With competitive bidding’s first-round implementation date less than two weeks away, the Center for Medicare & Medicaid Services and its DME MACs have been busily posting bulletins and articles meant to educate all stakeholders.
New Medicare Learning Network (MLN) articles now available discuss grandfathering, repairs, Advance Beneficiary Notices and other topics as they will apply to first-round national competitive bidding areas starting on July 1.
One new MLN article (click HERE to download) explains how grandfathering will apply to suppliers who did not win bids in the round-one competitive bidding areas (CBA), but wish to continue to rent DME to Medicare beneficiaries who are current customers.
“Grandfathering only applies when the patient is renting DME or oxygen equipment at the time the competitive bidding program becomes effective and the rental period for the item began before the start of the competitive bidding program,” the article says.
The article adds that suppliers not participating in competitive bidding (i.e., non-contract suppliers) can choose whether or not to participate in grandfathering. Should a non-contract supplier choose grandfathering, the supplier needs to give current customers the choice of staying with the supplier or changing to a supplier who won a bid for that equipment.
“If a non-contract supplier chooses not to be ‘grandfathered’ or if a beneficiary wants to change to a contract supplier, the non-contract supplier must pick up the rental equipment and oxygen equipment,” the article says. “Unless a beneficiary relocates outside of the CBA and the supplier service area, the supplier cannot discontinue services by picking up a medically necessary item prior to the end of a rental month for which the supplier was eligible to receive a rental payment, even if the last day of a rental month is after the start date of the program.”
For guidance on contacting beneficiaries regarding the grandfathering option, click HERE to download and view a different MLN article (number 5978) on the subject. The article also includes additional information on policies for picking up equipment from beneficiaries’ homes.
The article adds that a beneficiary can choose to change from a grandfathered supplier to a contracted supplier “at any time, and the contract supplier would be required to accept the beneficiary as a customer.”
The MLN article also discusses how repairs and parts replacements will be handled in CBAs, and how a non-contract supplier in a CBA can use an ABN if supplying a competitively bid item to a beneficiary. “The beneficiary is not liable for payment unless the non-contract supplier in a CBA obtains an ABN signed by the beneficiary,” the article stated. The MLN article number 5978 also contains additional information on competitive bidding repair work policies.
“Labor to repair equipment is not subject to competitive bidding and will be paid according to Medicare’s general payment rules,” the article stated. “Medicare allows for the repair and replacement of parts for beneficiary-owned items by any Medicare-enrolled supplier.”
