An Important Message from Medicare:

Starting January 1, 2011, Medicare is phasing in a new competitive bidding program in some areas of the country, including your area. This program will change the amount Medicare pays suppliers for certain durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) (e.g., walkers, certain power wheelchairs, and oxygen and oxygen equipment) and make changes to who can furnish these items under Medicare Part B. Under the first phase of this new program, the Medicare DMEPOS Competitive Bidding Program, beneficiaries with Original Medicare who permanently reside in or travel to 9 geographic areas, also called competitive bidding areas or CBAs, are required to obtain DMEPOS items in 9 product categories from a Centers for Medicare & Medicaid Services (CMS) designated “contract” supplier, unless an exception applies.

It is crucial that you, as someone who may refer or order these items, be informed about how this program will affect your Medicare patients so that Medicare will continue to pay for covered services. For purposes of the Medicare DMEPOS Competitive Bidding Program, “referral agent” includes such entities as Medicare enrolled providers, physicians, treating practitioners, discharge planners, social workers, and pharmacists who refer beneficiaries for services in a CBA.

We are sending you this letter because, as a referral agent with a practice location in a CBA, you play a critical role in helping your Medicare patients select the appropriate DMEPOS supplier. A beneficiary’s first contact with the program may be at the point when you hand him or her a prescription for an item or refer him or her to a Medicare supplier. Please help the beneficiary understand that if he or she resides in a CBA or is visiting a CBA and needs to obtain a DMEPOS competitive bid item, he or she must use a contract supplier unless an exception applies, as discussed in the educational products listed below.

The first phase of the new program begins in your area on January 1, 2011. To assist you in preparing for this date, we suggest that you become familiar with the following program information:

1. The enclosed Medicare Learning Network “DMEPOS Competitive Bidding Program Fact Sheet for Referral Agents” that further describes your role as a Referral Agent in this new program. This Fact sheet can also be found at www.cms.gov/MLNProducts/downloads/DME_Ref_Agt_Factsheet_ICN900927.pdf;

2. Competitive Bidding Program exceptions that apply to non-contract suppliers can be found in the “DMEPOS Competitive Bidding Program Non-Contract Supplier Fact Sheet” at http://www.cms.gov/MLNProducts/downloads/DME_Noncontract_Factsheet_ICN900925.pdf; and

3. Materials, including the letters and introductory brochure that were mailed to beneficiaries in each CBA to describe the new program, can be found at www.cms.gov/Partnerships/03_DMEPOS_Toolkit.asp.

The CMS designated Medicare DMEPOS Competitive Bidding Program contract suppliers for each CBA can be found in PDF lists at www.cms.gov/DMEPOSCompetitiveBid/01A2_Contract_Supplier_Lists.asp#TopOfPage. In addition, CMS will soon be updating its on-line supplier locator tool at www.medicare.gov/supplier with new features for competitive bidding. CMS will issue a message, through existing electronic mailing lists (email), when the competitive bidding program features have been added to the on-line supplier locator tool.

For the most current news, educational products, and announcements regarding the DMEPOS Competitive Bidding Program, please visit the dedicated DMEPOS Competitive Bidding Program website www.cms.hhs.gov/DMEPOSCompetitiveBid. Educational resources designed for the non-contract supplier and referral agent community can be located by clicking on “Educational Resources” found on the left hand side of the page. Information on the medical equipment and supplies included in the first phase can be found by clicking on “Product Categories, Items, and HCPCS”.

If you still have questions after reviewing the educational resources, your competitive bidding local ombudsman is available to assist you. Contact information for the ombudsman assigned to each CBA is enclosed. Your CMS Regional Office is also available for assistance.

In summary, as of January 1, 2011, please help your Medicare patients that reside in a CBA or are visiting a CBA to use the appropriate DMEPOS supplier when you are ordering or referring the patient for medical equipment or supplies. Understand the exceptions for when the patient is not required to use a CMS designated contract supplier. And finally, know how to access the contract supplier listing for the CBA. CMS thanks you in advance for helping Medicare beneficiaries who, as a result of this program, will pay less in out-of-pocket expenses and continue to receive quality products from accredited suppliers.

Enclosures

 

A link to the original letter is here

Charlotte-Gastonia-Concord NC/SC
Makisha Pressley-Callaham
(704) 795-6225
Makisha.P.Callaham@PalmettoGBA.comThis e-mail address is being protected from spambots. You need JavaScript enabled to view it

Cincinnati-Middletown, OH/KY/IN
Vinsetta Montgomery
(614) 475-4235
Vinsetta.Montgomery@PalmettoGBA.comThis e-mail address is being protected from spambots. You need JavaScript enabled to view it

Cleveland-Elyria-Mentor, OH
Kim Scippio
Kim.Scippio@PalmettoGBA.comThis e-mail address is being protected from spambots. You need JavaScript enabled to view it

Dallas-Fort Worth-Arlington, TX
Elena Armstrong
(903) 868-2705
Elena.Armstrong@PalmettoGBA.comThis e-mail address is being protected from spambots. You need JavaScript enabled to view it

Kansas City, MO/KS
Michal Mitko
(913) 884-6008
Michal.Mitko@PalmettoGBA.comThis e-mail address is being protected from spambots. You need JavaScript enabled to view it

Miami-Fort Lauderdale-Pompano Beach, FL
Letisha Davis
(954) 476-3508
Letisha.Davis@PalmettoGBA.comThis e-mail address is being protected from spambots. You need JavaScript enabled to view it

Orlando-Kissimmee, FL
Carmen Soto-Ortiz
(407) 282-0643
Carmen.Soto-Ortiz@PalmettoGBA.comThis e-mail address is being protected from spambots. You need JavaScript enabled to view it

Pittsburgh, PA
Rahshaan M. Felder
(724) 742-0167 <
Rahshaan.M.Felder@PalmettoGBA.comThis e-mail address is being protected from spambots. You need JavaScript enabled to view it

Riverside-San Bernardino-Ontario, CA
Janice Selling
(951) 780-3694
Janice.Selling@PalmettoGBA.comThis e-mail address is being protected from spambots. You need JavaScript enabled to view it

Starting January 1, 2011, if your patients with Original Medicare live in or visit one of the communities listed below, and must obtain any of the equipment or supplies included in the program (also listed below), they will almost always have to use Medicare contract suppliers for Medicare to help pay for the item.  

The first nine areas included in the new program are:

1. Charlotte - Gastonia-Concord, NC - SC
2. Cincinnati - Middletown, Ohio - Kentucky - Indiana
3. Cleveland - Elyria - Mentor, Ohio
4. Dallas - Fort Worth - Arlington, Texas
5. Kansas City, Missouri - Kansas
6. Miami - Fort Lauderdale - Pompano Beach, Florida
7. Orlando - Kissimmee, Florida
8. Pittsburgh, Pennsylvania
9. Riverside - San Bernardino - Ontario, California

The products and equipment included in the program are:  

1. Oxygen, oxygen equipment, and supplies
2. Standard power wheelchairs, scooters, and related accessories
3. Complex rehabilitative power wheelchairs and related accessories (Group 2 only)
4. Mail-order diabetic supplies
5. Enteral nutrients, equipment, and supplies
6. Continuous positive airway pressure (CPAP) devices and respiratory assist devices (RADs) and related supplies and accessories
7. Hospital beds and related accessories
8. Walkers and related accessories
9. Support surfaces (Group 2 mattresses and overlays in Miami-Fort Lauderdale-Pompano Beach only)

If your patients currently rent oxygen and oxygen equipment or durable medical equipment, they may be able to continue renting these items from their current supplier when the program takes effect, if the supplier decides to participate in the program as a “grandfathered” supplier.

Medicare has a variety of resources available to help you understand the new program at www.cms.gov/DMEPOSCompetitiveBid; DMEPOS Competitive Bidding Program Medicare Learning Network® (MLN) Fact Sheets can be found at www.cms.gov/MLNProducts/downloads/DMEPOS_Competitive_Bidding_Factsheets.pdf.

I’ve heard that more than once,  this week and I’m glad it was brought up on the call.
After it was asked, the first response indicated that it was correct. The non-winning provider would be unable to take patients outside of the CBA. However, Joel Kaiser of CMS came on the line and corrected the misinformation.

As we’ve expected all along, if the provider is located inside the CBA and the patient is outside of the CBA they can take the patient just as we do now. There would be no effect to the ability to bill for the patients equipment or the reimbursement.
So, that’s one rumor we can put to bed at least…

1.    A non-contract supplier that elects to become a grandfathered supplier must provide a 30-day written notification to each Medicare beneficiary who resides in a CBA and is currently renting competitively bid oxygen and oxygen equipment or DME from that supplier.  These notifications must be sent by Wednesday, November 17, 2010.  A non-contract supplier that elects to become a grandfathered supplier must also provide written notification to the Centers for Medicare & Medicaid Services (CMS) of this decision by Wednesday,  November 17, 2010.

2.    A non-contract supplier that elects not to become a grandfathered supplier is required to pick-up the item it is currently renting to the beneficiary from the beneficiary’s home after proper notification.  Proper notification includes a 30-day, a 10-day, and a 2-day notice of the supplier’s decision not to become a grandfathered supplier to its Medicare beneficiaries who are currently renting competitively bid DME or oxygen and oxygen equipment and who reside in a CBA.  The 30-day notification to the beneficiary must be sent by Wednesday, November 17, 2010, and must be in writing.

For more information on grandfathering requirements, please see the “DMEPOS Competitive Bidding Program Grandfathering Requirements for Non-Contract Suppliers Fact Sheet,” which is now available, free of charge, from the Medicare Learning Network® at http://www.cms.gov/DMEPOSCompetitiveBid/04_Educational_Resources.asp in the “Downloads” section.

This site is in its beta release. That means that while it is functional, it is not entirely complete. I have tested the site at length and find it to be very stable. However, there are some minor issues that will be fixed over the next several days.

It should be known that this is not a CMS website. This site was created by a DME supplier and is intended for referral sources, patients, and others who are affected by the Medicare Competitive Bidding Program.

The data
The data base used in this site contains all of the information released by Medicare regarding the companies who have won contracts under the Medicare Competitive Bidding Program. This is the exact data, taken verbatim from the PDF’s that were released. We converted those PDF’s into raw data and built this database around them.

ZIP Code Look UP
The patient’s home zip code determines if the patient will be included in the program or not. When the user enters the ZIP code, the system will inform them if the ZIP code is included in the program. If it is, it will show results for that competitive bidding area (CBA)

The Green Checkmark
You will find a green checkmark next to some providers. This checkmark tells the user that the company has all of the contracts they selected. We assume that a referral source will want to find a single source for patients when possible.

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Known Issues

At the moment there are several known issues that will be fixed in the next release:
1. Internet Explorer – some columns in the results page may not align correctly. The results are still perfectly usable; it just may not look as orderly as it should.

2. Some companies that were listed with multiple locations may show more than once in the search results. This will be resolved shortly. In the near future, all branch locations will be shown by the details link on the right.

3. The site needs more graphics… Yes, I agree