BALTIMORE — On Wednesday, CMS held its second in a series of eight Special Open Door Forums on the Round 1 rebid titled "Learn the Rules to Submit a Bid Successfully."
Cindy Dreher, content and policy lead for the Competitive Bidding Implementation Contractor, gave an overview of competitive bidding areas, product categories and rules providers must follow when submitting bids. Among the items in Dreher's presentation:
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The name of the Miami-Fort Lauderdale-Miami Beach CBA has been changed to Miami-Ft. Lauderdale-Pompano Beach, but the geographic area remains the same.
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If zip code changes have occurred since Round 1, such as one zip code that has been split into two, then both are now included in the CBA. If a zip code was deleted completely, then that zip code has been removed from the CBA. No new zip codes have been added that would expand the areas of a CBA.
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The Round 1 rebid will be conducted for essentially the same HCPCS codes as Round 1 in 2008, with the exception of negative pressure wound therapy and Group 3 complex rehab power wheelchairs, which are excluded permanently from competitive bidding. There are also exceptions for obsolete codes and codes no longer separately payable, such as oxygen accessories.
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Diabetic testing supplies comprise the only mail order category. "This does not include items obtained by beneficiaries from local storefronts," Dreher said. Beneficiaries may choose to obtain their diabetic test supplies from storefronts, which may or may not be a contract supplier, or by mail from a contract supplier. Mail order supplies can be delivered by common carriers such as the USPS, FedEX or UPS, but not by store employees in company-owned or personal vehicles.
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Any Medicare-enrolled DMEPOS supplier that meets requirements can bid. "Suppliers do not have to be physically located in a CBA to submit a bid for that CBA. However, any supplier must meet quality standards, accreditation and licensure requirements for that product category in that CBA to submit a bid in that CBA," Dreher said. All required licenses must be on file with the NSC before bid submission. Providers bidding outside a CBA must be able to serve the CBA from an existing location.
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If a CBA includes more than one state, the bidder must be licensed in each state included in the CBA.
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Suppliers serving as subcontractors must be accredited. Winning suppliers must notify CMS of subcontracting arrangements within 10 business days of the contract award or of entering into a subcontracting agreement.
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Rental payments for months 1-3 will be equal to 10 percent of the median winning purchase bid. For months 4-13, payments will be based on 7.5 percent of the median winning bid. Payments over the 13-month period will equal 105 percent of the median winning bid.
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All bid amounts must be "bona fide, feasible or realistic," Dreher said, and bidders must be able to support the bid with a manufacturer invoice or other documentation that verifies the item can be purchased for that amount. "Loss- leader bids, where an extremely low bid amount is submitted for one item and other items are realistically bid, are not acceptable," according to Dreher.
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If the amount for one item in product category is found to be not "bona fide," then that bid for that category will be disqualified. "It's critically important that the bid amount be very carefully reviewed before bid application is certified and before bidding closes," explained Dreher.
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Financial documentation requirements will be discussed in a future Open Door session.
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Of the 638 listeners on the call, several providers raised questions about the teleconference topics that drew these answers from CBIC and CMS officials.
Q: For CPAP, will Medicare consider the costs involved under new patient compliance requirements, such as revisiting the patient to download data and coordinating the patient's follow-up?
A: Those services you mentioned are included in the fee schedule amount. This is current policy.
Q: If a provider in Pensacola wants to bid oxygen in Miami, which is nine hours and 600 miles away, is there anything the Pensacola provider needs to do besides have a state oxygen license to be qualified to bid in Miami?
A: You can bid in a CBA where you don't have a physical location, but your existing locations must be able to provide all required services.
Q: Is there anything else they need to do to prove they can serve that CBA? As long as they say they can do it, they can do it?
A: As long as they comply with supplier standards.
Q: Do you have to be licensed in each state for mail order diabetic supplies? Some states require a physical location for licensure, which would preclude some mail order suppliers for providing to patients in those states.
A: The rule is you have to be licensed to provide that specific product category in that specific state if that state requires that license.
Q: Have you heard from accreditation organizations that they are having problems meeting deadlines, with subcontractors especially?
A: The accreditors are on target. Regarding subcontractors, there will be further guidance coming out. "We will have a DME Open Door Forum next Wednesday, so stay tuned there," said CMS' Sandra Bastinelli.
To listen in on the Sept. 9 Open Door, scheduled from 2 to 3 p.m. ET, call 800/837-1935 and reference Conference ID 22139267.
For further information on the Round 1 rebid, see the CBIC Web site at http://www.dmecompetitivebid.com.
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