From: Home Care Magazine

CMS sets calls for referral agents, contract winners

BALTIMORE — A multi-slide presentation held Monday afternoon (available for download as a PDF) and aimed at Round 1 providers who failed to win a competitive bidding contract yielded a lot of information — but a super-tight deadline to make crucial decisions. Specifically, non-contract suppliers must determine if they are willing and able to be grandfathered suppliers no later than Wednesday, Nov 17. If they choose not to be a grandfather supplier, they must also notify beneficiaries by that deadline — and begin to transfer business to contracted DMEPOS competitive bidding providers.

A non-contract supplier who decides not to take the grandfathering route must pick up rental equipment from the patient’s home after sending notifications that meet strict CMS guidelines. Proper notification includes a 30-day, 10-day, and finally a two-day notice reiterating the supplier’s decision to forego grandfather status. The first 30-day notification must be sent by Nov. 17, and it must be in writing.

Directions for notifying beneficiaries can be found on the Competitive Bidding Implementation Contractor (CBIC) website.

CMS’ call was the first of several that have been scheduled, with the remaining calls for referral agents in the Round 1 CBAs and contract winners:



According to information on Monday’s 90-minute call, bidders who failed to win contracts can call the CBIC (877/577-5331) for an explanation. Officials set Friday, Nov. 19, as the final day for such inquiries. If mistakes were made, CMS’ Martha Kuespert, senior technical advisor of the Chronic Care Policy Group, indicated that contracts could still be awarded.

Suppliers that elect to become grandfathered suppliers are also bound by the Nov. 17 deadline and must notify current Medicare beneficiaries with a written notice. The notice must include: all grandfathered items; the beneficiary’s right to choose; the supplier’s contact information; and 1-800-MEDICARE or references for questions.

Sample notification letters are also available on the CBIC website. Providers must properly document the beneficiary’s decision, and Kuespert reminded callers not to assume that beneficiaries wish to remain as a customer/patient. 

While the call included information and instructions on various aspects of the bidding program — CMS received over 100 questions in advance of the call — only a 10-minute period was reserved for live phone calls. Much of that time was devoted to a lengthy exchange with Miami provider Rob Brant of City Medical Services president of the Accredited Medical Equipment Providers of America.

Brant sought an answer to a specific situation involving so-called “snowbirds” who travel to Florida during the winter. Since under grandfathering suppliers must accept assignment for all patients, for those oxygen patients he is currently billing unassigned, asked Brant, “What do I tell these patients … Do I let these patients know I can no longer service you and tell them ‘You need to find another provider willing to take you?'”

Responded CMS’ Joel Kaiser, “When we are talking about grandfathered items, these are items for which you have a rental agreement with the beneficiary prior to the start of the competitive bidding program, so that would be Jan. 1. So if you are renting an item to a beneficiary who had permanent residence in a CBA as of Dec. 31 of 2010 — you are currently renting the item to them now and you are going to be renting to them Dec. 31 — then you need to make the decision.

“When you make the decision to become a grandfathered supplier for the entire product category for that CBA, if they live in that CBA, and you are furnishing the item for that beneficiary, you must grandfather for them as well. You can’t pick and choose patients for which you are going to grandfather.

“It is all or nothing,” said Kaiser. “You grandfather for all the patients for that product category and for that area.”

A transcript and audio recording of the Nov. 8 call should be available on the CMS website “in the coming days,” a CMS official said.

Fact sheets referenced on the call, including a fact sheet on grandfathering, are available on CMS’ website.