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

    From: CMS


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

    Registration for user IDs and passwords begins

    Authorized Officials are strongly encouraged to register no later than this date

    Backup Authorized Officials are strongly encouraged to register no later than this date

    CMS opens 60-day bid window for Round 2 and National Mail-order Competitions

    Registration closes

    Covered Document Review Date for bidders to submit financial documents

    60-day bid window closes

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

  • From CRE’s DME Hotline: 1-800-613-7678 (Detroit, MI)

    “Yes, I am calling in regards to this competitive bidding. I think this is very unfair. First of all I’d like to know what about Congress? All the money that they make and are they not getting any benefits taken away from them. They get the best healthcare, they get the best of everything. This is not fair to the American people.

    Congress was to be built, was when it started, it was a voluntary thing and they had a certain term. Now why do we have to have these people paying top, giving these people top dollar for their money. Now what about the senior citizens who are taking advantage of the different companies that provide us with healthcare?

  • Obama’s Medicare Administrator Berwick to Resign on Dec. 2

    Nov. 23 (Bloomberg) — Donald Berwick, who directed the U.S. health-care overhaul as head of the Medicare and Medicaid programs, resigned, and President Barack Obama nominated Berwick’s top deputy to run the effort.

    Berwick’s confirmation as chief of the Centers for Medicare and Medicaid Services has been blocked by Senate Republicans, who say comments he made in the past criticizing the U.S. health system and complimenting the British National Health Service rendered him unfit for the job.

    Obama appointed Berwick to his post during a congressional recess after the 2010 health-care law was enacted. The process circumvented Senate confirmation. The U.S. Constitution limits the terms of recess appointments.

  • Front of mind: Round 2

    From: HME News

    By Liz Beaulieu, Editor

    ATLANTA – What are the lessons learned from Round 1 of competitive bidding? Be accurate and be timely, says Mark Higley, vice president of development for The VGM Group.

    Higley outlined tips for providers in Round 2 in a jam-packed session at Medtrade in October. 

    One tip on how to be accurate: Get a copy of your 855S form and make sure it’s up to date. It sounds like a no-brainer, but Higley said a whopping 40% of providers who submitted bids for Round 1 were disqualified due to clerical errors on the enrollment form–things like the wrong name or the wrong social security number.
    Providers can be timely by doing things like figuring out who will register to submit the bid now, even though registration isn’t open yet. Higley said some providers submitted “panic bids” because they waited too long to make these decisions.
    Other tips Higley shared with the audience: Download the affected zip codes (the metropolitan statistical areas and the competitive bid areas don’t match up exactly, he said); learn the licensing requirements in the bid areas (“Licensure was a killer in the first round, especially respiratory licensing,” he said); and submit only the required financial documentation–nothing more, nothing less (“Don’t do anything to confuse these poor people,” he said).
    As for where the Round 2 single payment amounts will fall, Higley said he doesn’t think there’ll be as big of a reduction this time around. The original Round 1 came in at 26% below the current fee schedule; the red-bid came in at 32%.
    “Will we get to 32% this time?” Higley said. “I don’t think so. This is opinion only, but I think we’ll see 25%. (But) it’s not my suggestion that you bid that.”
  • High error rate points to ‘systemic’ problem at CMS

    Editor’s Note:  The massive error rates at CMS demonstrate the need for increased White House oversight of the agency’s operations.

    From:  HME News

    ‘If I was Medicare, this would be embarrassing’

    By Theresa Flaherty, Managing Editor

    BALTIMORE – CMS’s announcement last week of a 61% improper payment rate for home medical equipment points to the need for the agency to take a closer look at its own policies and procedures, say HME industry stakeholders.
    “It points to a systemic problem,” said Walt Gorski, vice president of government affairs for AAHomecare. “If 61% of the class is failing, you need to look at the teacher.”
    Other claims types, like inpatient hospital and physician/lab/ambulance, have error rates in the single digits. The overall error rate for Medicare fee-for-service is 8.6%.
    There are several key factors pushing the error rate for HME so high, say stakeholders. Chief among them: unclear and inconsistent medical policy.
    “Suppliers are filing claims based on the requirements that are set by Medicare,” said Wayne Stanfield, president and CEO of NAIMES. “Is it so convoluted and overburdensome that no one can get it right? If I was Medicare, this would be embarrassing.”
    Adding to the problem: Providers are dependent upon physician documentation.
    “Not only do we have to make sure our documentation is in order, but make sure the physician’s is, too,” said Gorski. “If you are not going to hold physicians accountable, you are not going to effect change.”
    Gorski also pointed out that auditors have too much free rein when it comes to interpreting coverage policy.
    “Policies are subject to auditor interpretation,” he said. “Sixty-one percent of the time, federal auditors are overruling the clinical decision making of physicians.”
    CMS last week also announced a three-year demonstration project to expand prepay reviews by Recovery Audit Contractors (RACs). Under the demo, auditors will identify improper claims before payment is made. They will be paid contingency fees from the money CMS saves by denying improper claims.
    “AAHomecare has made a number of recommendations to prevent bad claims from being paid at the outset,” said Gorski. “But if you allow independent contractors to get a piece (of the Medicare pie), that is only going to hurt the providers and, in turn, the beneficiaries.”

    From: HomeCare Magazine

    American Association for Homecare members expressed continued frustration over competitive bidding while meeting at Medtrade last week with an ombudsman representing the Centers for Medicare & Medicaid Services bidding program. Members cited problems with rules governing repair and replacement, grandfathering, physician medical necessity documentation and the method the Centers for Medicare & Medicaid Services uses for cataloguing complaints and inquiries.

    Members asked the competitive bidding ombudsman to act more decisively, and warned that patients were being unnecessarily restricted in their choice of medical equipment.

  • The True Cost of Low Cost Bidding

    Editor’s Note:  The Washington Post story linked to below is presented as a reminder – and a warning – of the lasting real world consequences of federal reliance on low cost bidders.

  • Poorly Designed Medicare Auctions Could Disrupt Device Marketplace

    From: Heartland.org

    by Loren Heal, a Research Programmer at University of Illinois at Urbana-Champaign and a reporter for the Heartland Institute.

    Auctions for contracts to sell durable medical equipment under Medicare may have design flaws that will lead to prices too low for market stability, some consumer advocates warn. They say this likely result will be shortages in supply to patients, higher costs to government and society, and lower quality of care.

  • CMS Fails to Respond to Crucial Public Comment in Competitive Bidding Final Rule

    Over two-and-a-half years after the close of the comment period on the Interim Final Rule for competitive bidding, CMS has issued the Final Rule which failed to address many of the concerns expressed regarding the agency’s competitive bidding process.  In refusing to respond to comments on the bidding process and how CMS evaluates bid, CMS stated:

    We note that we received many comments on a wide range of issues that were not addressed in the interim final rule. We thank commenters for sharing their views on these issues; however, because these comments were outside the scope of the interim final rule, we do not address those comments in this final rule.

  • “The Committee also must beware of programs masquerading as competition”

    Editor’s Note:  The following article rightly warns about the deep flaws in Medicare’s Uncompetitive Bidding Program that are disrupting patient access to needed DME supplies and services.

    From: Huffington Post

    For the Super Committee, an Option to Save Medicare

    by Grace-Marie Turner, President, Galen Institute

    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.