window on January 30, 2012.  This leaves suppliers just over one week to receive this credit report.

Many suppliers may have overlooked this requirement, which also states that if a credit report is not available for the company, then one for the principle owner is acceptable, provided it to is dated within 90 days PRIOR to the opening of the bid window.

—

VGM reviewed CMS1207-F (the “final rule” with regard to competitive bidding) and cited this text applicable to the issue:  “…a copy of their current credit report, which must have been completed within 90 days prior to the date in which the supplier submits its bid and must have been prepared by one of the following…”. 

Clearly the Rule is clear in that credit reports may be obtained up to the date of bid submission.  We believe the contractor’s Required Financial Documents Fact Sheet http://www.dmecompetitivebid.com/Palmetto/Cbic.Nsf/files/R2_Fact_Sheet_Required_Financial_Documents.pdf/$File/R2_Fact_Sheet_Required_Financial_Documents.pdf, which included under Item #3 (Credit Report with Numerical Score) the following text “…prepared  within 90 days prior to the opening of the bid window by one of the following…” was with the intent to suggest a target date such that potential bidders would not risk disqualification by obtaining a late report. 

To ensure our interpretations were correct, VGM’s Alan Morris contacted Palmetto GBA’s Chief Ombudsman Elaine Hensley.  A copy of the correspondence follows below:

—

From: <ELAINE.HENSLEY@palmettogba.com>
Date: January 24, 2012 7:05:16 AM CST
To: <Alan.Morris@vgm.com>
Subject: RE: Concerns over Credit Report Requirements

Good morning, Alan –

 This is the date established by CMS for Round 2 bidding.  Credit reports dated 90 days prior to the opening of the bid window are not valid.  Therefore, the credit report must be dated on or after that date.  Additionally, the credit report may be dated after the opening of the bid window.

 I hope this helps.

 —

I have further comments relative to the appropriate credit reporting agency; some HMEs are suggesting issues with Dun and Bradstreet.  With the exception of C corporations and certain other entities, there are options for personal credit score submittals.  I will detail these shortly in another post. 

If you have questions, email me at mark.higley@vgm.com

Thank you. 

You may remember a report put out by Professor Ken Brown PHD, regarding the effects of competitive bidding on rural states.  Professor Brown argued that the cuts in Medicare reimbursement to DME could potentially drive a number of firms, including bid winners, out of business.  These closings could affect branches across the country including branches in rural areas. 

Congress claims that rural America will not be  impacted by competitive bidding; however, Cleburne ,Texas is as rural as it gets.  Please view this video to see what I am talking about.

 http://www.youtube.com/watch?v=Fris3PKnkQs&list=UUP6e0Mmdt-b4AAeXLdDZr7Q&index=2&feature=plcp

Click here to view the proposed Market Pricing Program (MPP).

Providers may use the VGM DC Link  to locate the contact information for their Congressional members.

So let’s make it simple!

1).  Read this first:  http://dmecompetitivebid.com/Palmetto/Cbic.Nsf/files/R2_IACS_Quick_Steps_New_User.pdf/$File/R2_IACS_Quick_Steps_New_User.pdf

2).  Then look at ACTUAL step-by-step screen shots here: http://www.vgm.com/files/PDF/Round2RegistrationScreenShots.pdf

3).  Read the remainder of this Blog’s posts.  http://www.vgm.com/blog/index.php/category/regulatory/

4).  You should be in good shape!  Email me with any problems. 

http://www.vgmncbservices.com/bid_calculators.asp

The reasons for the update are to correct a minor code in the CPAP category, and to properly align the “percentage of composite bid” within the wheelchair file. 

Please review Thursday’s blog commentary relative to the high impact codes.  This is a most important concept. 

 One other issue:  Some HMEs are indicating concern with CMS’ “official” bid worksheets.   Using CPAP as an example http://dmecompetitivebid.com/Palmetto/Cbic.Nsf/files/R2_Worksheet_CPAP.pdf/$File/R2_Worksheet_CPAP.pdf

…readers will note this text:

 DMEPOS Competitive Bidding Bid Preparation Worksheet – Round 2

Estimated Capacity & Bid Amount Calculations

This worksheet is provided to assist you with determining your bid amount and estimated capacity for each item in the product category. This information will be entered in DBidS, the online bidding system, on Form B. Your capacity is the estimated number of units that you believe you can provide in the competitive bidding area in a calendar year. All bid amounts must be bona fide (rational and feasible for you to furnish at the bid price). You must not submit a bid for an item at a loss in order to improve your chances of winning a contract. It is important for you to consider and include your cost to purchase the item, overhead, and profit when determining a bid amount for a unit. CMS will evaluate bids to verify that they are bona fide and may ask you to submit additional information, including a rationale and invoices or other documents, to validate the bid amount. Save a copy of your completed worksheet to use if CMS requests documentation to support your bid amount. Please review the Request for Bids (RFB) instructions and fact sheets for assistance with completing your bid sheet (Form B)

 Each code includes a “worksheet” area where “Bidder Data” is requested on the right side of the page:

 Note that there is an area that requests input of “your cost”: 

 Your Cost to Purchase One (1) Unit

(Should be less than your bid amount)

This DOES NOT affect your actual bid.  It is CMS’ attempt to ensure that potential bidders are not bidding “at a loss”.   HMEs are reportedly calling their vendors and requiring “purchase data”.  It is NOT necessary.  It is an optional exercise.  Product acquisition unit costs are, in HME, relatively low as compared to the allowable due to the high service component.  You will NOT submit this worksheet to the CBIC by hardcopy mailing (e.g., along with the financial documents).   It is for your reference only.  Only your submitted bid amount in $ and in capacity on Form B  will be applied.

 Email with questions, concerns or clarifications at mark.higley@vgm.com

As I have explained numerous times in conversations with VGM members and in seminar sessions, of the almost 400 codes available in the nine categories only a handful of codes actually affect your overall composite bid. 

Simply stated, your composite bid compares you to your competitors that are also vying for a contract in your CBA.  Assuming other qualifications are met (e.g., financial, licensing, accreditation et al) the program is purely a mathematical function.  

The attached file includes about two dozen codes that impact the composite bid greater than 5%.   What this means is that the great majority of the remainder of the codes may be bid with MINIMUM discount (even $.01 off the current allowable) and not lower the composite bid more than a few cents…or less.  Again, you do NOT NEED TO DISCOUNT ALL CODES in the category the same amount.  If you, for example, wish to offer a bid in the hospital bed category of 15% off the current allowable, you could discount E0260 only; it represents about 90% of the weighted composite bid.  40 other codes collectively make up less than 1 percent (!). 

(Try it – go to http://www.vgmncbservices.com/bid_calculators.asp)

Bottom line: 

Find out more and register today!

Hosted by VGM Group Inc. Vice President of Development Mark Higley, this webinar will help you learn:

• What you need to do NOW in order to properly prepare your Round Two bid.
• Why you don’t have to be the lowest bidder to be awarded a contract.
• What can go wrong and what can go right when bidding.
• Stumbling points made by Round One bidders that you’ll want to avoid.

Date: Tuesday, January 24th
Time: 3:00 p.m. Eastern / 12:00 p.m. Pacific
Duration: 1 hour
Value Pricing: $89

If your HME business is just making it under the Round Two bidding wire, make sure you and your colleagues attend this critical HME Business webinar.

A Q&A session will be held during the last 15 minutes of the webinar.

Don’t miss out, register today!

 For the next few weeks, I’m going to introduce a series of videos used by various groups to explain the importance of receiving appropriate medical equipment from qualified providers.

 The expense of travel, a patient’s special needs, and accessibility can sometimes make getting to Washington D.C. to communicate with legislators very difficult.  Videos are a way to make sure that the consumer’s experiences are still being seen and heard. 

 Those highlighted in the videos will share the truth about their quality of life – or lack of it-due to poor funding, lack of proper equipment and untimely service. When one is confronted with these facts, it’s hard to avoid issues such as the Medicare competitive bidding program that hinder access. The impact of seeing and hearing from equipment users plays a major role in changing bad health care policies. 

 These videos can be shared by copying and pasting these links on Facebook or your websites.  Please spread the word about the importance of quality care and medical equipment and help educate the people you know about the businesses and organizations that are making a difference.

 The first video comes from NCART, National Coalition for Assistive and Rehab Technology.  NCART is an association of suppliers and manufacturers of complex rehab technology (CRT) products and services that are used by individuals with significant disabilities and medical conditions.

http://hme-business.com/articles/2012/01/05/ncart.aspx?s=esource_060112&admgarea=esource 

Let’s start with CMS’ official guidance:

Change of Ownership (CHOW): Implications for Bidding

If a CHOW occurs before the bid window closes, suppliers must update the information related to the CHOW on the Request for Bids (RFB) forms in DBidS. The supplier must also resubmit all accompanying hardcopy documents reflecting the CHOW by the close of the bid window. The supplier must also notify the NSC of the CHOW in accordance with the supplier standards. If a CHOW occurs during bid evaluation, bids will be evaluated based on the information provided as of the close of the bid window. Documentation and information submitted on the new owner will not be used during this time period. If a supplier is offered a contract and executes a CHOW transaction after the bid window closes, it must abide by the CHOW requirements provided in 42 CFR §414.422(d). Contracts under this program may not be sold and may only be transferred when permitted by CMS consistent with the requirements in 42 CFR §414.422. Additionally, a CHOW does not guarantee that a purchaser will be allowed to assume a competitive bidding contract. The purchaser must meet all of the competitive bidding requirements before CMS approves a novation agreement that transfers all contract obligations to the purchaser. Fact sheets and frequently asked questions regarding CHOWs can be found on the CBIC website.

My take:  Wait until March 30 if at all possible.  Separate entities may each submit a bid for a common CBA (assuming there is no current common ownership or management) and effectively allow for two shots at acquiring the product category contract.  The post March 30 (“Bid evaluation”) period is suitable to effect the transaction as “documentation and information submitted on the new owner will not be used during this time period”.

For transactions ocurring after the contracts have been awarded, CHOW procedures are available from VGM or on the CBIC website.

Hope this helps.

The software, with detailed instructions, has been loaded to encompass all 100 CBAs. 

Tip:  The Bid Calculator worksheet is designed to:

• Identify category HCPC codes that are most relevant (e.g., have the most impact) in the bidding process.
• Identify category HCPC codes that have a minimal impact on the bid determination as to be practically irrelevant.
• Flag bid amounts that may trigger “Bona Fide Bid” evaluation.

• VGM will hold an additional “Ins and Outs of National Competitive Bidding Round 2″ seminars in Atlanta on January 30-31. This will give you everything you need to know about the bid process. Look for more information and registration here: http://www.vgmeducation.com/TravelDetails.asp?ID=504

• On 1/6/2011 will have posted on our VGM National Competitive Bidding Services Website (www.vgmncbservices.com) new “Bid Calculator Worksheets” for all 100 CBAs. These ‘calculators’ will allow you to analyze and review the various HCPC codes that make up the product categories. You will see the codes that have the largest impact on your bid. These worksheets will flag potentially incorrect bids and warn you of bid violations. Also, available on this page http://www.vgmncbservices.com/map/cbas.asp are detailed maps of the competitive bid areas by ZIP code. These interactive maps will assist you in your analysis of your patient population and how much of your business is potentially affected by the program.

• Finally, in early February we will update the Bidding Website with a “Bid Submission Assistant”. While we await the bid window opening (January 30) we look forward to obtaining actual screen shots and assist you via a “walk through” of the step by step process of submitting your bid.

We’re here to help. Call us…

A few important items…

Is everyone (that is bidding) getting the AO registered?  If not, while you have until the first week of February, you should be doing this now.  There have been a few glitches with the 855S “authorized official” and the back-up official…but most have been settled promptly. 

Tip:   Call The CBIC Customer Service Center at 1-877-577-5331. If you have 855S concerns, call our Peggy Walker at 800.401.3643.

VGM’s Bid Calculator Tool will be ready shortly!  The software, with detailed instructions, will be delivered via email to all attendees of last year’s competitive bidding two day seminars.  VGM members who did not attend will be able to access the tool on a password protected URL.  Look for more information soon. 

Tip:  The Bid Calculator worksheet is designed to:

• Identify category HCPC codes that are most relevant (e.g., have the most impact) in the bidding process.
• Identify category HCPC codes that have a minimal impact on the bid determination as to be practically irrelevant.
• Flag bid amounts that may trigger “Bona Fide Bid” evaluation.

Great preparation advice:  http://dmecompetitivebid.com/Palmetto/Cbic.nsf/files/R2_RFB.pdf/$FIle/R2_RFB.pdf.  Read It.  All of it. 

Anti-Trust Guidance Issued by CMS.  You probably saw this last week in the trade pubs or other sources.  http://www.dmecompetitivebid.com/Palmetto/Cbic.nsf/files/R2_Fact_Sheet_Antitrust_Guidance.pdf/$FIle/R2_Fact_Sheet_Antitrust_Guidance.pdf.  Read this one as well. 

Tip: Be extremely cautious if you are considering working with third-party “consultants” in preparing your Round 2 bid!  The final bullet point of the guidance (…sharing competitively sensitive pricing or bidding data with any competitors, including through a third party (for example, a consultant), with the intent to facilitate any agreement or understanding …) is a warning shot across the bow that the agency will NOT tolerate anti-trust violations for this program.  Read the entire release here:  http://www.dmecompetitivebid.com/Palmetto/Cbic.nsf/files/R2_Fact_Sheet_Antitrust_Guidance.pdf/$FIle/R2_Fact_Sheet_Antitrust_Guidance.pdf

Some commentary:  Readers may be aware of the 2009 allegations of collusion brought by a major PMD manufacturer (as reported in HME News http://homecaremag.com/topics/competitive-bidding/collusion-warning-again-20091215)…

…which resulted in this article:

CMS: No price fixing, bid rigging, collusion (HME News, December 15, 2009)

 BALTIMORE – For the second time in a month, CMS warned HME providers yesterday that they must comply with all applicable federal anti-trust laws when they submit their bids for Round 1.2 of national competitive bidding.

“We take these laws very seriously and will not tolerate violations,” CMS stated in a Dec. 14 listserv message. “Any supplier suspected to have violated federal anti-trust laws by engaging in practices such as price fixing, bid rigging or other forms of collusion will be referred to the Department of Justice for investigation and is subject to having its bid rejected.”

During an Open Door Forum earlier this month, CMS officials warned listeners about price fixing, saying that they have “heard concerns about collusion that may be occurring.”

To help providers make sure they’re following the letter of the law, CMS included the following Q&A in the listserv:

Q: May bidders use a consultant for the preparation of their bids?

A: While bidders may use consultants to assist in the preparation of their bids, each bidder is responsible for validating and submitting its own bid. All bids must comply with all terms and conditions of the request for bids (RFB), regardless of whether a consultant is used.

Q: Are certain consultants or certain consultant services not appropriate for assisting in bid preparation?

A: If a bidder decides to use a consultant, any consultation service must be consistent with the DMEPOS competitive bidding program authorizing regulations and the RFB and permissible under all applicable federal laws. For example, a provider may not knowingly use a consultant that compares that supplier’s bid with, or knowingly makes bid item prices identical or substantially the same as, the bid of another bidder (s).

……..

Bottom line & request from VGM:   If you opt for a third party consultant, beware.  CMS is watching closely.  We believe the RFB instructions, fact sheets, and the improved DbidS software will minimize the likelihood of any clerical or procedural errors in this Round.  Essentially, the contracting criteria will revolve around the amount of discount offered by the supplier in key HCPC codes.  VGM, and other stakeholders, can assist you with this evaluation of the codes.  However, the AMOUNT of discount may not be suggested by VGM nor any other party…including “consultants”.  These entities have knowledge of up to hundreds of other HME company data.  Enough said.  If you are approached by any suggestion of a guarantee or improved chances of “winning the bid” by a third party, VGM wants to know about it.  So does CMS.  

Call me on my direct line at 888.224.1631 if you’re not clear on this matter or have questions.

More to follow… 

 The people that we spoke to are significant and their experiences are significant.  However, CMS touts that there are NO significant problems with competitive bidding and have plans to spread it to 91 more areas of the country. 

 If numbers matter, which in is this case they seem to, let’s work together to get those problems exposed.

1.  Share our literature with the people you know who need to learn about the program or who can educate others.
2. Share your stories or the stories of others who have been impacted by the program.
3. Use your website or Facebook page to share our information. Link to www.peopleforqualitycare.org or www.facebook.com/peopleforqualitycare.

-peace

PFQC

The “50 Percent Rule”

The Medicare statute requires bidders for mail-order diabetic supplies to demonstrate that their bids cover at least 50 percent, by volume, of all types of diabetic testing strips on the market (the “50 percent rule”).

Bidders must complete the National Mail-Order 50 Percent Compliance form https://www.dmecompetitivebid.com/secure/cbicsecure.nsf/NMO50Comply on the Competitive Bidding Implementation Contractor (CBIC) website (www.dmecompetitivebid.com) to indicate the brands they intend to furnish if awarded a contract. This may include brands that bidding suppliers intend to furnish only on a limited basis in order to comply with the physician authorization process. In these cases, although the supplier does not intend to furnish a significant quantity of these brands, the brands would still be counted in determining whether the supplier is in compliance with the 50 percent rule. The form MUST be received by the CBIC along with the other required hardcopy documents by the close of bidding. Only suppliers that meet the 50 percent rule and mail their forms in time to meet this deadline will be eligible for contract award. The brands provided on the form will also be used in the Supplier Directory on the Medicare website (www.medicare.gov) to assist beneficiaries and referral agents with selecting suppliers.

The “Anti-Switching Provision”

Federal regulations include an “anti-switching” provision as a term of the contract for suppliers under the national mail-order competition for diabetic supplies. This regulation prohibits contract suppliers from influencing or incentivizing beneficiaries to switch their current glucose monitor and testing supplies brand to another brand. The anti-switching rule requires contract suppliers to furnish the brand of testing supplies that work with the monitor currently in use by the beneficiary. This rule was established to protect beneficiary and physician choice of glucose monitors. If a contract supplier does not carry the brand the beneficiary has been using, it can inform the beneficiary that it does not carry that brand. The beneficiary may then engage the contract supplier about alternative brands and the supplier can describe what brands it offers; however, the supplier cannot be the one to initiate this conversation. It is important to know that most suppliers can furnish alternative brands of glucose monitors at little or no cost to a beneficiary who decides to switch to an alternative brand. Manufacturer rebates and trade-in promotions have been widespread for several decades and have significantly reduced or, in most cases, entirely eliminated the cost of switching from one glucose monitor brand to another.

The “Bid Preparation Worksheet” & “Estimated Capacity & Bid Amount Calculations”

This worksheet is provided to assist you with determining your bid amount and estimated capacity for each item in the product category. This information will be entered in DBidS, the on-line bidding system, on Form B. Your capacity is the estimated number of units that you believe you can provide in the competitive bidding area in a calendar year. All bid amounts must be bona fide (rational and feasible for you to furnish at the bid price). You must not submit a bid for an item at a loss in order to improve your chances of winning a contract. It is important for you to consider and include your cost to purchase the item, overhead, and profit when determining a bid amount for a unit. CMS will evaluate bids to verify that they are bona fide and may ask you to submit additional information, including a rationale and invoices or other documents, to validate the bid amount. Save a copy of your completed worksheet and calculations to use if CMS requests documentation to support your bid amount. Please review the Request for Bid (RFB) instructions http://www.dmecompetitivebid.com/Palmetto/Cbic.nsf/files/R2_Fact_Sheet_Mail-Order_Diabetic_Supplies.pdf/$FIle/R2_Fact_Sheet_Mail-Order_Diabetic_Supplies.pdf and fact sheets (particularly the National Mail-Order Competition for Diabetic Supplies fact sheet http://www.dmecompetitivebid.com/Palmetto/Cbic.nsf/files/R2_Fact_Sheet_Mail-Order_Diabetic_Supplies.pdf/$FIle/R2_Fact_Sheet_Mail-Order_Diabetic_Supplies.pdf and the Requirement to Submit a Bona Fide Bid fact sheet http://www.dmecompetitivebid.com/Palmetto/Cbic.nsf/files/R2_Fact_Sheet_Bona_Fide_Bid.pdf/$FIle/R2_Fact_Sheet_Bona_Fide_Bid.pdf) for assistance with completing your bid sheet (Form B).

Make sure your cost to buy one unit of diabetic test strips (HCPCS code A4253KL) includes all brands in your bid. You should weight the cost of each brand by the volume of that brand you estimate you will furnish as shown in the following table. The brands you enter in this worksheet must be the same product offerings you entered in the 50 Percent Compliance form https://www.dmecompetitivebid.com/secure/cbicsecure.nsf/NMO50Comply. Your estimated volume of a brand can be different from the percentage of market share on the 50 Percent Compliance form

For an example worksheet/template (suppliers enter their own brands, costs, and volume estimates tp determine “unit cost”, go to http://dmecompetitivebid.com/Palmetto/Cbic.Nsf/files/R2_Worksheet_National_Mail-Order.pdf/$File/R2_Worksheet_National_Mail-Order.pdf

The above link includes a bidding worksheet (HCPC codes, Code Description, Definition of a Bidding Unit, 2010 Beneficiary Count, 2010 Allowed Units, Bid Limit, and blank “Bidder Data” columns, for suppliers to enter Supplier Cost To Purchase, Bid Amount, and Estimated Capacity).

Questions regarding the national mail order program should be emailed to mark.higley@vgm.com

HAPPY HOLIDAYS!!!

Authorized Official Registration Deadline IS NOT December 22, 2012!!! CMS suggests “target date”; actual deadline is February 9, 2012 for all registrant entities.  CMS has urged all AOs to register no later than December 22, 2011 to ensure that AOs have time to designate other supplier employees to use the DMEPOS on-line bidding system (DBidS).  However this is NOT a deadline and will not preclude HMEs from registering their AOs after this date. 

2). VGM Government Relations is fielding a lot of questions with regards to the registration inquiry “justification of action.” We have been advised a proper response is: ROUND TWO DMEPOS COMPETITIVE BIDDING

3). Confirmations from IACS to an AOL (example hme@aol.com) Internet account MAY BE DELAYED for several hours.  The CBIC has suggested considering use of an alternate email service.

4). If your intended Backup Authorized Official (BAU) is NOT currently included in your 855S he or she will not be accepted by the program software.  You may register that individual as an End User (EU) or update the 855S via PECOS or manually https://www.cms.gov/cmsforms/downloads/cms855s.pdf by submitting the updates to the NSC.  Be cautious with regard to the deadline for registration!

5).  The “rules”…once more!

 If you are interested in bidding you must designate one Authorized Official (AO) from those listed on the CMS-855S enrollment form to act as your AO for registration purposes, and that AO must register.  

When bidding opens, suppliers will need to submit their bids using DBidS.   To help ensure bid security and privacy, suppliers interested in bidding must first register all employees that will enter information in DBidS to obtain a user ID and password through the Individuals Authorized Access to CMS Computer Services (IACS) system.  Only supplier employees that have a user ID and password will be able to access DBidS; suppliers that do not register will not be able to bid.

After an AO successfully registers, the AO may designate other authorized officials on the CMS-855S to serve as backup authorized officials (BAO).   The AO and BAOs can designate other supplier employees as end users (EU). BAOs and EUs must also register for a user ID and password to be able to use the on-line bidding system. The name, date of birth, and Social Security number (SSN) of the AO and BAOs must match exactly with what is on file with the National Supplier Clearinghouse (NSC) to register successfully.

Registering now allows the AO and/or BAO time to correct the supplier’s NSC records if their name, date of birth, and SSN does not match what is on file with the NSC.  We recommend that BAOs register no later than January 12, 2012 so that they will be able to assist AOs with approving EU registration.

Registration will close on February 9, 2012 at 9 p.m. prevailing Eastern Time – no AOs, BAOs, or EUs can register after registration closes.

To register, go to the Competitive Bidding Implementation Contractor (CBIC) website, www.dmecompetitivebid.com and click on “REGISTRATION IS OPEN” above the Registration Clock on the home page.   Please review the IACS Reference Guide posted on the website for step-by-step instructions on registration. You will also find a registration checklist and Quick Step guides on the CBIC website.   If you have any questions about the registration process, please contact the CBIC Customer Service Center at 1-877-577-5331.

The CBIC is the official information source for bidders.  All suppliers interested in bidding are urged to sign up for E-mail Updates on the home page of the CBIC website.  For information about Round 2 and the national mail-order competition, including bidder education materials, please refer to the resources located under Bidding Suppliers: Round 2 & National Mail-Order on the CBIC website.

We strongly urge all AOs to register no later than December 22, 2011 to ensure that AOs have time to designate other supplier employees to use the DMEPOS on-line bidding system (DBidS). 

When bidding opens, suppliers will need to submit their bids using DBidS.   To help ensure bid security and privacy, suppliers interested in bidding must first register all employees that will enter information in DBidS to obtain a user ID and password through the Individuals Authorized Access to CMS Computer Services (IACS) system.  Only supplier employees that have a user ID and password will be able to access DBidS; suppliers that do not register will not be able to bid.

After an AO successfully registers, the AO may designate other authorized officials on the CMS-855S to serve as backup authorized officials (BAO).   The AO and BAOs can designate other supplier employees as end users (EU). BAOs and EUs must also register for a user ID and password to be able to use the on-line bidding system. The name, date of birth, and Social Security number (SSN) of the AO and BAOs must match exactly with what is on file with the National Supplier Clearinghouse (NSC) to register successfully.

Registering now allows the AO and/or BAO time to correct the supplier’s NSC records if their name, date of birth, and SSN does not match what is on file with the NSC.  We recommend that BAOs register no later than January 12, 2012 so that they will be able to assist AOs with approving EU registration.

Registration will close on February 9, 2012 at 9 p.m. prevailing Eastern Time – no AOs, BAOs, or EUs can register after registration closes.

To register, go to the Competitive Bidding Implementation Contractor (CBIC) website, www.dmecompetitivebid.com and click on “REGISTRATION IS OPEN” above the Registration Clock on the home page.   Please review the IACS Reference Guide posted on the website for step-by-step instructions on registration. You will also find a registration checklist and Quick Step guides on the CBIC website.   If you have any questions about the registration process, please contact the CBIC Customer Service Center at 1-877-577-5331.

The CBIC is the official information source for bidders.  All suppliers interested in bidding are urged to sign up for E-mail Updates on the home page of the CBIC website.  For information about Round 2 and the national mail-order competition, including bidder education materials, please refer to the resources located under Bidding Suppliers: Round 2 & National Mail-Order on the CBIC website.

Other important program links!

VGM’s Legislative Updates – sign up here.

Official CBIC site to register and bid:  http://dmecompetitivebid.com/palmetto/cbic.nsf/DocsCat/Home

Attend VGM’s on-location two day bidding seminar January 30, 2012 (Atlanta).

Licensure or out of state questions for DME or national mail order bidding program?  Call VGM at 800.642.6065 and ask for Brittany Terrell. 

****NOTE: VGM Government Relations is fielding a lot of questions with regards to the registration inquiry “justification of action.” We have been advised a proper response is: ROUND TWO DMEPOS COMPETITIVE BIDDING

Speaker John Boehner has told his caucus to expect a two-month extension of the payroll tax. A two month extension on the Doc Fix is a huge positive for the durable medical equipment industry. If this is passed, providers have a two-month opportunity to reach out to their members of Congress to get language included in the repeal and replace of the competitive bidding program. A legislative proposal, known as the Market Pricing Program (MPP), has been presented to Congress to be included in the repeal and replace of the competitive bidding program. The Market Pricing Program (MPP) features an auction system to establish market-based prices around the country. The MPP would require CMS to make fundamental changes to ensure a financially sustainable program, which would allow for maximum participation of providers.

As the holidays approach, members of Congress will be traveling to their home districts. Use this opportunity to reach out to your legislators and invite them to visit your company location over the holidays. Discuss with them the impact of competitive bidding on access to quality care and service, as well as its impact on jobs. You may utilize the MPP talking points and VGM’s Job Loss Analysis.

To find your legislators’ contact information, visit VGM DC Link and search for your officials by entering your ZIP code or state.

For more information on the two-month extension, refer to the article from The Hill below.

The following is from The Hill…

House may return next week after passing short-term stopgap

By Erik Wasson – 12/16/11

 House lawmakers expect to leave town Friday and return next week to deal with extending the payroll tax holiday.

The House will pass a one-week continuing resolution to keep the government open Friday, as well as a $1 trillion nine-bill spending omnibus, House Appropriations Committee Chairman Hal Rogers (R-Ky.) said Friday.

Speaker John Boehner (R-Ohio) told his caucus to expect a two-month extension of the payroll tax holiday to be sent to the House by the Senate.

He also said the House will insist that language be added to the bill that is intended to force the administration to approve the Keystone oil sands pipeline from Alberta to the Gulf Coast. The White House has said Obama would reject a bill with that language.

“He said we will slap Keystone right back on there,” Rep. Steven LaTourette (R-Ohio) said.

In a brief press conference, Boehner told reporters that if the Senate sent back a two-month extension of the payroll tax and unemployment benefits, the House would make changes. He guaranteed that re-inserting the Keystone provisions would be one of those changes.

The Senate is also expected to pass the omnibus, but because it is so large, the bill cannot be formally enrolled in time to avert a partial government shutdown at midnight, making the short-term funding measure necessary.

House lawmakers expect to leave town Friday and return next week to deal with extending the payroll tax holiday.

The House will pass a one-week continuing resolution to keep the government open Friday, as well as a $1 trillion nine-bill spending omnibus, House Appropriations Committee Chairman Hal Rogers (R-Ky.) said Friday.

Speaker John Boehner (R-Ohio) told his caucus to expect a two-month extension of the payroll tax holiday to be sent to the House by the Senate.

He also said the House will insist that language be added to the bill that is intended to force the administration to approve the Keystone oil sands pipeline from Alberta to the Gulf Coast. The White House has said Obama would reject a bill with that language.

“He said we will slap Keystone right back on there,” Rep. Steven LaTourette (R-Ohio) said.

In a brief press conference, Boehner told reporters that if the Senate sent back a two-month extension of the payroll tax and unemployment benefits, the House would make changes. He guaranteed that re-inserting the Keystone provisions would be one of those changes.

The Senate is also expected to pass the omnibus, but because it is so large, the bill cannot be formally enrolled in time to avert a partial government shutdown at midnight, making the short-term funding measure necessary.

The pre-pay will be completed in a staggered series for different states and then prior authorization will be implemented. The full demonstration will be for 3 years. Once the pre-pay has been completed.

Prior Authorization — good for all

Please contact your legislators and let them know this will definately deny access to needed individuals and cause loss of jobs and close down small providers. Pre-pay means a delay of several months for payment on your claims (this will be first month review only on capped rental)

Questions call or comment here.

Peggy Walker, RN

800-401-3643

The following Dear Colleague letter is time sensitive! All signatures are due by NOON on Wednesday, December 14.

VGM encourages providers to forward the letter below to their members of Congress and/or call your members of Congress to ask that they cosign the letter to put a stop to the new three year demonstration project. Recently, CMS announced a new three year demonstration project that will go into effect January 1, 2012 in the following states (CA, FL, IL, NY, TX, MI, and NC). While this affects seven states, we know these projects rarely go away and are usually expanded. It is important that you contact your members of Congress and make them aware of this issue!

**SIGN BIPARTISAN LETTER TO SUPPORT POWER MOBILITY DEVICES**

Dear Colleague:

            Please join us on this bipartisan letter to the Centers for Medicare and Medicaid Services (CMS) to ensure seniors and those with disabilities have access to power mobility devices (PMD).

Recently, CMS announced a new three year demonstration project that will go into effect January 1, 2012. This project requires an initial 100% prepayment review of all power wheelchair claims in the seven largest Medicare beneficiary states: CA, FL, IL, NY, TX, MI, NC. The demonstration project is being initiated as an attempt to address fraud and improper payments, but instead has unintended consequences that hamper the operations of the PMD industry. As a result of this demonstration project, the industry will be forced to find additional working capital to survive, thereby threatening business operations and seniors.

This letter encourages CMS to halt the implementation of the demonstration project and instead, implement a formal notice and comment for rulemaking process on this topic. This ensures that stakeholders have the ability to provide input, and avoid any unintended consequences such as massive layoffs and halted operations that would unduly harm seniors and people with disabilities who rely on power mobility devices.

If your boss would like to cosign this letter, please contact Rep. Henry Cuellar’s Senior Legislative Assistant, Claudia Urrabazo at Claudia.urrabazo@mail.house.gov; or Rep. Lamar Smith’s Legislative Assistant, Shannon Moore at Shannon.moore@mail.house.gov. Deadline extended: noon on Wednesday, December 14, 2011.

Sincerely,

/s                                                                     /s

Henry Cuellar, Ph.D.                                       Lamar Smith

Member of Congress                                      Member of Congress

Letter is below:

December 12, 2011

Marilyn Tavenner

Principal Deputy Administrator of Centers for Medicare and Medicaid Services

Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore MD 21244-1850

Dear Administrator Marilyn Tavenner:

Thank you for your hard work ensuring that Medicare, Medicaid and health services are afforded and administered to the population. We are writing to express our concerns over the Medicare Prepay Review and Prior Authorization Demonstration Project for Power Mobility Devices (PMDs). 

On November 15, 2011, the Centers for Medicare and Medicaid Services (CMS) announced a three-year demonstration project that will conduct 100% prepay review for all new PMD claims in seven of the largest Medicare reimbursed states, beginning January 1, 2012. We applaud the agency’s efforts to reduce waste, fraud and abuse; however, we have many concerns with enacting a demonstration project of this size with minimal notice to the affected stakeholders.  Such a project could result in significant job losses and jeopardize seniors’ access to this important Medicare benefit.

As you are aware, Congress and CMS has significantly reduced pricing for PMDs and increased program integrity requirements for Medicare suppliers (e.g. accreditation, surety bonds, quality standards) over the past three years.  Specifically, on January 1, 2011, CMS enacted Round One of the Medicare Durable Medical Equipment Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding program, which includes power wheelchairs.  Also on January 1, 2011, Congress mandated that all Medicare Group 2 standard power wheelchairs be converted to a 13-month rental item requiring businesses to obtain substantial outside capital as a result of the transition.  Including a demonstration project to the requirements already in place could harm seniors that depend on durable medical equipment to live independently in their own homes. Additionally, taking a one-size-fits-all approach adds burdensome regulations to good-standing providers and threatens jobs.

We encourage you to halt the prepay review demonstration project due to the potential threats to businesses, jobs and seniors’ access to care.  Furthermore, we recommend that you work with all stakeholders, including physicians, beneficiaries, and suppliers to develop a program that restores access to these invaluable products and services without impacting legitimate businesses.  Any efforts should include a formal notice and comment period.  Thank you for your attention to this important matter.

Sincerely,

 __________________________                               __________________________

Henry Cuellar, Ph.D.                                                            Lamar Smith

Members of Congress                                                            Member of Congress

To read the revised Medicare Learning Network® fact sheet click here.

The following is from the National Journal…

Boehner Unveils GOP Extenders Bill

The measure would extend the payroll tax cut, unemployment benefits and provide a “doc fix.”

By Billy House December 9, 2011

House Republicans on Friday morning filed a 369-page bill to extend the current payroll-tax rate for one year, continue unemployment benefits, and prevent a scheduled cut in Medicare physician reimbursements. Congress is struggling to come up with compromises on these issues before the holiday recess.

Posting the package on the House Rules Committee website clears the way for promised action early next week.

“Everything in the House bill will be offset by spending cuts, many of which the president and independent experts have called for,” said Speaker John Boehner, R-Ohio, in a statement accompanying the package’s posting.

“This package does not include everything Republicans would like, nor does it have all that Democrats have called for; but it is a win for the American people and worthy of the president’s signature,” argued Boehner.

It remains uncertain whether Boehner will have enough votes in his own conference to pass the measure, despite the addition of several “sweeteners” to attract more backing-such as legislation requiring a decision on the controversial Keystone XL pipeline opposed by many Democrats and environmental groups.

For now, possible support from many House Democrats seems far from likely.

House Minority Leader Nancy Pelosi, D-Calif., launched an offensive on Friday hammering any possibility that GOP lawmakers would adjourn for Christmas without adopting a measure to extend the payroll-tax cut and unemployment insurance.

Pelosi panned the GOP plan as a partisan messaging toting “poison pills” that has no chance of acceptance by the Democratic-led Senate, even if passed in the House.  She told reporters that Republicans essentially are saying, “We’re going to pay for it in ways that affect Medicare beneficiaries. We’re going to .. hold this hostage this hostage to the Keystone Pipeline – there’s no time for that. This isn’t serious.

“There isn’t time for sending messages,” said Pelosi, who reiterated that House Democrats are prepared to stay in session as long as it takes through the holiday season to get the payroll tax holiday and federal jobless benefits extended.

Senate Majority Leader Harry Reid, D-Nev., said Friday the Keystone provision ensures the legislation’s defeat in the Senate if it survives a House vote next week.

“With the middle class facing a huge tax increase on the first of January, now is not the time to be debating unrelated measures like an oil pipeline,” Reid said in a statement. “If the House sends us their bill with Keystone in it, they are just wasting valuable time because it will not pass the Senate.”

Reid’s threat follows President Obama’s suggestion Thursday that he would veto any bill with the Keystone provision or other unrelated policy riders.

Please visit our website www.peopleforqualitycare.org to read our Christmas Letter.  Have a safe and joyous Holiday season.

Competitive Bidding Round 2 Registration Is Now Open 

Registration is now open and available to all suppliers interested in participating in the Round 2 and national mail-order competitions of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program.  When bidding opens, suppliers will need to submit their bids using the DMEPOS on-line bidding system (DBidS).   To help ensure bid security and privacy, suppliers interested in bidding must first register all employees that will enter information in DBidS to obtain a user ID and password through the Individuals Authorized Access to CMS Computer Services (IACS) system.  Only supplier employees that have a user ID and password will be able to access DBidS; suppliers that do not register will not be able to bid.

If you are a supplier interested in bidding, register now – don’t wait. Designate one authorized official (AO) listed on the CMS-855S enrollment form to act as your AO for registration purposes. The AO must register for a user ID and password first and must approve other supplier employees’ requests to register. After an AO successfully registers, the AO may designate other authorized officials on the CMS-855S to serve as backup authorized officials (BAO).   The AO and BAOs can designate other supplier employees as end users (EU). BAOs and EUs must also register for a user ID and password to be able to use the on-line bidding system. The name, date of birth, and Social Security number (SSN) of the AO and BAOs must match exactly with what is on file with the National Supplier Clearinghouse to register successfully.

We strongly urge all AOs to register no later than December 22, 2011 to ensure that BAOs and EUs have time to register before bidding begins. We recommend that BAOs register no later than January 12, 2012 so that they will be able to assist AOs with approving EU registration. Registration will close on February 9, 2012 at 9 p.m. prevailing Eastern Time – no AOs, BAOs, or EUs can register after registration closes.

To register, go to the Competitive Bidding Implementation Contractor (CBIC) website and click on “REGISTRATION IS OPEN” above the Registration Clock on the home page.   Please review the IACS Reference Guide posted on the website for step-by-step instructions on registration. You will also find a registration checklist and Quick Step guides on the CBIC website.   If you have any questions about the registration process, please contact the CBIC Customer Service Center at 1-877-577-5331.

The CBIC is the official information source for bidders.  All suppliers interested in bidding are urged to sign up for E-mail Updates on the home page of the CBIC website.  For information about Round 2 and the national mail-order competition, including bidder education materials, please refer to the resources located under Bidding Suppliers: Round 2 & National Mail-Order on the CBIC website.

Suppliers intending to submit a bid must first obtain a user ID and password to access “DBidS” by registering in the Individuals Authorized Access to the CMS Computer Services (IACS) application. Bidding suppliers will register in IACS on the CBIC website. Only an individual identified as an authorized official (AO) on the CMS-855S enrollment form can register the company and approve the registration of the end users and backup authorized officials (BAOs). A BAO is someone who is also identified as an AO on the 855S and can serve as a backup to the AO.

If you registered in the Round 1 Rebid, your old user ID has expired and cannot be used. You will need to register again to have access to DBidS for Round 2 and/or the national mail-order competition. Please note that you cannot access DBidS until the bidding window has opened.

Prior to registering in IACS, ensure you have completed the following steps:

* Choose one (1) authorized official (AO) listed on your CMS-855S enrollment form to act as your IACS registration AO. The AO’s role is instrumental to bidding and must be active to prevent the organization’s other users from losing access to the bidding system. Your company may have multiple individuals listed as the AOs on the enrollment form. However, for IACS registration purposes, only one AO may register for the Competitive Bidding Program. The other AOs listed on the enrollment form may act as backup authorized officials (BAOs) in IACS. If there is only one AO listed on the CMS-855S form, we strongly encourage you to add one or more to serve as BAOs in order to avoid disruption in the bidding process should the AO leave the organization or become unavailable during the bidding window. BAOs have many of the same capabilities in registration as an AO.

* Make sure that information on file with the National Supplier Clearinghouse (NSC) and in the Provider Enrollment, Chain and Ownership System (PECOS) is correct and current. In addition to your organization’s mailing address, the legal name, date of birth and Social Security number (SSN) of the AO and BAOs must match exactly with what is on your organization’s enrollment file in order to successfully register in IACS. If you need to change or correct this information, you may find change-of-information assistance and forms on the NSC website at www.palmettogba.com/NSC or you may contact the NSC at 1 (866) 238-9652.

*Determine which billing number or Provider Transaction Access Number (PTAN) to use for registration. You should only register ONE time with ONE PTAN. [There is only one specific situation that would require a supplier to add one or more PTANs to his or her profile in IACS. If a supplier has more than one location within the same competitive bidding area (CBA)and one or more of the locations furnishes a different product line that does not compete against the other location(s), the supplier must register twice and receive a distinct UID for each location that represents a completely different product line. This situation is discussed in detail in Section 5 - Creating an Organization]. You may register with any active PTAN. The PTAN provided in registration will be automatically populated in DBidS. When completing the DBidS application, you will associate or add other locations, if applicable. All commonly owned or commonly controlled locations that intend to provide competitively bid items or services within a CBA should be included on the bid application for the same product categories and CBAs.

*If you are bidding as part of a network, the primary network supplier should register ONE time with ONE PTAN. You may register with any active PTAN with which you are associated. If you are the primary network member and are also planning to submit a bid as an individual supplier outside the network, you do NOT need to register again as an individual supplier in IACS (See Section 5 – Creating an Organization). However, if you are a network member and you are also planning to submit a bid as an individual supplier outside the network, you will need to register as an individual supplier in IACS to submit a bid. Suppliers may not bid as a network for the national mail-order competition.

* Companies that are commonly owned and/or controlled should only register ONE time and submit ONE bid application that includes all locations that provide the product category in the CBA. All locations that provide the items in the product category to beneficiaries in a CBA must be included on the bid application. Regulations do not allow commonly owned or commonly controlled companies to bid against themselves. Commonly owned companies are companies where a supplier has ownership interest in total of at least 5 percent of another supplier. Ownership interest is defined by the competitive bidding program regulations as the possession of equity in the capital, the stock or the profits of another supplier. Commonly controlled companies are companies where one or more owners of a supplier is also an officer, director or partner of another supplier.

* Make sure the e-mail address you enter into IACS is correct and is working at the time of registration. This is important because you will be sent e-mails containing critical information during the registration and bidding periods.

* Prepare your computer:

CMS screens are designed to be viewed at a minimum screen resolution of 800 x 600.

Use Internet Explorer, version 6.0 or higher.

Verify that the latest version of JAVA and/or ActiveX is installed on your PC.

Disable pop-up blockers prior to attempting to access the CMS Applications Portal.

Please click here to access the IACS Reference Guide for step-by-step instructions:  http://www.dmecompetitivebid.com/Palmetto/Cbic.nsf/files/R2_IACS_Reference_Guide.pdf/$FIle/R2_IACS_Reference_Guide.pdf

 VGM urges all providers considering placing a bid for the Round 2 and/or National Mail Order bidding program to follow the links below and become familiar with the information. 

VGM will also be updating its National Competitive Bidding Services website (http://www.vgmncbservices.com/) immediately to include this new information.  Look for summary and commentary relative to these updates in future Legislative Updates. 

——-

RFB Instructions 

Round 2 & National Mail-Order Forms 

Required Financial Documents

Bid Preparation Worksheets

Bid Evaluation

Education Events

Fact Sheets

Thanks to many industry leaders for their hard work, and continued dedication to working together, a few delays have been announced for this new round of CB items. This is at at least some relief for complex rehab providers.

K0005s   (Ultra light weight wheelchairs)

E0986    (Power assist)

E1030    (w/c Vent Tray)

After consideration of feedback from stakeholders, CMS has removed ultra lightweight manual wheelchairs, gimbaled ventilator trays, and push activated power assist devices from the standard wheelchair product category for Round 2.  CMS expects to phase in these items in a future round.

Peggy Walker, RN

US Rehab/VGM

800-401-3643

The Centers for Medicare & Medicaid Services (CMS) has announced the bidding timeline for the Round 2 and national mail-order competitions of the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program.  To view the timeline, visit the Competitive Bidding Implementation Contractor (CBIC) web site at www.dmecompetitivebid.com.

Bidding Suppliers: Round 2 & National Mail-Order

Bidding Timeline for the 
DMEPOS Competitive Bidding Program 
Round 2 and National Mail-Order Competitions

TIMELINE 

11/30/2011   The Centers for Medicare & Medicaid Services (CMS) announces bidding timeline, begins bidder education program 

12/5/2011*�
Registration for user IDs and passwords begins 

12/22/2011*�
Authorized Officials are strongly encouraged to register no later than this date 

1/12/2012*�
Backup Authorized Officials are strongly encouraged to register no later than this date 

1/30/2012*�
CMS opens 60-day bid window for Round 2 and National Mail-Order Competitions 

2/9/2012*�
Registration closes 

2/29/2012*�
Covered Document Review Date for bidders to submit financial documents 

3/30/2012*�
60-day bid window closes 

Fall 2012*�
CMS announces single payment amounts, begins contracting process 

Spring 2013*�
CMS announces contract suppliers, begins contract supplier education campaign 

Spring 2013*�
CMS begins supplier, referral agent, and beneficiary education campaign 

July 1, 2013*�
Implementation of Medicare DMEPOS Competitive Bidding Program Round 2 and National Mail-Order Competition contracts and prices 

* = Target date. Actual date will be announced through listserv notice. Keep informed – click here to sign up for the listserv. 

last updated on 11/30/2011

Bidder Education Program

CMS has also launched a comprehensive bidder education program.  This program is designed to ensure that DMEPOS suppliers interested in bidding receive the information and assistance they need to submit complete bids in a timely manner.  The CBIC is the official information source for bidders and the focal point for bidder education.  The CBIC web site, www.dmecompetitivebid.com, features a comprehensive array of important information for suppliers, including bidding rules, user guides, policy fact sheets, checklists, and bidding information charts.   The education program will also include webcasts that will cover all the essential topics suppliers will need to know in order to bid.   These webcasts will be posted on the CBIC web site and will be available 24 hours a day/7 days a week.  When a webcast is posted, the CBIC will announce its availability through a CBIC e-mail update announcement.  To sign up to receive webcast announcements and other key registration and bidding information, visit the CBIC web site at www.dmecompetitivebid.com and subscribe to e-mail updates.

In addition to viewing the information on the CBIC website, DMEPOS suppliers are encouraged to call the CBIC toll-free help desk, 1-877-577-5331, with their questions and concerns. 

To view the Press Release, please click: www.cms.gov/apps/media/press_releases.asp 

To view the Fact Sheet, please click:   www.cms.gov/apps/media/fact_sheets.asp 

For more information on Round Two from the CBIC Web page:

http://www.dmecompetitivebid.com/palmetto/cbic.nsf/What’s New?openview

Created 12/01/2011

WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) announced Wednesday operational details for the next stage in its competitive bidding program despite ongoing opposition from patient advocacy groups, economists and 145 members of Congress.

The Medicare Competitive Bidding Program for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) was expanded by the Affordable Care Act and CMS expects it will save Medicare, seniors and taxpayers more than $28 billion over 10 years.

According to CMS, the first phase of the program has saved Medicare 35 percent compared to the fee schedule and resulted in lower cost for Medicare patients so far in 2011.
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“Today marks another step forward in our progress towards obtaining fair prices for equipment like wheelchairs and walkers,” said CMS Administrator Donald M. Berwick, MD, in a statement. “We are looking forward to a robust competition that will achieve better value and preserve access for our beneficiaries.”
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Under the program, DMEPOS suppliers compete to become Medicare contract suppliers by submitting bids to provide certain items in competitive bidding areas (CBAs).
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The first phase of the program was implemented for nine product categories in nine areas of the country on Jan. 1, 2011. 

CMS released the detailed schedule for Round 2 bidding on Wednesday. Registration will begin on December 5, and the 60-day supplier bidding period will begin in late January of 2012.
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Round 2 expands the program to 91 additional metropolitan areas, and the new prices are expected to take effect on July 1, 2013. A National Mail Order Competition to help bring down prices for mail order diabetic supplies will coincide with the Round 2 timeline. 

Not everyone agrees with CMS that the bidding program has been a success

“It is safe to say that the only organization that views the bidding system as a success is the federal agency in charge of its implementation,” said Tyler J. Wilson, president of the American Association for Homecare.

According to AAH, 30 patient advocacy groups, 244 economists and auction experts and 145 members of Congress oppose the program, citing reduced access to care, flaws in the program design and negative impact on local jobs.  

“In Round 1, the Medicare bidding program caused more problems than it solved,” said Tyler. “Round 2 will just compound the disruption and dissatisfaction that is occurring right now with respect to beneficiaries and DME providers as well as physicians, case managers, discharge planners and others who help connect those who need good homecare with those who provide it.”  

Despite this ongoing controversy, CMS is moving ahead with Round 2.
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“We have considered feedback from many stakeholders to implement process improvements to make the competitive bidding program even stronger,” said Jonathan Blum, deputy CMS administrator and director of the Center for Medicare, in a statement. “In addition to the enhancements we’ve made to our bidder education program, we will be strengthening our rigorous bid evaluation process by increasing our scrutiny of bids.”
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The Round 2 categories of products are similar to those in Round 1, with some additions. The Round 2 product categories are:

• Oxygen, oxygen equipment, and supplies;
• Standard (power and manual) wheelchairs, scooters, and related accessories (a new category that combines all mobility devices);
• Enteral nutrients, equipment, and supplies;
• Continuous Positive Airway Pressure (CPAP) devices and Respiratory Assist Devices (RADs) and related supplies and accessories;
• Hospital beds and related accessories;
• Walkers and related accessories;
• Negative Pressure Wound Therapy pumps and related supplies and accessories (new category);
• Support surfaces (Group 2 mattresses and overlays).

Beneficiaries may continue to use their current suppliers at this time. Similar to the successful implementation of Round 1 of the program, CMS will conduct extensive outreach to beneficiaries in the Round 2 areas prior to the new program taking effect.

2) California is a big state full of outspoken activist for people with different abilities.  We need to spend more time there.

3) IPads were an excellent and easy way to allow advocates to contact congress with no hassle.

4) We officially ran out of our year’s supply of 50,000 pieces of competitive bidding literature for consumers.  Looks like we will be ordering more for next year.

5) Travel Tip:  Alaskan Airlines provides free beer and wine from Portland to San Jose!

While they are working in their home districts for Thanksgiving and Holiday recess, providers should take this opportunity to contact their legislators to invite them to visit their company site location. Invite them to your site to discuss the competitive bidding program, its impact from Round 1 implementation, and the upcoming Round 2.

When meeting with your members of Congress, utilize the Leitten Study and the Rogers/Rehberg Letter for talking points. The Rogers/Rehberg letter was written to the Honorable Gene Dodaro requesting an immediate and comprehensive review of the Medicare Competitive Bidding Program for durable medical equipment (DME). Ask that your legislators support the Rogers/Rehberg letter.

Providers can request to meet with their representatives and two senators by either calling their local office to schedule an appointment. Providers can also meet with their legislators by attending scheduled town hall meetings. Schedule town hall meetings can usually be found on legislators’ Web site or by calling their local offices. Contact information and the Web sites may be found at www.vgmdclink.com.

All Power Operated Vehicles (K0800-K0805 and K0809-K0812)

• All standard power wheelchairs (K0813 thru K0829)
• All Group 2 complex rehabilitative power wheelchairs (K0835 thru K0843)
• All Group 3 complex rehabilitative power wheelchairs without power options (K0848 thru K0855)
• All pediatric and Group 4 power wheelchairs (K0887 thru K0891)
• Miscellaneous power wheelchairs (K0898)

Group 3 complex rehabilitative power wheelchairs with power options (K0856 thru K0864) have been excluded from this demonstration project.

Some example questions that can be submitted are:

1. During this process will the Prior Authorization team also be looking for Administrative Errors or just Medical Necessity?
2. Will physicians receive any incentives to encourage them to complete this process?
3. Who will be responsible for collecting the data and documentation for the PA? The physicians’ office or the supplier?
4. Who will receive the Prior Authorization confirmation or denial? The physician and the supplier or just the physician?
5. Who will receive the Prior Authorization confirmation or denial? The physician and the supplier or just the physician?
6. What if the ordering practitioner refuses to cooperate with the providers?

Fact sheets for the details of this process can be viewed at: https://www.cms.gov/apps/media/press/factsheet.asp?Counter=4168 

The states mentioned / 43% of the $606 million total Medicare expenditures for PMDs in 2010.

2 phases of the demonstration starting January 1, 2010

1. First phase will be a prepayment review process lasting from 3 to 9 months in which all applicable (not known what these are) will be reviewed on a pre-pay basis.
2. Second phase (which will be good for us since we do not have to deliver before being reviewed) BUT physicians and treating practitioners will submit the prior authorization (while working with the supplier) no details on how this is to happen/ who collects data?
3. The pre pay will be phased out during first year (this is to last 3 years) and prior authorization will be implemented throughout the seven states.

NOTE: if you choose to not do a prior authorization during this second phase and instead bill without a PA and your claim is accepted you will receive a 25% discounted rate on your claim. This is to make sure all suppliers use the prior authorization process. CMS has stated that the combined affect on claims will be approximately 325,000 claims over the three-year demonstration. (I can’t see anyone doing this anyway) Prior Authorization is good for the suppliers in many ways.

The big issue will be getting the ordering practitioner to participate. It is important for all of our members to be aware and ask your questions in the venue provided.

Get involved – READ the information __ make sure you put your questions in now and be on CMS call!

 Friday DEC 2 2011 – 2:00 to 3:30 Eastern Time Only

 1-866-501-5502 – ID   29840167

Transcript available on or around Tuesday, December 13 2011 http://www.cms.gov/OpenDoorForums_ODF_SpecialODF.asp

Call Peggy Walker, RN at 800-401-3643 if you need any assistance.

Centers for Medicare & Medicaid Services

Special Open Door Forum:

Medicare’s Prepayment Review and

Prior Authorization Demonstration Project for Power Mobility Devices

Friday, December 2, 2011

­­­2:00pm- 3:30pm Eastern Time

Conference Call Only

The purpose of this Special Open Door Forum (ODF) is to provide an opportunity for suppliers to ask questions about the Demonstration. 

The Centers for Medicare & Medicaid Services (CMS) will conduct a demonstration that will implement a prior authorization process for certain medical equipment for all people with Medicare who reside in seven states with high populations of fraud- and error-prone providers (California, Florida, Illinois, Michigan, New York, North Carolina, and Texas).  This is an important step toward paying appropriately for certain medical equipment that has a high error rate.  This demonstration will help ensure that a beneficiary’s medical condition warrants their medical equipment under existing coverage guidelines. Moreover, the program will assist in preserving a Medicare beneficiary’s right to receive quality products from accredited suppliers. 

The Prior Authorization demonstration will be implemented in two phases. During the first phase (the first three to nine months), the Medicare Administrative Contractors will conduct prepayment reviews on certain medical equipment claims. The second phase, for the remainder of this three-year demonstration, will implement prior authorization, a tool utilized by private-sector health care payers to prevent improper payments and deter fraud.

To read more about the Demonstration visit: http://go.cms.gov/cert-demos.

Participants may submit questions prior to the Special ODF to pademo@cms.hhs.gov by Thursday, December 1, 2011, 5pm ET.

We look forward to your participation.

Special Open Door Participation Instructions:

Dial: 1-866-501-5502 & Conference ID: 29840167 

Note: TTY Communications Relay Services are available for the Hearing Impaired.  For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.

A transcript and audio recording of this Special ODF will be posted to the Special Open Door Forum website at http://www.cms.gov/OpenDoorForums/05_ODF_SpecialODF.asp and will be accessible for downloading beginning on or around Tuesday, December 13, 2011.

 For automatic emails of Open Door Forum schedule updates (E-Mailing list subscriptions) and to view Frequently Asked Questions please visit our website at http://www.cms.gov/opendoorforums/.

The following article from Huffington Post discusses taking first steps to modernizing entitlement programs such as Medicare and Medicaid. The Super Committee can take the long-term view of reform with steps that will move away from the failed approach of Washington micro-management and toward modern reforms that rely on consumer choice and market competition.

In this article, competitive bidding is described as a program that is actually driving out competition and violating all the rules of a market-driven bidding system. In order to save consumer choice and access to quality medical goods and services, this program should be SHUT DOWN!

All providers should forward this article to their members of Congress and ask that they help shut down the competitive bidding program, as well as save beneficiary’s choice and access to quality care.

For the Super Committee, an Option to Save Medicare

By Grace-Marie Turner

The congressional Super Committee knows that entitlement programs, especially Medicare and Medicaid, are driving our nation’s ballooning budget deficit, yet both Republicans and Democrats fear they are politically untouchable.

But they must be changed to survive and for Congress to have any hope of controlling federal spending.

Legislators can move past this political paralysis by taking first steps to begin to modernize entitlement programs.

The Medicare Prescription Drug Program provides a model for reform. Since its adoption in 2003, Part D has provided affordable drug coverage to seniors by harnessing competition and consumer choice. Private companies approved by Medicare offer prescription drug coverage to seniors who shop to find the plan that best meets their needs. In the process, they force health plans to actively compete to offer the lowest prices and best benefit design.

The result is an entitlement program that is actually under budget. Medicare Part D is coming in 46 percent below original estimates — saving money for taxpayers and seniors. The average Part D enrollee is now paying just $30 a month, far below the $53 premium originally projected by this point. Between 2010 and 2011, average Part D premiums rose just $1.

House Budget Chairman Paul Ryan has a plan to extend this concept to all of Medicare. He would provide seniors with a credit they could use to purchase a Medicare-approved health plan of their choice from among competing plans.

When it begins in the year 2022, the Ryan proposal would provide a generous payment so seniors can pick the health plan that best meets their needs. This federal contribution would be adjusted based on their age, financial well-being, health status, and similar considerations. The older, the poorer, the sicker seniors are, the larger their Medicare payments would be. Everyone who qualifies for Medicare would be guaranteed coverage.

This idea was widely criticized earlier this year when it was included in the House budget, but as Super Committee members honestly study the options, they can’t help but see that this is the right platform to modernize and save Medicare. A number of bi-partisan commissions have come to the same conclusion.

This could be an opportunity for the Super Committee to put down markers for congressional standing committees to get to work on reforms that will grow over time and reduce the future flood of red ink driven by uncontrolled entitlement spending. Congress’ challenge is to make sure the payment is adequate for seniors to obtain coverage while not putting future taxpayers in the poor house.

The alternative is the path we are on, embedded in the new health law — deep cuts in payments to doctors that will drive many out of practice and rationing by the unelected, unaccountable Independent Payment Advisory Board, leading to longer and longer waiting times for medical services.

Spending on Medicare and other entitlement programs must be contained. To survive, Medicare must be changed, and the question is whether it will be through the cuts, price controls, and rationing under current law, or through Rep. Ryan’s plan that enables enrollees to apply the government’s contribution to guaranteed health coverage while bringing the power of market competition to reduce health costs.

While it works to develop positive reform, it is just as important for the Super Committee to avoid changes that will make problems worse. Sen. Jay Rockefeller (D-WV) and Rep. Henry Waxman (D-CA) want the Super Committee to raise money by requiring pharmaceutical firms to pay a minimum rebate on prescription drugs for people who qualify for both Medicare and Medicaid. This is a misguided proposal. Studies show that these rebates would ultimately shift costs back to seniors in the form of higher drug costs and premiums.

The Committee also must beware of programs masquerading as competition. The so-called “Competitive Bidding Program” for Medicare is designed to save money in Medicare’s purchasing of durable medical equipment — everything from diabetic supplies to sophisticated home wound care equipment.

Instead of Washington setting prices, the agency that runs Medicare is supposed to get competitive bids on these medical supplies. It sounds like a good idea. But the regulations the agency set up to implement this program are actually driving out competition and violating all the rules of a market-driven bidding system. Companies can bid so low that they drive out legitimate suppliers, and then the winning bidder doesn’t have to supply the product! This program will disrupt patients’ access to medical goods and should be shut down, not expanded.

Yet the Obama administration has proposed extending this program to Medicaid, despite letters sent by 30 patient advocacy groups, 244 economists and 145 members of Congress objecting. The price distortions in the program are likely to ricochet throughout the health sector, making it difficult if not impossible to find the true competitive price for medical devices in the future, according to Tom Bradley, chief of Medicare cost estimates at the Congressional Budget Office. The Super Committee would do well to shut this program down completely.

The key to real reform is building in changes to Medicare and Medicaid that rely on consumer choice and competition, not price controls and crushing government regulations.

Rationing, regulations, and price controls always fail. The Medicare drug program shows how a truly competitive program can work. It works because consumers are in charge of seeking the best value in their health spending, forcing providers to deliver better services at lower cost.

To ensure the future of Medicare and Medicaid — and to correct our disastrous fiscal course — the Super Committee can take the long-term view of reform with steps that will move away from the failed approach of Washington micro-management and toward modern reforms that rely on consumer choice and market competition.

The Center for American Progress not only discusses noticeable flaws with the implementation of the competitive bidding program, they have also put forth recommendations for the program. The first stated recommendation by the center includes extending the competitive bidding process to all feasible goods such as medical devices and laboratory tests, by January 2013.

All providers, doctors, and hospitals should join in our fight against competitive bidding as the program may affect them next!

Competitive Bidding in Medicare

by Zeke Emanuel, David M. Cutler, Topher Spiro
October 26, 2011

Many of the prices Medicare pays for goods are exorbitant, and the same good could be purchased for much less. Wheelchairs, oxygen equipment, hospital beds used at home, and artificial-feeding supplies are all well-documented examples of goods that Medicare purchases at inflated prices. The Medicare price for an oxygen concentrator, for example, was $1,703 higher than the average price on the Internet at one time.[1]

Medicare’s competitive bidding program for some durable medical equipment is an attempt to remedy this cost problem. Rather than using a government fee schedule, prices are market-based: Medicare holds an auction and lower bids win the contract. In the first round of competitive bidding, which covered nine product categories, the average price savings was 35 percent.[2] This results in savings for Medicare, as well as savings for beneficiaries through lower coinsurance and monthly premiums.

But there were serious problems with implementation of competitive bidding, including a lengthy delay between bids and acceptance, unclear quality standards and performance obligations, lack of transparency on pricing and quantities, and contract terminations and delays mandated by law. According to most experts, competitive bidding could be dramatically improved to assure low costs without sacrificing product quality or access.

The Affordable Care Act requires the secretary of health and human services to expand competitive bidding for durable medical equipment, prosthetics, orthotics, and supplies to 91 of the largest metropolitan areas and then to all regions by 2016. Congress can accelerate this timeline, expand the number of goods and services subject to competitive bidding, enhance the operations and monitoring of the process, and realize significant cost savings.

Recommendations

Require competitive bidding for all durable medical equipment, prosthetics, orthotics, and supplies nationwide, and extend the process to medical devices and laboratory tests, by January 2013. This recommendation affirms the value of competitive bidding by requiring implementation three years sooner and expanding the program to all feasible goods.

Establish a Medicare Competitive Bidding Committee, composed of individuals from the private sector with acquisition experience and experts in competitive bidding. Since proper implementation of competitive bidding is complex and technical, the committee- rather than government staff at the Centers for Medicare & Medicaid Services -would oversee the process. The committee would monitor the market response to ensure product quality and access, and have authority to add and/or subtract goods and services subject to competitive bidding. For instance, it might be possible to extend competitive bidding to outpatient radiological examinations such as CT scans or MRIs.

Ezekiel J. Emanuel and David M. Cutler are Senior Fellows at the Center for American Progress. Topher Spiro is the Managing Director for Health Policy at the Center for American Progress.

Notes

[1]. Statement by Kerry Weems, acting administrator, Centers for Medicare and Medicaid Services, before the Committee on Ways and Means Subcommittee on Health, U.S. House of Representatives, May 6, 2008.

[2]. Centers for Medicare and Medicaid Services, “Next Steps for Expansion of the Medicare Durable Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program” (2011).

We’re gathering stories about the importance of medical equipment providers in the lives of those who depend on quality service and equipment to live at home.

We would love to see you if you live in the area. Take a look at our schedule.

Care Fair 2011, Hilton Seattle Airport – Nov. 15
Care Fair 2011, Red Lion Jantzen Beach, Portland – Nov. 17
Abilities Expo, San Jose Convention Center, CA – Nov. 18-20

Contact us at kelly.turner@peopleforqualitycare.org for questions or to meet up.

www.huffingtonpost.com/mobileweb/gracemarie-turner/super-committee-medicare_b_1077105.html

Our booth gives providers the opportunity to contact Congress with an important message to support H.R. 1041, the bill that will repeal competitive bidding.  We’re learning that some providers are hesitant to take action. They feel that since they aren’t currently in a bidding area, their message is not impactful. In addition they feel insulated from the changes that are affecting thousands of beneficiaries.

We’re here with a postive message that our input to Congress does make a difference, and it will take health care professionals and Medicare beneficiaries to come together with a unified message- Americans deserve quality home care.  

In addition, competitive bidding is spreading so it’s important for providers nationwide to join the action. We’re facing major challenges as an industry, and our attitudes will make all of the difference in the world when it comes to advocating for the needs of medical equipment users.

So what can you do to make a difference?

1. Request literature from People for Quality Care to distribute to your customers. It’s easy to understand and meant to educate consumers about competitive bidding and how they can speak out against it.

2. Contact your Congress person on behalf of the customers you serve. Have you heard a story about how competitive bidding has left someone without service or as left them  confused by contacting multiple providers for their equipment needs? Share those stories with Congress. Email them from our website by entering your zip code. www.peopleforqualitycare.org

3. Keep a positive attitude that this battle is not yet lost. Even if it seems impossible, your care for customers will show through in your advocacy. It only makes sense that we take this on together.

The NAS Supplier Contact Center can only answer general questions about the RAC program. Medicare suppliers are advised to contact the RAC directly with questions or comments concerning RAC activities.