BALTIMORE--A second CMS provider training call last week showed just how many questions about competitive bidding remain.

Among a barrage of detail-oriented queries, a range of topics included subcontracting, patient residency, what will happen in cases where contract winners are not licensed (if required) in states where they won bids and what exactly is being done to educate beneficiaries about the impending changes.

With just a few weeks left before round one is scheduled to take effect July 1, CMS allowed one-and-a-half hours for the May 27 session, designed to field questions about exactly how the bidding program will work. The time came and went with a ceaseless flow of calls--and not everyone got their questions addressed.

Following is a sample of questions from those who made it through the call-in queue.

--Jurisdiction: What to do when a patient's residence conflicts with his or her billing address

An Ohio caller asked about a patient who was being solicited by a winning bidder in Florida--but the patient resided in a nursing home in Detroit. The caller explained that the confusion in this situation derived from the fact that the patient's Power of Attorney is located in Florida.

In answer, CMS' Joel Kaiser, deputy director of DMEPOS policy, said, “If the beneficiary's permanent address is in a competitive bidding area but they are receiving services in an area outside of the competitive bidding area, then we would consider that beneficiary in 'travel status.'”

Kaiser's answer actually raises more questions, according to industry consultant Sylvia Toscano of Professional Medical Administrators in Boca Raton, Fla.

“If a patient resides in Wisconsin, let's say, but their sibling or son or daughter handles their Medicare affairs and that relative resides in a CBA, the permanent address with Medicare is listed as the relative's address,” Toscano, who listened in on the conference call, explained. “The item of DME such as oxygen would need to be provided by a contract supplier but there are no contract suppliers in Wisconsin because they are not in round one. How does the patient receive their equipment? How would a local supplier be paid under the Medicare program in this instance?”

--Licensure: What happens when bid winners are not properly licensed to serve a bidding area?

Rob Brant, a Miami provider and president of Accredited Medical Equipment Providers of America (AMEPA), asked Kaiser what would happen with those companies--at least eight of them in the Miami CBA alone, according to Brant--that won bids but do not have an oxygen license in the state of Florida.

“The contract suppliers were accredited to furnish the items they have been awarded a contract for,” answered Kaiser. “If you have information about a specific contract supplier where you think they were accredited for something inappropriately then you should send an email to us and we will research it.”

Kaiser's answer, which addressed accreditation, confused Brant.

“[Kaiser] kept saying 'We put the responsibility on the accrediting body.' But he is not even answering the question as to whether they checked the licensure,” Brant said. (For more, see "Oxygen Licensure Is Issue for Some Bid Winners" in this issue.)

--Subcontracting: Can we or can't we?

Toscano asked Kaiser the following question: “The article off of the [National Supplier Clearinghouse] Web site states that CMS interprets [section] 1834 of the Social Security Act to mean 'A supplier receiving payment from Medicare must be the entity furnishing and billing for the items or services, specifically a supplier cannot contract with other entities to provide essential services.' Are we allowed to subcontract for competitive bidding if we did not have an agreement in place at the time that this was filed?”

Kaiser's response: “Yes, you may subcontract. The contracted supplier is the one who will be submitting the claims for reimbursement. The contracted supplier is the one who is responsible for meeting the terms of the contract and ensuring that the items and services that are paid for under the DME benefit are provided. It is the contractor who is doing the billing. They may subcontract with other entities to provide various services for DME.”

Toscano then pointed out that Palmetto GBA's Web site states that “suppliers may not contract with other entities to provide essential services as the supplier is the entity receiving payment for Medicare, and therefore must be the one providing the items or services.”

Kaiser said he would have to consult with CMS' Office of Financial Management to get clarification on the issue.

“Can you explain 'essential services'?” Toscano persisted.

”I think we need to wait and get that answer from our supplier enrollment, supplier standards experts, who are not here today,” Kaiser said.

--Grandfathering: What should providers be doing?

Kaiser noted that CMS' new Chapter 36 of the Internet-only claims processing manual includes a section on grandfathering. “This relates to individuals who are receiving oxygen and oxygen equipment, or rented DME, from a supplier currently,” he told listeners. “We provide guidelines for the supplier regarding their decision to remain as a grandfathered supplier, giving the beneficiary that option, or what they should be doing if they elect not to be a grandfathered supplier. And that goes along with the whole transition issue.

“We're expecting current suppliers, who obviously have to notify the beneficiary if they are not going to grandfather, when they are going to pick up the equipment. There are obviously rules on when they can pick up the equipment, so they will have to be making arrangements with the supplier about that. They will have to be communicating with beneficiaries to make those arrangements and supply that information as to whether they are going to continue to provide services to the beneficiary.

“And if they are not, then the guidelines provide for them to refer the patient to a contracted supplier and to go through the channels to locate a new contract supplier,” Kaiser said.