Tam's Blog

GET READY FOR COMPETITIVE BIDDING!

2009-07-15T04:42:00.000-07:00

The BIG deadline for Medicare Accreditation and Surety Bond looms on Sept. 30, 2009. Why the BIG push? COMPETITIVE BIDDING! If you have enjoyed Medicare's Monster Roller Coaster ride so far - get ready! Medicare beneficiaries and providers alike need to hang on and squeeze their eye shut tight - the lightening loops in the dark are just ahead!

The background of Competitive bidding:

Section 302 of the Medicare Modernization Act of 2003 (MMA) established requirements for a new competitive bidding program for certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS). The MMA requires that competitive bid payment amounts be used to replace the current Medicare DMEPOS fee schedule payment amounts for selected items in selected areas. The competitive bid payment amounts are determined by using bids submitted by DMEPOS suppliers. The intent of the competitive bidding program is to set more appropriate payment amounts for DMEPOS items, which will result in reduced beneficiary out-of-pocket expenses and savings to taxpayers and the Medicare program.....Well, that is the intent anyway...

In layman's terms, if you are a Medicare supplier, located in on of the Metropolitan Statistical Areas listed below and you would like to keep providing the products listed below you MUST be

-accredited,

-have all of the required state licensure,

-a surety bond and

-currently submitting your bids

in order to keep your Medicare billing privileges.

The Round 1 Rebid will occur in the following MSAs:
• Cincinnati – Middletown (Ohio, Kentucky and Indiana)
• Cleveland – Elyria – Mentor (Ohio)
• Charlotte – Gastonia – Concord (North Carolina and South Carolina)
• Dallas – Fort Worth – Arlington (Texas)
• Kansas City (Missouri and Kansas)
• Miami – Fort Lauderdale – Miami Beach (Florida)
• Orlando (Florida)
• Pittsburgh (Pennsylvania)
• Riverside – San Bernadino – Ontario (California)

The Round 1 Rebid will include the following product categories:
• Oxygen Supplies and Equipment
• Standard Power Wheelchairs, Scooters, and Related Accessories
• Complex Rehabilitative Power Wheelchairs and Related Accessories (Group 2)
• Mail-Order Diabetic Supplies
• Enteral Nutrients, Equipment and Supplies
• CPAP, RADs, and Related Supplies and Accessories
• Hospital Beds and Related Accessories
• Walkers and Related Accessories
• Support Surfaces (Group 2 mattresses and overlays) in Miami

In case your are really starting to scream, here is the link to Medicare's Competitive Bidding Website:

http://www.cms.hhs.gov/DMEPOSCompetitiveBid/01_overview.asp#TopOfPage

2009-05-28T17:23:00.001-07:00

FYI.. CMS advises HME providers who choose NOT to obtain accreditation at this time, to submit an amended CMS-855S application reflecting their voluntary termination. By filing this application, the HME provider will not be revoked and subsequently barred from the Medicare Program. Phamacies that choose NOT to become accreditated but wish to remain a DMEPOS provider for drugs and biologicals should submit an amended CMS 855S only. In addition to updating the application, providers should ensure that they have checked the appropiate boxes in Section 2(c) to reflect which drugs and biologicals they will provide to beneficiaries.

You must get going on accreditation!!

2008-10-28T07:21:00.000-07:00

CMS has set Sept. 30, 2009, as the deadline by which all DMEPOS suppliers must be accredited in order to continue Medicare billing privileges. During the conference, Bastinelli also urged providers to get their accreditation applications in by Jan. 31, 2009, in order to make sure they have time to meet the September deadline. CMS has said it cannot guarantee accreditation for providers who do not apply to one of its approved accrediting bodies by Jan. 31.
-This quote is coming right out of the final rule that was published on Medicare's website on October 14, 2008.
I have checked out the 10 accrediting body websites and they are all saying that the first site visit would be scheduled six months after your initial contact.

Advanced Beneficiary Notice with Medicare

2008-09-10T08:12:00.000-07:00

September 1, 2008 Mandatory ABN submission on statutorily non-covered items from Medicare. Continue to bill with the GY modifier.

Accreditation

2008-09-09T11:28:00.000-07:00

It seems lately that I have had difficulty convincing folks who are not in the accreditation process yet to GET GOING! Yes, it is intrusive, expensive and time consuming but here are some great reasons to get motivated:
1. After September 2009, if you bill Medicare in ANY capacity, your Medicare supplier number will be inactivated and you will not be able to participate in the Medicare program without being either in the process of obtaining your accreditation certificate or already accredited.
2. Once you go through this process you will be able to become a preferred provider for all insurance carriers much quicker and easier. Thus reducing your dependence on Medicare as the sole source of revenue.
3. Accrediting companies get your business in order and prepared for a carrier audit. This will give you peace of mind as well as help you run your business as streamlined as possible.
4. The longer you wait, you will run the risk of the accrediting companies getting backlogged and charging whatever they want. Medicare only recognizes ten companies.

Here is the list of Medicare's approved accrediting bodies:

-- Joint Commission on Accreditation of Healthcare Organizations
-- Community Health Accreditation Program
-- Healthcare Quality Association on Accreditation
-- National Board of Accreditation for Orthotic Suppliers
-- Board of Certification in Pedorthics
-- Accreditation Commission for Healthcare, Inc
-- Board for Orthotist/Prosthetist Certification
-- National Association of Boards of Pharmacy
-- Commission on Accreditation of Rehabilitation Facilities
-- American Board for Certification in Orthotics and Prosthetics, Inc.
-- The Compliance Team, Inc.

Fall Reminder

2008-08-12T08:45:00.000-07:00

Just a reminder as we head into fall...... Medicare timely filing is running out for dates of service Oct. 1, 2006 to September 30, 2007. If you have outstanding accounts receivables from these dates of service you can outsource these problems to DMe Billing Solutions now. We can work on the cleanup using Claim Status Inquiry. These last few months go quick to give us a call 704.642.1061.

Surprising pitfall for clients

2008-08-01T11:07:00.000-07:00

A big pitfall for some of my clients has been not informing Medicare that their business address or incorporation status has changed. This may seem simple enough but I have have been surprised how many clients have fallen into this problem. If Medicare tries to send the supplier something (check?) and it is returned, then your Medicare supplier number is turned off. It's that simple; except it will take about three months to get it turned back on again. One of my suppliers was denied a reinstatement and it took them six months to go through the process all over again. This was a crippling experience for them. If as a new supplier you set up as a sole proprietor and then change to an LLC or Inc. then Medicare has to be informed immediately. Keep in mind that when you change incorporation status you will recieve new Medicare supplier number. Here is a list of reasons that will get your Medicare supplier number revoked:

change of address not on file, change of incorporation, change of ownership/partnership status, beneficiary calls Medicare becuase they can't get in touch with the supplier, did not file CMS855S renewal paperwork in a timely manor & very soon, not being an accredited supplier by September 30, 2009

There are lots of other reasons that your supplier number can be revoked but the rest are criminal reasons. I am not an attorney so I can't comment on those problems!

Purpose of the blog

2008-07-28T09:22:00.000-07:00

Hi there!

I intend to use this blog to communicate to my readers some of the pitfalls and snaggs that my clients have run into and how we/they handled the problems. Billing durable medical equipment is not straight forward and "easy". I am contacted daily by companies that have a great idea for starting a DME business. The Medicare climate has changed drastically and will continue to do so in 2009. Hopefully this blog will help folks steer clear of situations that have not reared their ugly head yet or help folks work through tough situations that have already come up. Please feel free to post your comments!