Who must request and sign the change of location or change of information form to update a contract?
Changes to a contract must be at the request of an authorized official (AO) or backup authorized official (BAO) on record for the contract. Contract suppliers may add or remove AOs and BAOs using the Contract Supplier Change of Location/Information Form, located in Connexion under the Forms tab, located on the top navigation bar.
| 12/15/2016 |
If a supplier purchases 5 percent or greater of the stock of a contract supplier (seller), can the purchasing supplier add its location(s) to the seller’s contract?
If a supplier purchases 5 percent or greater interest in a contract supplier, we can add its location(s) to the seller’s contract using the Contract Supplier Location Update Form signed by the seller if:
• the purchasing supplier and the seller have updated their CMS 855S enrollment applications with the National Supplier Clearinghouse (NSC) and its enrollment records reflect the purchase;
• these companies are considered commonly owned or commonly controlled by the NSC;
• the seller's contract is active (not cancelled or terminated) and the contract supplier (seller) continues to exist and operate as before the stock sale;
• the purchasing supplier’s location(s) meets all of the competitive bidding requirements for the
competitive bidding area (CBA) and product category, such as enrollment, licensure, and accreditation;
• the location(s) is not already on another contract for the same CBA/ product category combination; and
• an authorized official or backup authorized official on record for the seller’s contract signs the form.
| 05/22/2014 |
If a contract supplier is negotiating a change of ownership (CHOW) with a supplier that chooses to become a grandfathered supplier, can the contract supplier continue to serve those grandfathered beneficiaries after the CHOW transaction is effective? If yes, will CMS make additional payments for the grandfathered items?
Yes, the contract supplier may continue to serve these beneficiaries throughout the remainder of the rental period. By purchasing a grandfathered supplier, the contract supplier is essentially stepping into the shoes of the grandfathered supplier. For that reason, no additional payments will be authorized.
Examples of what contract suppliers will be paid as a grandfathered supplier:
• For rented items in the oxygen product category, the contract supplier will be paid the single payment amount for the remainder of the existing rental period or until the item is no longer medically necessary.
• For rented items in the capped rental product category, the contract supplier will be paid the fee schedule amount for the remainder of the existing rental period or until the item is no longer medically necessary.
• For rented items in the inexpensive or routinely purchased (IRP) product category, the contract supplier will be paid the fee schedule amount until the point at which payments for the item equal 100 percent of the fee schedule amount for the purchase of the item.
| 01/24/2014 |
If a contract supplier is involved in a change of ownership (CHOW) with a supplier that chose to become a grandfathered supplier, can the contract supplier continue to serve those grandfathered beneficiaries after the CHOW transaction is effective? If yes, will CMS make additional payments for the grandfathered items?
Yes, the contract supplier may continue to serve these beneficiaries throughout the remainder of the rental period. By purchasing a grandfathered supplier, the contract supplier is essentially stepping into the shoes of the grandfathered supplier. For that reason, no additional payments will be authorized.
Examples of what contract suppliers will be paid as a grandfathered supplier:
- For rented items in the oxygen product category, the contract supplier will be paid the single payment amount for the remainder of the existing rental period or until the item is no longer medically necessary.
- For rented items in the capped rental product categories (hospital beds; continuous positive airway pressure (CPAP) devices; respiratory assistive devices (RADs); standard (manual and power) wheelchairs and scooters; support surfaces and negative pressure wound therapy (NPWT) pumps, the contract supplier will be paid the fee schedule amount for the remainder of the existing rental period or until the item is no longer medically necessary.
- For rented items in the inexpensive or routinely purchased (IRP) product category (walkers), the contract supplier will be paid the fee schedule amount until the point at which payments for the item equal 100 percent of the fee schedule amount for the purchase of the item.
| 04/02/2013 |
I am a non-contract supplier. If I buy or merge with a contract supplier, will CMS pay for contract items I furnish after the effective date of the change of ownership (CHOW) but before the date CMS signs the novation agreement?
Yes. When CMS signs the novation agreement, it will become effective retroactive to the effective date of the CHOW.
Please wait to submit claims for contract items you furnish after the CHOW until CMS notifies you that the novation agreement has been accepted.
If you submit claims before the novation agreement has been accepted, the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) will not know that you are a contract supplier, and the claims may be denied.
Payment for covered items furnished after the effective date of the CHOW will be made at the single payment amount according to the competitive bidding contract.
| 04/01/2013 |
I am a supplier and want to buy or merge with a DMEPOS competitive bidding contract supplier. Can I make the change of ownership (CHOW) contingent upon CMS’ approval of a novation agreement?
No. A CHOW is a business transaction between two DMEPOS suppliers; CMS is not a party to that transaction. However, CMS is a party to any novation agreement involving a competitive bidding contract. CMS will execute a novation following a CHOW only if the successor or new entity meets all program requirements identified in §414.422(d).
| 04/01/2013 |
Who must request and sign the change of location or change of information form to update a contract?
Changes to a contract must be at the request of an authorized official (AO) or backup authorized official (BAO) on record for the contract. Contract suppliers may add or remove AOs and BAOs using the Contract Supplier Change of Location/Information Form, located in Connexion under the Forms tab, located on the top navigation bar.
| 12/15/2016 |
Can a Contract Supplier refuse to furnish competitively bid items to beneficiaries within a competitive bidding area (CBA) once it has met the estimated capacity provided on its bid?
No. When bidding, each bidder must state its expected capacity to furnish the items in each product category for which it is submitting a bid. The estimated capacity is used during bid evaluation for the purpose of selecting a sufficient number of contract suppliers to meet demand for the product category in the CBA. However, the projected capacity submitted by a bidder does not become a binding term of the contract because contract suppliers are required to furnish the items in their contract to all beneficiaries who maintain a permanent residence in the CBA, or who visit the CBA, and who request the items from them. (See Federal regulations at 42 CFR §414.422.)
The Request for Bids clearly indicates that a contract supplier must furnish competitively bid items to any beneficiary who maintains a permanent residence in or who visits a CBA and who requests those items from the contract supplier, starting on day one of the contract period. Furnishing medically necessary contract items to all beneficiaries throughout the CBA is also a term of the competitive bidding program contract.
Suppliers are not allowed to “pick and choose” which beneficiaries they will serve within a CBA. Furthermore, contract suppliers are required to provide beneficiaries with timely service in accordance with the quality standards. Refusing to furnish medically necessary competitively bid items to beneficiaries throughout the entire CBA is a breach of contract, and may lead to contract termination.
| 11/26/2013 |
As the primary supplier, I understand that I am responsible for submitting claims on behalf of the Medicare beneficiary. Does this mean I cannot use a billing agent?
No. Contract suppliers may employ billing agents to the extent permitted by standard Medicare rules. If a contract supplier subcontracts with another supplier for purchase of inventory (supplier standard #4), delivery and instruction on the use of a Medicare-covered item (supplier standard #12), or repair of rented equipment (supplier standard #14), the contract supplier or its billing agent must submit the claim to Medicare using the contract supplier's billing number. The subcontractor should not submit claims.
| 04/01/2013 |
I hear that Medicare will soon begin denying claims for DMEPOS items and services that are referred by physicians and treating practitioners who are not enrolled with Medicare in PECOS. Are competitive bidding contract suppliers required to furnish DMEPOS items and services in their contracts to any Medicare beneficiary residing in a competitive bidding area, regardless of whether the prescribing physician or eligible treating professional is enrolled with Medicare?
Medicare has issued regulations implementing new requirements for DMEPOS suppliers, including DMEPOS contract suppliers (see the interim final rule with comment period (IFC) titled Medicare and Medicaid Programs; Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and Changes in Provider Agreements published on May 5, 2010; 75 FR 24437).
The requirements for physicians and treating practitioners to be enrolled in Medicare as a condition for Medicare claims payment, as set forth in that regulation, are consistent with contract suppliers’ responsibilities under the Competitive Bidding Program. Contract suppliers are expected to follow the requirements set forth in the May 5, 2010, IFC because covered items under the Competitive Bidding Program generally include only those DMEPOS items for which payment would otherwise be made under Medicare’s DMEPOS fee schedules outside the Competitive Bidding Program.
When Medicare begins to implement this new requirement, competitively bid and non-competitively bid items and services ordered by a physician or other treating practitioner who is not enrolled in Medicare will not be paid, as stipulated by the Affordable Care Act (ACA 2010). Therefore, contract suppliers would not be required to furnish items to beneficiaries whose ordering physician or treating practitioner is not enrolled with Medicare in PECOS.
| 04/01/2013 |
After entering my bid data into the DMEPOS Bidding System (DBidS), I decided to change my business type from a single-location supplier to a multiple-location supplier (or from a multiple-location supplier to a single-location supplier). However, when I changed the business type, I lost all the Form B information previously entered. Why did this happen? Can I get this missing Form B information back?
Your organization's Form Bs are linked to your location(s). When you modify Form A to change your business type, this impacts your locations and the Form Bs associated with those locations. Unfortunately, there is no way for us to restore or retrieve the information once it has been deleted. You must create the Form B(s) again and re-enter the information that was lost.
| 10/09/2012 |
I clicked "Enter" and all of the information I just entered was lost. Why did this happen? Will I be able to retrieve my information?
The DMEPOS Bidding System (DBidS) screens have four tools to help you navigate through the application: NEXT, BACK, SAVE, and PRINT. To ensure the correct submission of your information, you must use these four navigation tools or available hyperlinks in the application. If you click Enter, your screen will reset and your information will be lost. Make sure that you click the appropriate button, such as Save, Back, or Next. Also, do not use the back (<--) or forward (-->) arrow buttons on the Internet browser toolbar to move from one page to another, and do not use keyboard navigation (hot keys/access keys) to move within the DBidS application. Once your information is lost, it cannot be retrieved.
| 10/09/2012 |
I registered in IACS during the last round of bidding (Round 1 Rebid or Round 2/National Mail-Order). Why can't I access DBidS with my user ID and password from that round?
The user IDs that Individuals Authorized Access to CMS Computer Services (IACS) created for previous rounds are now inactive. If you plan to bid in the Round 1 Recompete, your organization's authorized official will need to register again. All other supplier employees who need to access the bidding system also need to register specifically for the Round 1 Recompete.
| 10/09/2012 |
I am an end user (EU) entering bid data on behalf of my organization. Why am I not able to access Form A?
The Form A: Business Organization Information page requests general information about the organization, and the DMEPOS Bidding System (DBidS) requires that this section be completed by an authorized official (AO) or backup authorized official (BAO). After your AO or BAO completes the Business Organization Information section, a pop-up box containing your organization's bidder number will appear and you will be able to access Form A to enter information into the Location Specific Information screen. Please note that only one user at a time may enter data in Form A. If someone in your organization is in Form A and you try to use it, you will get a message saying that Form A is locked. Once the other user leaves Form A, you should be able to access it without receiving the error message.
Also, as an EU, you will not be able to approve Form A or certify Form B - these tasks must be completed by your organization’s AO or BAO.
| 10/09/2012 |
I've completed Form A. Why am I not able to access Form B?
The DMEPOS Bidding System (DBidS) will not allow you to proceed to Form B if you have not completed and approved Form A. Form A must be completed and approved by your authorized official (AO) or backup authorized official (BAO) before Form B can be created or accessed. If the AO or BAO has not approved Form A, the Form A Status page will display Pending Approval. The AO or BAO may access the Form A Approval page by selecting the Pending Approval link on the status page. Remember that if you modify any information in Form A after it has been approved, the AO or BAO will need to re-approve Form A.
| 10/09/2012 |
Our company has been entering information into Form B, but I just got a message saying that DBidS is locked. What do I need to do?
Multiple users may be in Form B at the same time, but only as long as each user is entering information for a different product category/competitive bidding area. If you try to enter information into the same Form B that another user is in, you will receive a message that the form is locked by another user. Once the other user exits Form B, you should be able to access it without receiving the error message.
Also, please note that only one user can access a specific Form A at any one time. If someone in your organization is in Form A and you try to use it, you will get a message saying that Form A is locked. Once the other user leaves Form A, you should be able to access it without receiving the error message.
| 10/09/2012 |
I got a warning message saying "You will be logged out of DBidS for inactivity. Please save your data." Why did the DMEPOS Bidding System (DBidS) log me out when I clicked the "Save" or "Next" button?
Timing out after a period of inactivity is a common security tool that is often used in very secure computer applications. The DBidS application times out after 15 minutes of inactivity. To remain active in the application, you must click Save every 10 minutes. Simply typing information into the system is not recognized as activity in the DBidS system. The system recognizes activity when you click Save or Next. After ten minutes of inactivity, you will receive a warning message, and if you do not click OK within five minutes and click Save, you will be logged out of the application. Any data entered on the screen after you last clicked Save will be lost. If the DBidS application times out, you must close all browser windows and open a new browser to log back in to DBidS.
| 10/09/2012 |
Is the information I enter into the DMEPOS Bidding System (DBidS) secure?
When you log in to the DBidS, you are on a secure server. All the information that you enter is encrypted to provide the highest possible security.
The Centers for Medicare & Medicaid Services (CMS) will protect the confidentiality of bidders’ proprietary financial and bidding information to the extent provided by law and will follow the procedure stated in 45 CFR §5.65. CMS will not share information about any bidder's proposal with other bidders. However, an independent evaluator may be granted access to bidders' or networks’ bidding information as permitted by law. Any reports that are created to evaluate the program will be reported in an anonymous or aggregate format. Bidding information may be reviewed as required by law by the U.S. Government Accountability Office (GAO) and the Department of Health and Human Services (DHHS) Office of Inspector General (OIG), and by the Department of Justice (DOJ) as permitted by law. CMS will request that any reports created by the GAO and DHHS/OIG to evaluate the program report bidding information in an anonymous or aggregate form.
Contractor staff with access to bidding information is required to sign a statement agreeing to maintain the confidentiality of each bidder's information.
| 10/09/2012 |
Is there a particular Internet browser or other software application that I need to use to successfully access and navigate within the DMEPOS Bidding System (DBidS)?
DBidS works best in Microsoft Internet Explorer 6.0 or greater. If you are using an alternate browser such as Mozilla Firefox, Google Chrome, or Safari, you may have difficulty navigating the bidding system. In addition, you must have JavaScript enabled on your computer, and any pop-up blockers should be disabled. The application is best viewed with a screen resolution of 1024 x 768.
| 10/09/2012 |
I am receiving an error message when I try to enter a special character into the DMEPOS Competitive Bidding System (DBidS). Are there special characters that the DBidS does not accept?
DBidS accepts most special characters. If using special characters, please use the international keyboard or Alt Control keys to enter information. If you need instructions on using the international keyboard or Alt Control instructions, please refer to the Quick Step by Step User Guide to Submitting a Bid in DBidS on the this website.
| 10/09/2012 |
When will the DMEPOS Bidding System (DBidS) reflect the receipt of my required hardcopy documents on the Status screen?
The Documentation Status section will display Yes within 48 hours after your documents are received by the Competitive Bidding Implementation Contractor (CBIC). If your document package is received after the bid window closes, DBidS will not acknowledge receipt of the document(s) and the indicator will remain NO. An indication that your hardcopy document package was received does not mean that the documents in the package are accurate, complete, or otherwise meet the requirements of the Request for Bids.
| 10/09/2012 |
When I (authorized official [AO] or backup authorized official [BAO]) try to approve Form A or certify Form B, I get an error message saying that my user name is incorrect. I am using the same user name that I used to log in to the DMEPOS Bidding System (DBidS). Why am I getting this error message?
When you are approving Form A or certifying Form B, you must enter your DBidS login user name in capital letters. This means that all of the letters in your user name must be capitalized, or uppercase. If you attempt to use lowercase letters, or a mix of uppercase and lowercase, DBidS will not accept the data and will not allow you to continue.
| 10/09/2012 |
I am entering manufacturer/model data in Form B, but DBidS seems to be missing some of the HCPCS codes in this product category. Why is this?
While you are required to bid on all Healthcare Common Procedure Coding System (HCPCS) codes in a product category, the DMEPOS Bidding System (DBidS) requires you to enter manufacturer/model information for only the top 80 percent of the HCPCS codes in the product category. Therefore, you will not see all of the HCPCS codes included in the product category listed. Also, you cannot add more HCPCS codes to this section of DBidS.
| 10/09/2012 |
Can suppliers charge QMBs, including QMB Plus beneficiaries, for Medicare cost-sharing under the competitive bidding program?
No. The amount of payment made by Medicare plus the amount of payment made under the Medicaid State Plan (if any) is payment in full for the service. If you try to collect more than the amounts paid by Medicare and Medicaid, you could be subject to sanctions.
| 04/02/2014 |
How can suppliers identify what type of dual eligible beneficiary they are dealing with?
Suppliers have several methods to determine the type of dual a beneficiary is. First, all dual eligible beneficiaries receive a letter of eligibility from the State Medicaid agency explaining their eligibility benefits. Suppliers should request this letter when dealing with the beneficiary. Some states issue a Medicaid eligibility card explaining the type of Medicaid coverage for which the beneficiary is eligible. This card usually has the beneficiary’s name along with other identifying information detailing the type of beneficiary. Finally, a State’s Medicaid Management Information System (MMIS) has a provider accessible means (either electronic or phone) which allows providers using beneficiary information (found on the beneficiary’s letter of eligibility or card) to verify the type of beneficiary along with the Federal/State approved Medicare/Medicaid eligibility for the beneficiary. This electronic/phone system would only be accessible by providers who have enrolled in the State’s Medicaid program for purposes of payment.
| 04/02/2014 |
How will suppliers be reimbursed for Medicare cost-sharing for QMB and QMB Plus beneficiaries?
Each state Medicaid program is legally responsible for paying suppliers for any Medicare cost-sharing that is due for QMBs and QMB Plus beneficiaries, according to its CMS-approved Medicare cost-sharing payment methodology. Federal law gives states the authority to pay cost-sharing for QMBs and QMB Plus beneficiaries at the Medicare cost-sharing amount, the Medicaid State Plan rate for the same service, or a rate between those amounts that is established by the state and approved by CMS. States are allowed to limit payment for QMB and QMB Plus cost-sharing to the amount necessary to provide a total payment to the supplier (including Medicare, Medicaid, required nominal Medicaid co-payments, and third party payments) equal to the amount a state would have paid for the service under the State Plan. When the cost-sharing claim is for Medicare-covered services that are not included in the Medicaid State Plan, the state is still liable to pay the cost-sharing claim, but may establish reasonable payment limits, approved by CMS, for the service.
To receive payment, DMEPOS contract suppliers must enroll as a State Medicaid provider with each state in their service area. Contact information for each State’s Medicaid program is available at www.medicaid.gov.
| 04/02/2014 |
What are the different types of dual eligible beneficiaries, and what does Medicaid pay for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) for each type?
There are 7 different types of dual eligible beneficiaries. However, out of the 7 types only the 4 types identified below are provided actual Medicare cost-sharing benefits from Medicaid. The other 3 types receive Medicaid payment of Medicare premiums only.
- Qualified Medicare Beneficiary (QMB)
- A QMB is a person who is entitled to Medicare Part A and is eligible for Medicare Part B; has an income that does not exceed 100 percent of the Federal Poverty Level (FPL), and whose resources do not exceed twice the Supplemental Security Income (SSI) limit. A QMB who does not qualify for any additional Medicaid benefits is referred to as “QMB Only”.
- Medicaid pays Medicare cost-sharing amounts only for Medicare-covered DMEPOS. If Medicare denies payment, Medicaid will not pay for the DMEPOS.
- QMB Plus
- A QMB Plus is a person who meets all of the standards for QMB eligibility and also meets the financial criteria for another Medicaid coverage group. Such individuals are entitled to all benefits available to a QMB, as well as all benefits available under the State Plan to a fully eligible Medicaid recipient.
- Medicaid pays Medicare cost-sharing amounts only for Medicare-covered DMEPOS. If Medicare doesn’t cover the DMEPOS, but the Medicaid State Plan does, Medicaid will pay for the DMEPOS, subject to limitations established in the State Plan, when the beneficiary obtains the item or service from a Medicaid-participating provider.
- Specified Low Income Medicare Beneficiaries (SLMB) Plus
- A SLMB Plus is an individual who meets the standards for SLMB eligibility, but who also meets the financial criteria for another Medicaid coverage group.
- If Medicare doesn’t cover the DMEPOS, but the Medicaid State Plan does, Medicaid will pay for the DMEPOS, subject to limitations established in the State Plan, when the beneficiary obtains the item or service from a Medicaid-participating provider.
- Full Benefit Dual Eligible (FBDE)
- A FBDE is an individual who meets the standards for Medicaid but does not meet the income or resource criteria for a QMB or a QMB Plus beneficiary. The FBDE Medicaid income/resource eligibility criteria are different from the criteria for SLMB Plus. These eligibility criteria determine Medicaid benefits and establish the Medicare cost-sharing benefits for the beneficiary.
- If Medicare doesn’t cover the DMEPOS, but the Medicaid State Plan does, Medicaid will pay for the DMEPOS, subject to limitations established in the State Plan, when the beneficiary obtains the item or service from a Medicaid-participating provider. Medicaid will also pay the Medicare cost-sharing related to payment of premiums, deductibles and Medicare co-pays.
| 04/02/2014 |
Where can I find more information about dual eligible beneficiaries?
For more information about QMBs and other individuals who are dually eligible to receive Medicare and Medicaid benefits, please refer to the Medicare Learning Network® publication titled “Medicaid Coverage of Medicare Beneficiaries (Dual Eligibles),” which is available at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/medicare_beneficiaries_dual_eligibles_at_a_glance.pdf
For additional information, please review:
| 04/02/2014 |
Do I need to sign each page of Form C?
No. You are required to only sign within the designated signature block.
| 05/22/2014 |
I am purchasing a contract supplier’s business. Who should submit Form C?
The supplier that holds the contract with CMS at the time Form C is due should complete and submit Form C. If the purchaser submits Form C before the novation agreement with CMS is finalized, the updates will not be published in the Supplier Directory.
| 05/22/2014 |
What happens if I submit my corrections/additions after the deadline for this quarter?
If we do not receive your changes by the deadline, we will use the Form C you submitted timely for the Medicare Supplier Directory update for this quarter. Please ensure you submit a complete Form C within next quarter’s reporting window.
| 05/22/2014 |
Where can I find my contract number?
You can find your contract number on the first page of the cover letter of your fully executed contract (underneath your company’s address). It is also listed in the upper left corner of Attachment A of your contract.
| 05/22/2014 |
I have already submitted my form, but I need to make a correction and/or an addition to it. What do I do?
Complete another form with your identifying information at the beginning of the form and then enter only the information that needs to be corrected or added. You do not need to enter all product information again. When you submit the form, please include a cover sheet specifying that this is a correction/addition to a previously submitted form.
| 05/21/2014 |
How long do I have to submit corrections/additions?
You must submit changes by the Form C deadline for the quarter.
| 05/20/2014 |
Can the signature from a company official be a stamp or do you require a hand-written signature?
A stamped signature on a Form C submission is acceptable.
| 04/01/2013 |
How do I report the model and manufacturer for an enteral feeding supply kit?
An enteral feeding supply kit may contain items from different manufacturers with various models. You should report the model and manufacturer information for the dominant item included in the kit.
| 04/01/2013 |
How do I save data on the form?
Data entered into Form C does not save. You may enter all required information at one time and then select “View Completed Form and Print.”
You may also choose to enter product information for each single product category and competitive bidding area (CBA) combination and then select “View Completed Form and Print.” You must print each form since this information is not saved.
It is important that you print, sign and send ALL forms to the CBIC by the deadline. You must submit information for all product category and CBA combinations for which you were awarded a contract.
Please remember that you will not be able to make any changes to your information once you proceed to the “PRINT” page. Please review all information and make any changes before you proceed to print. If you use the browser to go back after you are on the print screen, you will need to re-enter all the information.
| 04/01/2013 |
I don't see my product's model on the list of choices. How can I have it added to the list?
You will need to contact your product's manufacturer and request they submit a Coding Verification Review application to have their product listed on the Medicare Pricing, Data Analysis, and Coding (PDAC) Durable Medical Equipment Coding System (DMECS) website. The applications can be found at www.dmepdac.com. If you need additional information, contact the PDAC’s helpline at 877-735-1326.
| 04/01/2013 |
I have already submitted my form, but I need to make a correction and/or an addition to it. What do I do?
Complete another form with your identifying information at the beginning of the form and then enter only the information that needs to be corrected or added. You do not need to enter all product information again. When you print the form, please indicate on the form that this is a correction/addition to a previously submitted form.
| 04/01/2013 |
Should I fax the form or mail it?
You can either mail or fax the form to the CBIC. However, we recommend that you fax it to the CBIC at 803-264-6228.
If you choose to mail the form, please send it to:
Palmetto GBA
Competitive Bidding Implementation Contractor
2743 Perimeter Pkwy Ste 200-400
Augusta, GA 30909-6499
| 04/01/2013 |
Can the form be mailed to the CBIC on the due date, or do I have to send it in time for the CBIC to get it by the due date?
You always need to send the form in time for the CBIC to get it by the due date.
| 09/28/2011 |
What happens if I send the form in late?
Failure to meet this deadline is considered a breach of contract and could lead to termination of your contract.
| 09/28/2011 |
How can I find out if the CBIC has received my form? Will I be notified?
You can call the CBIC customer service center at 877-577-5331, and we will verify whether the report has been received.
| 09/28/2011 |
When can I expect my updated product information to be reflected on the Medicare Supplier Directory?
You should expect to see the updated product information posted within 30 days after the Form C submission deadline.
| 09/28/2011 |
If a beneficiary who resides in a competitive bidding area (CBA) changes from a Medicare Advantage (MA) Plan, either voluntarily or involuntarily, to Medicare fee-for-service (original Medicare), can he/she remain with his/her current managed care supplier even if the supplier is not a contract supplier for the specific competitively bid item the beneficiary receives from the supplier? Will Medicare continue to pay the supplier for the items and services?
Yes. The beneficiary can remain with their current supplier and Medicare may pay for the competitively bid items and services as long as 1) the managed care supplier is Medicare-enrolled, 2) the managed care supplier agrees to become a grandfathered supplier, and 3) the beneficiary was enrolled in the MA Plan at the time the competitive bidding program began. This rule only pertains to those items that are currently being rented to beneficiaries residing in the CBA and to the competitively bid items necessary for the use of the rented item. The supplier must accept assignment on all grandfathered claims. All of the competitive bidding grandfathering rules apply in this situation. For additional information on the grandfathering rules, please review the Grandfathering Information portion of this website.
| 07/30/2014 |
Are competitively bid capped rental items subject to the payment reduction after the 3rd month rental?
Yes. Under competitive bidding, payment for capped rental DME items is made in an amount equal to 10 percent of the single payment amount for each of the first 3 months and 7.5 percent of the single payment amount for the remaining 4 through 13 months of rental. The supplier is required to transfer title to the equipment to the beneficiary after 13 months of continuous use.
| 05/16/2013 |
Can a non-contract supplier furnish competitively bid items to beneficiaries maintaining a permanent residence within a CBA?
| 05/16/2013 |
Can a supplier choose to grandfather certain beneficiaries and not others?
No. A supplier that chooses to become a grandfathered supplier for an item must continue to provide the item to all beneficiaries who choose to continue receiving the item from the grandfathered supplier.
A grandfathered supplier for oxygen and oxygen equipment must continue furnishing the oxygen and oxygen equipment for any period of medical need for the remainder of the reasonable useful lifetime (five years) of the equipment.
A grandfathered supplier for other rented durable medical equipment (DME) must furnish the item for the remaining months of the rental period, unless the item is no longer medically necessary. For capped rental DME, the grandfathering relationship ends when the ownership is transferred to the beneficiary or the item is no longer medically necessary. For example, if a non-contract supplier grandfathers the rental of a CPAP device, the supplier must continue to rent the item to the beneficiary unless the ownership is transferred to the beneficiary or the item is no longer medically necessary.
After the DMEPOS Competitive Bidding Program is implemented, when a new period of continuous use begins following a break in need of greater than 60 days plus the days remaining in the last paid rental month, the beneficiary must obtain new or additional equipment from a contract supplier.
For more information, please view The DMEPOS Competitive Bidding Program Grandfathering Requirements for Non-Contract Suppliers fact sheet, which you can find on this website by selecting Educational Information, then Fact Sheets.
| 05/16/2013 |
If a beneficiary has been renting a competitively bid durable medical equipment (DME) item from a supplier that does not become a contract supplier and chooses to switch to a contract supplier at the start of a competitive bidding program, what month should the new contract supplier start billing? When can the non-contract supplier pick up its equipment?
The non-contract supplier must continue to furnish and bill for the rented DME item up to the first "anniversary date" that occurs after the start of the Competitive Bidding Program. (The anniversary date is the day of the month on which the item was first delivered to the beneficiary. Please note that an anniversary date can change if there is a break in service or need of more than 30 days.)
Under no circumstances may the non-contract supplier discontinue services by picking up a medically necessary item prior to the end of a month for which the supplier is eligible to receive a rental payment, even if the last day ends after the start date of the Competitive Bidding Program.
If a beneficiary chooses to switch to a contract supplier, the non-contract supplier and the contract supplier must make arrangements for the pickup of the old equipment and delivery of the new equipment that are suitable to the beneficiary. Such arrangements need to be coordinated between the non-contract and contract suppliers to ensure that the beneficiary has continued access to medically necessary equipment.
The contract supplier can start billing beginning with the first anniversary date that occurs once the Competitive Bidding Program begins.
For more information, please view The DMEPOS Competitive Bidding Program Grandfathering Requirements for Non-Contract Suppliers Fact Sheet.
| 05/16/2013 |
If a beneficiary who is receiving capped rental durable medical equipment (DME) or oxygen prior to the start of the competitive bidding program moves from a non-competitive bidding area to a competitive bidding area (CBA), is a contract supplier eligible to start a new capped rental period or entitled to receive additional payments for oxygen?
No. Contract suppliers are eligible to begin a new capped rental period or entitled to receive additional payments for oxygen only when a beneficiary is otherwise eligible to receive equipment from a grandfathered supplier. Regulations at 42 CFR 414.408(j) indicate that suppliers can become grandfathered suppliers only for beneficiaries permanently residing in a CBA who were renting DME or oxygen from them prior to the implementation of the program. Beneficiaries not residing in a CBA at the time the program began are not eligible for the grandfathering option. Therefore, the capped rental period for DME does not restart and the contract supplier is not entitled to receive additional oxygen rental payments, as specified in 42 CFR 414.408(h).
Beneficiaries moving into a CBA after the competitive bidding program becomes effective must use a contract supplier to receive competitively bid oxygen and DME. The moving beneficiary must return his/her rented item to the original supplier and receive replacement equipment from a contract supplier. A contract supplier is entitled to receive payments for the remainder of the rental period or until the equipment is no longer medically necessary, whichever occurs first.
The competitive bidding program has not changed the coverage criteria or medical necessity documentation requirements for competitively bid items.
A new detailed written order is required when a beneficiary switches suppliers. Each supplier that bills for an item must, in the event of an audit, be able to produce sufficient information to show that the coverage criteria and related medical necessity documentation requirements are met. The Medicare law requires that the supplier that furnishes the oxygen and oxygen equipment during the 36th month of continuous use must continue to furnish the oxygen and oxygen equipment after the cap for any period of medical need for the remainder of the reasonable useful lifetime of the equipment.
For more information, please view the DMEPOS Competitive Bidding Program Grandfathering Requirements for Non-Contract Suppliers fact sheet, which you can find on this website by selecting Educational Information, then Fact Sheets.
| 05/16/2013 |
What will contract suppliers be paid when they furnish oxygen and oxygen equipment or capped rental durable medical equipment (DME) to a beneficiary who transitions to them from a non-contract supplier in the middle of the 36-month or 13-month rental payment period?
If a beneficiary who would otherwise be entitled to obtain oxygen from a grandfathered supplier changes to a contract supplier, the contract supplier will be paid at least 10 monthly payment amounts at the single payment amount regardless of how many months the previous supplier was paid.
For example, for rental agreements in months 2 through 26, the new contract supplier will be paid for the remaining rental months of the period. Contract suppliers assuming rental agreements that are in months 27 or later will receive a minimum of 10 payments regardless of how many months the previous supplier was paid.
If the beneficiary changes to a new contract supplier, the new contract supplier must replace the equipment. If the beneficiary changes from a contract supplier to another contract supplier, the new contract supplier is NOT entitled to a minimum number of months of payment and will be paid the single payment amount for the duration of the rental period not to exceed 36 months.
If a beneficiary who would otherwise be entitled to obtain a capped rental DME item from a grandfathered supplier changes to a contract supplier, a new 13-month rental period begins regardless of how many months the previous supplier was paid. However, rental payments only continue if the item continues to be medically necessary. The contract supplier will be paid the single payment amount. If the beneficiary changes from a contract supplier to another contract supplier, a new rental period does NOT begin, and the new contract supplier will be paid the single payment amount for the duration of the capped rental period.
For more information, please view The DMEPOS Competitive Bidding Program Grandfathering Requirements for Non-Contract Suppliers Fact Sheet.
| 05/16/2013 |
If a beneficiary’s stationary oxygen equipment reaches the 36 month cap, and a physician later adds a portable oxygen unit to the beneficiary’s order, can the non-contract supplier currently providing the stationary oxygen contents also provide the portable oxygen unit?
Yes, Medicare law requires the supplier (contract or non-contract) who furnished the oxygen in the 36th month to provide oxygen, oxygen equipment, and related supplies and accessories until the beneficiary’s medical need for the oxygen ceases or until the end of the reasonable useful lifetime of the oxygen equipment is reached. Once the five-year reasonable useful lifetime for the stationary oxygen equipment ends, the beneficiary can elect to obtain new oxygen equipment, but they must obtain the replacement equipment from a contract supplier. Once the contract supplier furnishes the new, replacement equipment, a new 36-month rental cap and period of continuous use and a new five-year reasonable useful lifetime for both the stationary and portable oxygen equipment will begin.
| 08/23/2013 |
Prior to the 36th month cap, if a physician prescribes portable oxygen for a beneficiary who is already receiving stationary oxygen equipment from a grandfathered supplier, can the grandfathered supplier also provide the portable oxygen unit?
Yes, the grandfathered supplier must furnish the portable oxygen unit. The Medicare monthly payment amount for oxygen and oxygen equipment includes payment for stationary oxygen equipment, stationary oxygen contents, and portable oxygen contents. An add-on payment for the portable oxygen equipment will be made to the grandfathered supplier.
| 08/23/2013 |
Can a non-contract supplier furnish competitively bid items to beneficiaries maintaining a permanent residence within a CBA?
| 05/16/2013 |
Can a supplier choose to grandfather certain beneficiaries and not others?
No. A supplier that chooses to become a grandfathered supplier for an item must continue to provide the item to all beneficiaries who choose to continue receiving the item from the grandfathered supplier.
A grandfathered supplier for oxygen and oxygen equipment must continue furnishing the oxygen and oxygen equipment for any period of medical need for the remainder of the reasonable useful lifetime (five years) of the equipment.
A grandfathered supplier for other rented durable medical equipment (DME) must furnish the item for the remaining months of the rental period, unless the item is no longer medically necessary. For capped rental DME, the grandfathering relationship ends when the ownership is transferred to the beneficiary or the item is no longer medically necessary. For example, if a non-contract supplier grandfathers the rental of a CPAP device, the supplier must continue to rent the item to the beneficiary unless the ownership is transferred to the beneficiary or the item is no longer medically necessary.
After the DMEPOS Competitive Bidding Program is implemented, when a new period of continuous use begins following a break in need of greater than 60 days plus the days remaining in the last paid rental month, the beneficiary must obtain new or additional equipment from a contract supplier.
For more information, please view The DMEPOS Competitive Bidding Program Grandfathering Requirements for Non-Contract Suppliers fact sheet, which you can find on this website by selecting Educational Information, then Fact Sheets.
| 05/16/2013 |
Can a supplier of oxygen and oxygen equipment choose to grandfather stationary oxygen and oxygen equipment and not portable oxygen equipment?
No. In accordance with the Medicare law and regulations, the Medicare monthly payment amount for oxygen and oxygen equipment includes payment for stationary oxygen equipment, stationary oxygen contents, and portable oxygen contents. If the supplier is also furnishing portable oxygen equipment to the beneficiary, an add-on payment is made for portable oxygen equipment only. Since payments for portable oxygen contents is included in the monthly payment amount for oxygen and oxygen equipment while payments for portable oxygen equipment is included in the add-on payment, the supplier must be a grandfathered supplier for both stationary and portable oxygen and oxygen equipment in order to be in compliance with the statutorily mandated payment structure for oxygen and oxygen equipment.
| 05/16/2013 |
Does a beneficiary currently receiving oxygen and oxygen equipment prior to the 36-month rental cap or renting a capped rental item (e.g., CPAP device) from a grandfathered supplier who has been inpatient for over 60 days plus the days remaining in the last paid rental month and still needs the oxygen or capped rental item upon returning home have to switch to a contract supplier?
No. This is considered a temporary interruption in billing or a break in service. The beneficiary’s use of the equipment did not cease while he or she was inpatient. Therefore, the medical need never ended. The grandfathered supplier must continue providing the oxygen or rented DME item upon the beneficiary’s discharge from the hospital or facility. This policy applies to any type of break in service (e.g., admission to a nursing facility, enrollment in a managed care plan, travel out of the country, etc.).
| 05/16/2013 |
Following the 5-year or 60-month reasonable useful lifetime for oxygen equipment, the beneficiary can elect to obtain replacement oxygen equipment, which triggers the start of a new 36-month rental payment period. Following the 60th month, will a non-contract supplier be permitted to provide the replacement oxygen equipment, or will the beneficiary need to obtain it from a contract supplier for oxygen and oxygen equipment for the competitive bidding area (CBA)?
The beneficiary must obtain the replacement oxygen equipment from a contract supplier for oxygen and oxygen equipment for the CBA. The non-contract supplier should coordinate with the contract supplier during this transition.
| 05/16/2013 |
If a beneficiary who is receiving capped rental durable medical equipment (DME) or oxygen prior to the start of the competitive bidding program moves from a non-competitive bidding area to a competitive bidding area (CBA), is a contract supplier eligible to start a new capped rental period or entitled to receive additional payments for oxygen?
No. Contract suppliers are eligible to begin a new capped rental period or entitled to receive additional payments for oxygen only when a beneficiary is otherwise eligible to receive equipment from a grandfathered supplier. Regulations at 42 CFR 414.408(j) indicate that suppliers can become grandfathered suppliers only for beneficiaries permanently residing in a CBA who were renting DME or oxygen from them prior to the implementation of the program. Beneficiaries not residing in a CBA at the time the program began are not eligible for the grandfathering option. Therefore, the capped rental period for DME does not restart and the contract supplier is not entitled to receive additional oxygen rental payments, as specified in 42 CFR 414.408(h).
Beneficiaries moving into a CBA after the competitive bidding program becomes effective must use a contract supplier to receive competitively bid oxygen and DME. The moving beneficiary must return his/her rented item to the original supplier and receive replacement equipment from a contract supplier. A contract supplier is entitled to receive payments for the remainder of the rental period or until the equipment is no longer medically necessary, whichever occurs first.
The competitive bidding program has not changed the coverage criteria or medical necessity documentation requirements for competitively bid items.
A new detailed written order is required when a beneficiary switches suppliers. Each supplier that bills for an item must, in the event of an audit, be able to produce sufficient information to show that the coverage criteria and related medical necessity documentation requirements are met. The Medicare law requires that the supplier that furnishes the oxygen and oxygen equipment during the 36th month of continuous use must continue to furnish the oxygen and oxygen equipment after the cap for any period of medical need for the remainder of the reasonable useful lifetime of the equipment.
For more information, please view the DMEPOS Competitive Bidding Program Grandfathering Requirements for Non-Contract Suppliers fact sheet, which you can find on this website by selecting Educational Information, then Fact Sheets.
| 05/16/2013 |
If a non-contract supplier chooses to become a grandfathered supplier for oxygen and oxygen equipment, will that supplier be permitted to bill for oxygen contents furnished after the 36-month rental cap period or will the patient have to obtain oxygen contents from a contract supplier?
The Medicare law requires that the supplier that furnishes the oxygen and oxygen equipment during the 36th month of continuous use must continue to furnish the oxygen and oxygen equipment after the cap for any period of medical need for the remainder of the reasonable useful lifetime of the equipment. This requirement continues to apply under the DMEPOS Competitive Bidding Program, regardless of the role of the supplier (i.e., contract supplier, grandfathered supplier, or non-contract supplier not electing to become a grandfathered supplier).
It is important to know that this requirement applies even in situations in which the beneficiary relocates on a temporary (i.e., snowbird) or permanent basis outside the supplier’s normal service area. The supplier that furnishes the oxygen or oxygen equipment in the 36th month of continuous use of oxygen and oxygen equipment is prohibited from transferring its ongoing obligations to a contract supplier, regardless of whether it has elected to become a grandfathered supplier and regardless of whether the beneficiary remains in the competitive bidding area (CBA).
| 05/16/2013 |
What will contract suppliers be paid when they furnish oxygen and oxygen equipment or capped rental durable medical equipment (DME) to a beneficiary who transitions to them from a non-contract supplier in the middle of the 36-month or 13-month rental payment period?
If a beneficiary who would otherwise be entitled to obtain oxygen from a grandfathered supplier changes to a contract supplier, the contract supplier will be paid at least 10 monthly payment amounts at the single payment amount regardless of how many months the previous supplier was paid.
For example, for rental agreements in months 2 through 26, the new contract supplier will be paid for the remaining rental months of the period. Contract suppliers assuming rental agreements that are in months 27 or later will receive a minimum of 10 payments regardless of how many months the previous supplier was paid.
If the beneficiary changes to a new contract supplier, the new contract supplier must replace the equipment. If the beneficiary changes from a contract supplier to another contract supplier, the new contract supplier is NOT entitled to a minimum number of months of payment and will be paid the single payment amount for the duration of the rental period not to exceed 36 months.
If a beneficiary who would otherwise be entitled to obtain a capped rental DME item from a grandfathered supplier changes to a contract supplier, a new 13-month rental period begins regardless of how many months the previous supplier was paid. However, rental payments only continue if the item continues to be medically necessary. The contract supplier will be paid the single payment amount. If the beneficiary changes from a contract supplier to another contract supplier, a new rental period does NOT begin, and the new contract supplier will be paid the single payment amount for the duration of the capped rental period.
For more information, please view The DMEPOS Competitive Bidding Program Grandfathering Requirements for Non-Contract Suppliers Fact Sheet.
| 05/16/2013 |
Will a beneficiary who is currently receiving oxygen and oxygen equipment prior to the 36-month rental cap or renting a capped rental item (e.g., CPAP device) from a grandfathered supplier have to obtain his or her equipment from a contract supplier if there is a break in need of greater than 60 days plus the days remaining in the last paid rental month?
Yes. The beneficiary will be required to obtain his or her new equipment from a contract supplier since there is a break in need of greater than 60 days plus the days remaining in the rental month.
A break in need is when the beneficiary’s medical condition changes or improves and the equipment or service is no longer required. In these situations, the period of continuous use of the equipment in the prior rental episode ended and a new period of continuous use and 36- or 13-month rental period may begin as long as the contract supplier submits a new prescription, new medical necessity documentation and a statement describing the reason for the interruption which shows that medical necessity in the prior episode ended.
In all cases where the break in need for oxygen equipment occurs after the supplier has received payment for the 36th month of continuous use, the supplier is responsible for continuing to furnish the oxygen equipment during any period of medical need for the remainder of the reasonable useful lifetime of the equipment. In these situations, the supplier must continue furnishing the equipment, and a new 36-month rental payment period does not begin regardless of the length of the break in medical need and regardless of the number of breaks in medical need.
| 05/16/2013 |
As a delegated official on my organization's CMS-855S form, how should I register for bidding purposes – as an authorized official (AO), backup authorized official (BAO), or end user (EU)?
If you are not listed as an AO on your organization’s CMS-855S enrollment form, but you are someone the company trusts to conduct company business (delegated official), you may only register as an end user (EU). As an EU, you can help create your organization’s bid and enter bid information but cannot approve the registrations of others associated with your organization, approve Form A, or certify Form B. Only individuals listed as an authorized official on the CMS-855S form may register in IACS as an authorized official or backup authorized official.
For more information on user roles and capabilities in IACS, please view the IACS Reference Guide.
| 08/16/2012 |
Can I register as an end user for more than one company?
It most cases, this is not permitted. The only time you are allowed to access more than one bidding organization’s application in the DMEPOS Bidding System (DBidS) is if all companies/organizations have the same authorized official and the same provider transaction access numbers (PTANs). This would ONLY occur if the authorized official registered two or more PTANs for locations that furnish distinct product lines in the same competitive bidding area (CBA) and do not compete with one another for the same business.
For more information on associating to an organization, please view the IACS Reference Guide.
| 08/16/2012 |
Can I share my User ID and password with others in my organization so they may access the bidding system?
No. Do not disclose or lend your User ID and/or password to anyone else. They are for your use only and serve as your electronic signature. This means that you will be held responsible for the consequences of unauthorized or illegal transactions. Sharing of accounts may lead to termination of system access privileges and/or adverse action up to and including legal prosecution. Those that intend to view or enter bid data for your organization need to register and obtain their own User IDs and passwords.
For information on how to register, please view the IACS Reference Guide.
| 08/16/2012 |
How do I register in IACS?
Please review the IACS Reference Guide available on this website for detailed steps on how to register in IACS. We encourage you to register early so that you may access the bidding system to complete your bid application as soon as possible. Upon successfully completing registration, you will receive a User ID and password to access the DMEPOS bidding system, DBidS.
| 08/16/2012 |
How do I remove a member of my organization/company from being able to access the bid system?
It is very important that you contact the Competitive Bidding Program customer service center at 1-877-577-5331 for assistance. If the user is not removed, that user will continue to have access to confidential bid data. A customer service representative will remove the member’s association to your organization. The member will no longer be able to access or view any information in the registration system, enter bid data, or submit a bid to the Competitive Bidding Program for the bidding organization.
| 08/16/2012 |
How do I remove myself from my organization if I no longer wish to be involved with the registration or bidding process? (Disassociate from an organization).
Backup authorized officials (BAOs) and end users (EUs) are able to use the disassociate feature in IACS to remove themselves. Authorized officials (AOs) may also use this feature, but only if they are the only member of their organization that is registered in IACS. This means there is not a BAO or an EU associated to that AO’s organization(s). No user (AO, BAO or EU) may remove another user.
To view instructions on how to disassociate a user from an organization, please refer to the IACS Reference Guide available on this website.
| 08/16/2012 |
How do I update my user information such as name, date of birth, e-mail address, telephone number, etc. in IACS?
You can find specific instructions for updating your e-mail address, phone number, company name and address in the IACS Reference Guide located on this website under Round 1 Recompete Bidding Suppliers.
Your name and date of birth can be updated in IACS. However, you must call the Competitive Bidding Program customer service center at 1-877-577-5331 for assistance.
| 08/16/2012 |
I am submitting a bid as a network supplier; can I also submit a bid as an individual supplier and how does this affect my registration?
You may submit separate bids as a member of a network and as an individual supplier in the following scenarios:
- You are bidding on different product categories within the same competitive bidding area (CBA);
- You are bidding on the same product category in a different CBA; or
- You are bidding on a different product category in a different CBA.
If you are planning to submit a bid as an individual supplier outside of the network and you are the primary network member for the network, you will register in IACS once as the authorized official with a Provider Transaction Access Number (PTAN) for the network bid and add or associate another PTAN for your individual bid. You will need to use the “Creating an Organization” feature in IACS to add a PTAN as an individual supplier.
If you were not the primary network member who registered the network (your PTAN was NOT used for the network’s registration), you will need to register as an individual supplier in IACS to submit a bid.
For more information on registering in IACS or adding a PTAN (creating an organization) in IACS, please view the IACS Reference Guide.
| 08/16/2012 |
I registered previously to compete in other rounds. Do I need to register again?
Yes. In order to participate in the Round 1 Recompete, all suppliers are required to first register in IACS. This includes suppliers that bid in any previous rounds and are interested in competing in the Round 1 Recompete.
For more information on how to register, please view the IACS Getting Started Checklist.
| 08/16/2012 |
If I need to verify the information I have on file with the NSC such as my AO's information, licensure, accreditation, etc., can I contact the NSC and verify this information over the telephone?
Suppliers should verify all enrollment information, such as authorized officials, product categories, location specific information, copies of licensure, business structure, etc., in the Provider Enrollment, Chain, and Ownership System (PECOS) application. To register to view your organization’s information in PECOS, please review the information on the External User Services’ (EUS) website at www.eushelpdesk.com or contact EUS at 866-484-8049. Suppliers are strongly encouraged to register to view their enrollment information in PECOS.
However, if you do not wish to register to view your information in PECOS, you may verify your authorized official's information and organization’s mailing address through the National Supplier Clearinghouse (NSC) customer service line. You should send all other requests for verification of other enrollment information on file, such as product categories, location specific information, copies of licensure, business structure, etc., to the NSC in writing. Suppliers should follow the NSC’s current guidelines for requesting this information in writing.
To verify accreditation dates, you should verify this information with the applicable CMS approved accreditation organization. You may find contact information for the CMS approved accreditation organizations on the CMS website at www.cms.gov.
| 08/16/2012 |
Is there anything I should do to prepare to register in IACS?
- Choose one (1) authorized official (AO) listed on the CMS-855S enrollment form to act as your AO for registration purposes. Your company may have multiple individuals listed as the AO on the CMS-855S enrollment form on file in Provider Enrollment, Chain, and Ownership System (PECOS) as well as with the National Supplier Clearinghouse (NSC). However, for IACS registration purposes, you may only have one AO register for the Competitive Bidding Program. The other AOs included on the CMS-855S enrollment form may act as backup authorized officials (BAOs). Backup authorized officials have many of the same registration and bidding capabilities as an authorized official.
- You may view your enrollment information on the Medicare PECOS application if you have registered with External User Services or EUS. For more information about registering with EUS to view your PECOS information, please refer to the EUS website at www.eushelpdesk.com or you may contact EUS at 866-523-4759.
- Ensure that your enrollment information on file with the NSC and in PECOS is current and correct. The last names and Social Security numbers of AOs and BAOs must match that on file in PECOS in order to complete registration.
- Suppliers should also verify that the AO’s and BAO’s name on file with the NSC, as listed in PECOS matches their legal name on their Social Security card. The end users’ (EU) last name, and Social Security number will be validated with the Social Security Administration files.
- Visit the NSC’s website at www.palmettogba.com/nsc to review information about updating your enrollment information. Please keep in mind that the NSC has up to 45 days to update your file. You may find change-of-information assistance and forms on the NSC’s website or you may contact the NSC at 1-866-238-9652. Read the IACS Reference Guide prior to accessing IACS.
- Determine which Provider Transaction Access Number (PTAN) will be used for registration. In most cases, you should only register one time with one PTAN. You may register with any active PTAN that has been assigned to your organization; however, there are two occasions when you need to add (associate) another PTAN to your organization. If a supplier has more than one location and one or more locations furnish a different product category that does not compete against another, such as pharmacy and DME, the authorized official (AO) would register one NSC number to represent one product category and add (associate) another PTAN to that organization. Also, if you are the primary network bidder and you are also bidding as an individual in another competitive bidding area/product category competition, you would register once with a PTAN for the network bid and then add (associate) another PTAN to the organization for your individual bid. For more information, please review the IACS Reference Guide.
- Make sure that the e-mail address you enter in IACS is correct and is working. This is very important because you will be sent e-mails containing critical information during your registration process.
- Prepare your computer! To optimize your access to the various screens in IACS, please ensure that the following criteria are met:
- Screen Resolution: These screens are designed to be viewed at a minimum screen resolution
of 800 x 600.
- Internet Browser: Use Internet Explorer, version 6.0 or higher.
- Plugins: Verify that the latest version of JAVA and/or ActiveX is installed on your PC.
- Pop-up Blockers: Disable pop-up blockers prior to attempting to access the CMS Applications
Portal.
| 08/16/2012 |
My company is bidding on two product lines in the same CBA and the AO has registered with two PTANS because these product lines are offered out of different locations. How do I associate my profile to each PTAN as a backup authorized official or end user?
Please refer to the Instructions on How to Associate with an Organization link on the Round 1 Recompete portion of the Competitive Bidding Program's website by selecting Bidding Suppliers and then Registration. The authorized official (AO) does not need to register twice but only needs to add (or associate) a second Provider Transaction Access Number (PTAN) to their organization. This guide will explain how to associate or add a backup authorized official (BAO) or an end user (EU) to your user profile for the additional PTAN. Remember, a BAO or EU may complete this process only if the AO is the same for both PTANs. After the request to associate an organization is submitted, the AO must approve the addition.
For additional information on registering and associating with an organization, please view the IACS Reference Guide.
| 08/16/2012 |
My partners and I own several DME companies. Do I need to register each company separately?
No. Only one authorized official (AO) should register one time for his or her organization consisting of commonly owned or controlled companies, including parent-subsidiaries. The AO may register using any active Provider Transaction Access Number (PTAN) assigned to any of the commonly owned locations. The other commonly owned locations will be added on Form A in DBidS by the bidder. If a commonly owned or controlled supplier organization is awarded a contract, all eligible locations listed on Form A will be considered contract suppliers for the awarded CBA/product category competition(s).
If a company with multiple locations that are commonly owned or commonly controlled submits multiple bids for the same product category in the same CBA, the bids will be rejected because the program rules do not allow commonly owned or commonly controlled supplier organizations to bid against themselves.
For more information, please view the Common Ownership and Control fact sheet.
| 08/16/2012 |
The authorized official is no longer with our company. How do we update our information (Convert a BAO to an AO)?
Contact the Competitive Bidding Program customer service center at 1-877-577-5331 for assistance. During the registration period, a customer service representative will assign your backup authorized official (BAO) to the authorized official’s (AO) role. The Provider Transaction Access Number (PTAN) entered by the original AO will now be associated to the new AO. Once the change has been completed, the original AO will no longer be associated with the bidding organization.
Once a user is disassociated or removed from a bidding organization, that user cannot access or modify any information in IACS, enter bid data, or submit a bid to the Competitive Bidding Program for the organization.
| 08/16/2012 |
What does commonly owned or commonly controlled mean?
The final rule defines common ownership as two or more suppliers with one or more having an ownership interest totaling at least 5 percent in the other. "Ownership interest" is defined as "the possession of equity in the capital, the stock or the profits of another supplier."
Commonly controlled means that an owner of one supplier organization is also an officer, director or partner in another supplier organization.
For more information, please view the Common Ownership or Control fact sheet.
| 08/16/2012 |
What is IACS?
IACS stands for: Individuals Authorized Access to the CMS Computer Services. It is an online application that allows authorized users to access the Centers for Medicare and Medicaid's (CMS) secure systems, including the DMEPOS Bidding System, referred to as DBidS.
For more information, please view the IACS Reference Guide.
| 08/16/2012 |
What is the difference among the "user roles?"
IACS assigns a "user role" to individuals who will be performing specific functions during the bidding process. There are three types of assigned user roles in IACS:
Authorized Official (AO) – Each supplier's bidding organization will be allowed only one AO for registration purposes. The AO’s role is instrumental in bidding. The AO’s role must be active to avoid all other users for the organization from losing access to the DMEPOS bidding system, DBidS. The AO’s role is to:
- Register a company or bidding organization. The AO is the only individual that can register the
company or organization in IACS;
- Update the organization’s information. The AO is the only individual that can modify an
organization’s profile information in IACS;
- Approve or reject backup authorized official (BAO) and end user (EU) access to the organization;
- Enter and view bid data; and
- Approve Form A and certify Form B in DBidS. This function can also be performed by the BAO.
NOTE: For registration purposes, there can be only ONE AO for a bidding organization. However, there may be multiple AOs listed on the CMS-855S enrollment form with the National Supplier Clearinghouse (NSC). The other AOs on the CMS-855S form may register as BAOs. However, it is important to note that the AO is accountable and responsible for the actions of those he or she approves into the organization to view or submit bid data.
Backup Authorized Official (BAO) - Each supplier organization may designate one or more BAOs. A BAO has many of the same capabilities as the AO.
- A BAO must also be listed as an AO on the CMS-855S enrollment form.
- While there can only be ONE AO, there can be more than one BAO for an organization.
- A BAO can associate with more than one company or organization as long as that organization has
the same AO. This situation would rarely occur and ONLY occur if the supplier (AO) registered
with more than one PTAN, each representing a different location that furnishes non-competing
product lines (such as pharmacy and DME). For example, Apex DME Company has three (3) AOs
listed on their CMS-855S enrollment application – John, Mary, and Sally. Mary is selected to be the
designated AO for IACS registration. So, John and Sally become the BAOs. Mary is also the AO
listed with on the enrollment form and in IACS for Apex Pharmacy Company. So, John and Sally
may also be the BAO for Apex Pharmacy. This will allow John and Sally to view, modify and enter
bid data for both Apex DME and Apex Pharmacy.
- A BAO has the authority to approve or reject an end user’s request to be included on the
company’s registration profile and access the organization’s bid to enter and view data.
- A BAO can enter bid data.
- A BAO can approve Form A and certify Form B in DBidS.
Including at least one BAO in IACS is highly recommended to avoid any disruption in the bidding process. The AO's role is instrumental to bidding. The AO's role must be active to avoid all other users of the organization from losing access to DBidS. If the AO leaves the organization or is otherwise unavailable, it’s important to have a BAO who can be promoted to an AO role. If you have only one AO listed on your enrollment form, then we encourage you to add another. However, it’s important to remember that the individual must meet certain qualifications to be added as an AO or BAO. You can find the qualifications on the NSC’s website or you can call the NSC for specific information.
End User (EU) - Each supplier organization may have one or more EUs. The EU has limited capabilities.
- An EU is NOT required to be listed on the CMS-855S enrollment form.
- An EU may be someone who is not an AO or a BAO but one whom the company trusts to conduct
company business and enter bid information once the bid window opens.
- Like a BAO, an EU is able to associate to one or more companies or organizations that have the
same AO. This situation would rarely occur and ONLY occur if the supplier (AO) registered with
more than one PTAN, each representing a different location that furnishes non-competing product
lines (such as pharmacy and DME).
- An EU cannot approve Form A or certify Form B. This function must be done by the AO or a BAO.
- There may be multiple EUs but only one EU may be in the DBidS system entering data on the same
form (Form A or Form B) at the same time. If there are multiple Form Bs (one for each product
category and CBA), then there may be one EU entering data on each Form B at the same time.
| 08/16/2012 |
Who should register in IACS?
If you are interested in bidding in the Round 1 Recompete competition you must designate an authorized official (AO) to register in IACS. The AO must be listed on the CMS-855S enrollment form with the National Supplier Clearinghouse (NSC) and in the Provider Enrollment, Chain, and Ownership System (PECOS). For competitive bidding purposes, there can be only one AO for an organization registered in IACS.
If NSC enrollment information must be changed or updated, AOs must wait to register in IACS until the NSC has completed the update and the AO receives written confirmation from the NSC. It is important to note that the NSC has up to 45 days to update information. Individuals who are designated by the AOs as a backup authorized official (BAO) or end user (EU) also need to register in IACS if they are to access DBidS on behalf of the bidding supplier organization.
NOTE: You should not register in IACS if you do not plan to submit a bid application.
For more information on how to register in IACS, please view the IACS Reference Guide.
| 08/16/2012 |
Will I be able to update my user profile throughout the bidding process?
Yes. You may make limited updates to your user profile during the bid window such as updating your e-mail address and contact information. However, once registration closes, you will not be able to register to obtain a user ID and password or add another user. We strongly encourage authorized officials to register early so that they may approve other users and make any necessary corrections.
For more information on updating your user profile, please view the Modifying User/Contact Information section of the IACS Reference Guide.
| 08/16/2012 |
Will I ever need to have more than one PTAN in IACS? If so, how do I add PTANs in IACS?
In most cases, no. You should only register one provider transaction access number (PTAN) to represent all locations. There are only two situations when you are permitted to register in IACS with two or more PTANs. If you have more than one location within the same competitive bidding area (CBA) and one or more of the locations furnishes a different product category that does not compete against another, you would register one PTAN to represent each product category.
For example, you have four (4) locations in Miami. Three (3) of the locations currently provide respiratory equipment and one (1) location provides only enteral nutrition. The location that provides enteral nutrition does not have a license to provide oxygen, and the locations that provide oxygen do not have a license to provide enteral nutrition. As a bidding supplier, you intend to submit a bid to provide oxygen in Miami and another bid to provide enteral nutrition in Miami from your other location. In this case you may have two (2) PTANs associated in IACS representing each bid application for each product category.
The second occasion is if you are the primary network bidder and are also bidding as an individual, you would register once with a PTAN for the network bid and add another PTAN for your individual bid.
For additional information on registering or adding a PTAN (creating an organization) in IACS, please refer to the IACS Reference Guide.
| 08/16/2012 |
Are competitively bid capped rental items subject to the payment reduction after the 3rd month rental?
Yes. Under competitive bidding, payment for capped rental DME items is made in an amount equal to 10 percent of the single payment amount for each of the first 3 months and 7.5 percent of the single payment amount for the remaining 4 through 13 months of rental. The supplier is required to transfer title to the equipment to the beneficiary after 13 months of continuous use.
| 05/16/2013 |
Can a supplier choose to grandfather certain beneficiaries and not others?
No. A supplier that chooses to become a grandfathered supplier for an item must continue to provide the item to all beneficiaries who choose to continue receiving the item from the grandfathered supplier.
A grandfathered supplier for oxygen and oxygen equipment must continue furnishing the oxygen and oxygen equipment for any period of medical need for the remainder of the reasonable useful lifetime (five years) of the equipment.
A grandfathered supplier for other rented durable medical equipment (DME) must furnish the item for the remaining months of the rental period, unless the item is no longer medically necessary. For capped rental DME, the grandfathering relationship ends when the ownership is transferred to the beneficiary or the item is no longer medically necessary. For example, if a non-contract supplier grandfathers the rental of a CPAP device, the supplier must continue to rent the item to the beneficiary unless the ownership is transferred to the beneficiary or the item is no longer medically necessary.
After the DMEPOS Competitive Bidding Program is implemented, when a new period of continuous use begins following a break in need of greater than 60 days plus the days remaining in the last paid rental month, the beneficiary must obtain new or additional equipment from a contract supplier.
For more information, please view The DMEPOS Competitive Bidding Program Grandfathering Requirements for Non-Contract Suppliers fact sheet, which you can find on this website by selecting Educational Information, then Fact Sheets.
| 05/16/2013 |
If a beneficiary has been renting a competitively bid durable medical equipment (DME) item from a supplier that does not become a contract supplier and chooses to switch to a contract supplier at the start of a competitive bidding program, what month should the new contract supplier start billing? When can the non-contract supplier pick up its equipment?
The non-contract supplier must continue to furnish and bill for the rented DME item up to the first "anniversary date" that occurs after the start of the Competitive Bidding Program. (The anniversary date is the day of the month on which the item was first delivered to the beneficiary. Please note that an anniversary date can change if there is a break in service or need of more than 30 days.)
Under no circumstances may the non-contract supplier discontinue services by picking up a medically necessary item prior to the end of a month for which the supplier is eligible to receive a rental payment, even if the last day ends after the start date of the Competitive Bidding Program.
If a beneficiary chooses to switch to a contract supplier, the non-contract supplier and the contract supplier must make arrangements for the pickup of the old equipment and delivery of the new equipment that are suitable to the beneficiary. Such arrangements need to be coordinated between the non-contract and contract suppliers to ensure that the beneficiary has continued access to medically necessary equipment.
The contract supplier can start billing beginning with the first anniversary date that occurs once the Competitive Bidding Program begins.
For more information, please view The DMEPOS Competitive Bidding Program Grandfathering Requirements for Non-Contract Suppliers Fact Sheet.
| 05/16/2013 |
If a beneficiary who is receiving capped rental durable medical equipment (DME) or oxygen prior to the start of the competitive bidding program moves from a non-competitive bidding area to a competitive bidding area (CBA), is a contract supplier eligible to start a new capped rental period or entitled to receive additional payments for oxygen?
No. Contract suppliers are eligible to begin a new capped rental period or entitled to receive additional payments for oxygen only when a beneficiary is otherwise eligible to receive equipment from a grandfathered supplier. Regulations at 42 CFR 414.408(j) indicate that suppliers can become grandfathered suppliers only for beneficiaries permanently residing in a CBA who were renting DME or oxygen from them prior to the implementation of the program. Beneficiaries not residing in a CBA at the time the program began are not eligible for the grandfathering option. Therefore, the capped rental period for DME does not restart and the contract supplier is not entitled to receive additional oxygen rental payments, as specified in 42 CFR 414.408(h).
Beneficiaries moving into a CBA after the competitive bidding program becomes effective must use a contract supplier to receive competitively bid oxygen and DME. The moving beneficiary must return his/her rented item to the original supplier and receive replacement equipment from a contract supplier. A contract supplier is entitled to receive payments for the remainder of the rental period or until the equipment is no longer medically necessary, whichever occurs first.
The competitive bidding program has not changed the coverage criteria or medical necessity documentation requirements for competitively bid items.
A new detailed written order is required when a beneficiary switches suppliers. Each supplier that bills for an item must, in the event of an audit, be able to produce sufficient information to show that the coverage criteria and related medical necessity documentation requirements are met. The Medicare law requires that the supplier that furnishes the oxygen and oxygen equipment during the 36th month of continuous use must continue to furnish the oxygen and oxygen equipment after the cap for any period of medical need for the remainder of the reasonable useful lifetime of the equipment.
For more information, please view the DMEPOS Competitive Bidding Program Grandfathering Requirements for Non-Contract Suppliers fact sheet, which you can find on this website by selecting Educational Information, then Fact Sheets.
| 05/16/2013 |
What will contract suppliers be paid when they furnish oxygen and oxygen equipment or capped rental durable medical equipment (DME) to a beneficiary who transitions to them from a non-contract supplier in the middle of the 36-month or 13-month rental payment period?
If a beneficiary who would otherwise be entitled to obtain oxygen from a grandfathered supplier changes to a contract supplier, the contract supplier will be paid at least 10 monthly payment amounts at the single payment amount regardless of how many months the previous supplier was paid.
For example, for rental agreements in months 2 through 26, the new contract supplier will be paid for the remaining rental months of the period. Contract suppliers assuming rental agreements that are in months 27 or later will receive a minimum of 10 payments regardless of how many months the previous supplier was paid.
If the beneficiary changes to a new contract supplier, the new contract supplier must replace the equipment. If the beneficiary changes from a contract supplier to another contract supplier, the new contract supplier is NOT entitled to a minimum number of months of payment and will be paid the single payment amount for the duration of the rental period not to exceed 36 months.
If a beneficiary who would otherwise be entitled to obtain a capped rental DME item from a grandfathered supplier changes to a contract supplier, a new 13-month rental period begins regardless of how many months the previous supplier was paid. However, rental payments only continue if the item continues to be medically necessary. The contract supplier will be paid the single payment amount. If the beneficiary changes from a contract supplier to another contract supplier, a new rental period does NOT begin, and the new contract supplier will be paid the single payment amount for the duration of the capped rental period.
For more information, please view The DMEPOS Competitive Bidding Program Grandfathering Requirements for Non-Contract Suppliers Fact Sheet.
| 05/16/2013 |
When is a contract supplier responsible for repairing equipment?
A contract supplier is responsible for repairing equipment that the supplier is currently renting to a Medicare beneficiary, including oxygen equipment furnished after the equipment rental payment cap.
The monthly rental payments made by Medicare for durable medical equipment (DME) and oxygen equipment include payment for necessary repairs, maintenance and servicing of the rented equipment. For oxygen equipment, the statute and regulations require the supplier to continue furnishing the oxygen equipment after the rental payment cap for any period of medical need for the remainder of the reasonable useful lifetime of the oxygen equipment. A contract supplier may repair the rental equipment itself or subcontract for this service.
CMS recognizes that contract suppliers may not have the training or expertise to repair all brands or types of equipment; therefore, a contract supplier is not obligated to repair beneficiary-owned equipment. Any Medicare-enrolled supplier may perform repairs to beneficiary-owned equipment.
| 03/21/2011 |
Can a supplier choose to grandfather certain beneficiaries and not others?
No. A supplier that chooses to become a grandfathered supplier for an item must continue to provide the item to all beneficiaries who choose to continue receiving the item from the grandfathered supplier.
A grandfathered supplier for oxygen and oxygen equipment must continue furnishing the oxygen and oxygen equipment for any period of medical need for the remainder of the reasonable useful lifetime (five years) of the equipment.
A grandfathered supplier for other rented durable medical equipment (DME) must furnish the item for the remaining months of the rental period, unless the item is no longer medically necessary. For capped rental DME, the grandfathering relationship ends when the ownership is transferred to the beneficiary or the item is no longer medically necessary. For example, if a non-contract supplier grandfathers the rental of a CPAP device, the supplier must continue to rent the item to the beneficiary unless the ownership is transferred to the beneficiary or the item is no longer medically necessary.
After the DMEPOS Competitive Bidding Program is implemented, when a new period of continuous use begins following a break in need of greater than 60 days plus the days remaining in the last paid rental month, the beneficiary must obtain new or additional equipment from a contract supplier.
For more information, please view The DMEPOS Competitive Bidding Program Grandfathering Requirements for Non-Contract Suppliers fact sheet, which you can find on this website by selecting Educational Information, then Fact Sheets.
| 05/16/2013 |
Can a supplier of oxygen and oxygen equipment choose to grandfather stationary oxygen and oxygen equipment and not portable oxygen equipment?
No. In accordance with the Medicare law and regulations, the Medicare monthly payment amount for oxygen and oxygen equipment includes payment for stationary oxygen equipment, stationary oxygen contents, and portable oxygen contents. If the supplier is also furnishing portable oxygen equipment to the beneficiary, an add-on payment is made for portable oxygen equipment only. Since payments for portable oxygen contents is included in the monthly payment amount for oxygen and oxygen equipment while payments for portable oxygen equipment is included in the add-on payment, the supplier must be a grandfathered supplier for both stationary and portable oxygen and oxygen equipment in order to be in compliance with the statutorily mandated payment structure for oxygen and oxygen equipment.
| 05/16/2013 |
Does a beneficiary currently receiving oxygen and oxygen equipment prior to the 36-month rental cap or renting a capped rental item (e.g., CPAP device) from a grandfathered supplier who has been inpatient for over 60 days plus the days remaining in the last paid rental month and still needs the oxygen or capped rental item upon returning home have to switch to a contract supplier?
No. This is considered a temporary interruption in billing or a break in service. The beneficiary’s use of the equipment did not cease while he or she was inpatient. Therefore, the medical need never ended. The grandfathered supplier must continue providing the oxygen or rented DME item upon the beneficiary’s discharge from the hospital or facility. This policy applies to any type of break in service (e.g., admission to a nursing facility, enrollment in a managed care plan, travel out of the country, etc.).
| 05/16/2013 |
Following the 5-year or 60-month reasonable useful lifetime for oxygen equipment, the beneficiary can elect to obtain replacement oxygen equipment, which triggers the start of a new 36-month rental payment period. Following the 60th month, will a non-contract supplier be permitted to provide the replacement oxygen equipment, or will the beneficiary need to obtain it from a contract supplier for oxygen and oxygen equipment for the competitive bidding area (CBA)?
The beneficiary must obtain the replacement oxygen equipment from a contract supplier for oxygen and oxygen equipment for the CBA. The non-contract supplier should coordinate with the contract supplier during this transition.
| 05/16/2013 |
If a beneficiary who is receiving capped rental durable medical equipment (DME) or oxygen prior to the start of the competitive bidding program moves from a non-competitive bidding area to a competitive bidding area (CBA), is a contract supplier eligible to start a new capped rental period or entitled to receive additional payments for oxygen?
No. Contract suppliers are eligible to begin a new capped rental period or entitled to receive additional payments for oxygen only when a beneficiary is otherwise eligible to receive equipment from a grandfathered supplier. Regulations at 42 CFR 414.408(j) indicate that suppliers can become grandfathered suppliers only for beneficiaries permanently residing in a CBA who were renting DME or oxygen from them prior to the implementation of the program. Beneficiaries not residing in a CBA at the time the program began are not eligible for the grandfathering option. Therefore, the capped rental period for DME does not restart and the contract supplier is not entitled to receive additional oxygen rental payments, as specified in 42 CFR 414.408(h).
Beneficiaries moving into a CBA after the competitive bidding program becomes effective must use a contract supplier to receive competitively bid oxygen and DME. The moving beneficiary must return his/her rented item to the original supplier and receive replacement equipment from a contract supplier. A contract supplier is entitled to receive payments for the remainder of the rental period or until the equipment is no longer medically necessary, whichever occurs first.
The competitive bidding program has not changed the coverage criteria or medical necessity documentation requirements for competitively bid items.
A new detailed written order is required when a beneficiary switches suppliers. Each supplier that bills for an item must, in the event of an audit, be able to produce sufficient information to show that the coverage criteria and related medical necessity documentation requirements are met. The Medicare law requires that the supplier that furnishes the oxygen and oxygen equipment during the 36th month of continuous use must continue to furnish the oxygen and oxygen equipment after the cap for any period of medical need for the remainder of the reasonable useful lifetime of the equipment.
For more information, please view the DMEPOS Competitive Bidding Program Grandfathering Requirements for Non-Contract Suppliers fact sheet, which you can find on this website by selecting Educational Information, then Fact Sheets.
| 05/16/2013 |
If a non-contract supplier chooses to become a grandfathered supplier for oxygen and oxygen equipment, will that supplier be permitted to bill for oxygen contents furnished after the 36-month rental cap period or will the patient have to obtain oxygen contents from a contract supplier?
The Medicare law requires that the supplier that furnishes the oxygen and oxygen equipment during the 36th month of continuous use must continue to furnish the oxygen and oxygen equipment after the cap for any period of medical need for the remainder of the reasonable useful lifetime of the equipment. This requirement continues to apply under the DMEPOS Competitive Bidding Program, regardless of the role of the supplier (i.e., contract supplier, grandfathered supplier, or non-contract supplier not electing to become a grandfathered supplier).
It is important to know that this requirement applies even in situations in which the beneficiary relocates on a temporary (i.e., snowbird) or permanent basis outside the supplier’s normal service area. The supplier that furnishes the oxygen or oxygen equipment in the 36th month of continuous use of oxygen and oxygen equipment is prohibited from transferring its ongoing obligations to a contract supplier, regardless of whether it has elected to become a grandfathered supplier and regardless of whether the beneficiary remains in the competitive bidding area (CBA).
| 05/16/2013 |
What will contract suppliers be paid when they furnish oxygen and oxygen equipment or capped rental durable medical equipment (DME) to a beneficiary who transitions to them from a non-contract supplier in the middle of the 36-month or 13-month rental payment period?
If a beneficiary who would otherwise be entitled to obtain oxygen from a grandfathered supplier changes to a contract supplier, the contract supplier will be paid at least 10 monthly payment amounts at the single payment amount regardless of how many months the previous supplier was paid.
For example, for rental agreements in months 2 through 26, the new contract supplier will be paid for the remaining rental months of the period. Contract suppliers assuming rental agreements that are in months 27 or later will receive a minimum of 10 payments regardless of how many months the previous supplier was paid.
If the beneficiary changes to a new contract supplier, the new contract supplier must replace the equipment. If the beneficiary changes from a contract supplier to another contract supplier, the new contract supplier is NOT entitled to a minimum number of months of payment and will be paid the single payment amount for the duration of the rental period not to exceed 36 months.
If a beneficiary who would otherwise be entitled to obtain a capped rental DME item from a grandfathered supplier changes to a contract supplier, a new 13-month rental period begins regardless of how many months the previous supplier was paid. However, rental payments only continue if the item continues to be medically necessary. The contract supplier will be paid the single payment amount. If the beneficiary changes from a contract supplier to another contract supplier, a new rental period does NOT begin, and the new contract supplier will be paid the single payment amount for the duration of the capped rental period.
For more information, please view The DMEPOS Competitive Bidding Program Grandfathering Requirements for Non-Contract Suppliers Fact Sheet.
| 05/16/2013 |
Will a beneficiary who is currently receiving oxygen and oxygen equipment prior to the 36-month rental cap or renting a capped rental item (e.g., CPAP device) from a grandfathered supplier have to obtain his or her equipment from a contract supplier if there is a break in need of greater than 60 days plus the days remaining in the last paid rental month?
Yes. The beneficiary will be required to obtain his or her new equipment from a contract supplier since there is a break in need of greater than 60 days plus the days remaining in the rental month.
A break in need is when the beneficiary’s medical condition changes or improves and the equipment or service is no longer required. In these situations, the period of continuous use of the equipment in the prior rental episode ended and a new period of continuous use and 36- or 13-month rental period may begin as long as the contract supplier submits a new prescription, new medical necessity documentation and a statement describing the reason for the interruption which shows that medical necessity in the prior episode ended.
In all cases where the break in need for oxygen equipment occurs after the supplier has received payment for the 36th month of continuous use, the supplier is responsible for continuing to furnish the oxygen equipment during any period of medical need for the remainder of the reasonable useful lifetime of the equipment. In these situations, the supplier must continue furnishing the equipment, and a new 36-month rental payment period does not begin regardless of the length of the break in medical need and regardless of the number of breaks in medical need.
| 05/16/2013 |
When is a contract supplier responsible for repairing equipment?
A contract supplier is responsible for repairing equipment that the supplier is currently renting to a Medicare beneficiary, including oxygen equipment furnished after the equipment rental payment cap.
The monthly rental payments made by Medicare for durable medical equipment (DME) and oxygen equipment include payment for necessary repairs, maintenance and servicing of the rented equipment. For oxygen equipment, the statute and regulations require the supplier to continue furnishing the oxygen equipment after the rental payment cap for any period of medical need for the remainder of the reasonable useful lifetime of the oxygen equipment. A contract supplier may repair the rental equipment itself or subcontract for this service.
CMS recognizes that contract suppliers may not have the training or expertise to repair all brands or types of equipment; therefore, a contract supplier is not obligated to repair beneficiary-owned equipment. Any Medicare-enrolled supplier may perform repairs to beneficiary-owned equipment.
| 03/21/2011 |
Can a physician or other treating practitioner send the order for an external infusion pump to a pharmacy (subcontractor) that is coordinating the drug used with the pump or must the order be sent to the contract supplier that will be furnishing the pump?
This question is addressed by the quality standards and supplier standards. All DMEPOS suppliers, including contract suppliers and noncontract suppliers, must comply with these standards. Under the supplier standards, a supplier may subcontract for purchase of inventory, delivery and instruction, and repair of rented equipment. Services such as intake and assessment, coordination of care with the physician, submitting claims on behalf of the beneficiary, ownership and responsibility for equipment furnished to the beneficiary, and ensuring product safety are all services for which the primary supplier is responsible. The DMEPOS quality standards include additional requirements for intake and assessment (e.g., they require suppliers to consult with the prescribing physician as needed to confirm the order and to recommend any changes or refinements).
All subcontracting arrangements must comply with all applicable laws and regulations, including the anti-kickback statute. The Department of Health and Human Services Office of Inspector General is responsible for the anti-kickback statute. Please contact them with any questions or concerns you may have about the applicability of that statute to a particular subcontracting arrangement.
| 05/22/2014 |
As the primary supplier, I understand that I am responsible for submitting claims on behalf of the Medicare beneficiary. Does this mean I cannot use a billing agent?
No. Contract suppliers may employ billing agents to the extent permitted by standard Medicare rules. If a contract supplier subcontracts with another supplier for purchase of inventory (supplier standard #4), delivery and instruction on the use of a Medicare-covered item (supplier standard #12), or repair of rented equipment (supplier standard #14), the contract supplier or its billing agent must submit the claim to Medicare using the contract supplier's billing number. The subcontractor should not submit claims.
| 04/01/2013 |
On the subcontractor disclosure form, is it acceptable to provide the subcontractor's corporate headquarters' address?
No. The rules require that the location providing the services must be accredited. The address of the particular location that will perform the subcontracting service is required. Corporate headquarters' addresses are not acceptable.
| 05/19/2011 |
Can a contract supplier refer a beneficiary to a subcontractor if the contract supplier chooses not to carry certain items within a product category?
Contract suppliers are required to provide all items within a product category. However, as with any Medicare enrolled supplier, a supplier may subcontract for the purchase of inventory, delivery and instruction on the use of an item, or the maintenance and repair of rented equipment. Therefore, a contract supplier may subcontract for the purchase of inventory from a subcontractor and for the delivery and instructions on the use of the equipment. In accordance with the quality standards and the supplier standards, it is expected that beneficiaries and referral agents will communicate with the contract supplier when arranging for DMEPOS items and services. Also, remember that contract suppliers are 100% responsible for services furnished to beneficiaries and that subcontractors can’t do everything. Please review the Subcontracting Fact Sheet and Subcontracting FAQs on this website for more information.
| 11/03/2009 |
Our business currently uses subcontractors to deliver our inventory and instruct the beneficiaries on how to use it. On Form B, we will indicate that we use a subcontractor. I understand that we must submit a letter of intent; however, should we also submit a copy of the existing contract?
If you already have a contractual agreement with your subcontractor, you may submit a copy of that agreement along with your required documents.
For more information, please view the Subcontracting fact sheet, which you can find on this website by selecting Educational Information, then Fact Sheets.
| 10/20/2009 |
What are the requirements regarding subcontracting for inventory under the supplier standards? Does the supplier have to have title to the equipment?
The DMEPOS supplier must have title to the equipment when the equipment is furnished to the beneficiary. For further guidance on the purchase of inventory requirements, visit the National Supplier Clearinghouse (NSC) website, www.palmettogba.com/NSC.
| 10/16/2009 |
Do manufacturers need to be accredited to perform warranty repairs?
No. Manufacturers do not need to be accredited when they make such repairs. Repairs made under warranty are not a covered service or paid for by Medicare.
For more information, please view the Repairs and Replacements and Subcontracting fact sheets, which you can find on this website by selecting Educational Information, then Fact Sheets.
| 09/30/2009 |
May a contract supplier subcontract specifically for the delivery of the item?
A contract supplier may subcontract specifically for the delivery of the item (e.g., by using a common carrier such as Federal Express, the United States Postal Service, or the United Parcel Service). If the subcontractor only delivers the item, the subcontractor need not be accredited. If the subcontractor is providing more than the delivery by setting up the equipment or giving instructions about the use of the item, then the subcontractor must be accredited.
| 09/30/2009 |
Under the supplier standards, may a supplier subcontract out for other services?
A supplier may subcontract for the purchase of inventory, delivery and instruction on use of the Medicare-covered item, or the maintenance and repair of rented equipment. Services such as intake and assessment, coordination of care with the physician, submitting claims on behalf of the beneficiary, ownership and responsibility for equipment furnished to the beneficiary, and ensuring product safety are all services for which the primary supplier is responsible.
For more information, please view the Subcontracting fact sheet, which you can find on this website by selecting Educational Information, then Fact Sheets.
| 09/30/2009 |
What are the rules regarding referrals from subcontractors?
All contract suppliers and their subcontractors must comply with federal laws and regulations including the Stark and federal anti-kickback statutes. To report suspected illegal practices, please contact the Competitive Bidding Implementation Contractor (CBIC) Customer Service Center toll-free at 877-577-5331.
| 09/30/2009 |
What services may be subcontracted? Which subcontractors need to be accredited?
All DMEPOS suppliers, including contract suppliers, must comply with the DMEPOS supplier standards. The primary supplier is responsible for ensuring that its subcontractors perform in compliance with all applicable laws, regulations, and policies. Consistent with the DMEPOS supplier standards, a subcontractor may provide the following: 1) Purchase of inventory: The supplier standard at 42 CFR 424.57 (c)(4) requires that the DMEPOS supplier, “Fills orders, fabricates, or fits items from its own inventory or by contracting with other companies for the purchase of items necessary to fill the order. If it does, it must provide, upon request, copies of contracts or other documentation showing compliance with this standard. A supplier may not contract with any entity that is currently excluded from the Medicare program, any state health care programs, or from any other federal government executive branch procurement or non-procurement program or activity.” A subcontractor that only performs this service does not need to be accredited. 2) Delivery and instruction on use of Medicare-covered item: The supplier standard at 42 CFR 424.57 (c)(12) requires that the DMEPOS supplier, “Must be responsible for the delivery of Medicare covered items to beneficiaries and maintain proof of delivery. (The supplier must document that it or another qualified party has, at an appropriate time, provided beneficiaries with necessary information and instructions on how to use Medicare-covered items safely and effectively.)” A subcontractor that only delivers the item does not need to be accredited. If the subcontractor provides more than the delivery by setting up the equipment or giving instructions about the use of the item, then the subcontractor needs to be accredited unless a professional exemption applies. 3) Maintenance and repair of rented equipment: The supplier standard at 42 CFR 424.57 (c)(14) requires that the DMEPOS supplier, “Must maintain and replace at no charge or repair directly, or through a service contract with another company, Medicare-covered items it has rented to beneficiaries. The item must function as required and intended after being repaired or replaced.” A subcontractor that only repairs equipment that a supplier is renting to a beneficiary does not need to be accredited. If the subcontractor provides more than the repair of the equipment by setting up the repaired item or giving instructions about the use of the repaired item, then the subcontractor needs to be accredited unless a professional exemption applies. Services such as intake and assessment, coordination of care with the physician, submitting claims on behalf of the beneficiary, ownership and responsibility for equipment furnished to the beneficiary, ensuring product safety, etc., are all services for which the primary supplier is responsible. For more information, please view the Fact Sheet.
| 09/30/2009 |
What will contract suppliers be paid when they furnish oxygen and oxygen equipment or capped rental durable medical equipment (DME) to a beneficiary who transitions to them from a non-contract supplier in the middle of the 36-month or 13-month rental payment period?
If a beneficiary who would otherwise be entitled to obtain oxygen from a grandfathered supplier changes to a contract supplier, the contract supplier will be paid at least 10 monthly payment amounts at the single payment amount regardless of how many months the previous supplier was paid.
For example, for rental agreements in months 2 through 26, the new contract supplier will be paid for the remaining rental months of the period. Contract suppliers assuming rental agreements that are in months 27 or later will receive a minimum of 10 payments regardless of how many months the previous supplier was paid.
If the beneficiary changes to a new contract supplier, the new contract supplier must replace the equipment. If the beneficiary changes from a contract supplier to another contract supplier, the new contract supplier is NOT entitled to a minimum number of months of payment and will be paid the single payment amount for the duration of the rental period not to exceed 36 months.
If a beneficiary who would otherwise be entitled to obtain a capped rental DME item from a grandfathered supplier changes to a contract supplier, a new 13-month rental period begins regardless of how many months the previous supplier was paid. However, rental payments only continue if the item continues to be medically necessary. The contract supplier will be paid the single payment amount. If the beneficiary changes from a contract supplier to another contract supplier, a new rental period does NOT begin, and the new contract supplier will be paid the single payment amount for the duration of the capped rental period.
For more information, please view The DMEPOS Competitive Bidding Program Grandfathering Requirements for Non-Contract Suppliers Fact Sheet.
| 05/16/2013 |
Do normal utilization parameters for accessories and supplies continue to apply when a patient transitions from a non-contract supplier to a contract supplier? For example, if a patient received a new continuous positive airway pressure (CPAP) mask in month six and transitioned to a contract supplier in month seven, is the contract supplier eligible to bill for a new mask upon setup? Can the contract supplier still provide these items, or is the patient not eligible since he or she received the mask in the month prior?
New accessories or supplies, such as the CPAP mask in the example given, would not be necessary just because of the transition to the new supplier. The normal utilization parameters continue to apply unless the accessory previously purchased from the non-contract supplier does not work with the new equipment furnished by the contract supplier. If a previously purchased accessory is not compatible with the new equipment, the contract supplier may bill for the new item(s). Due to claims editing limitations, the new item(s) may deny for “same or similar” and require a redetermination. Resolution through the appeals channel is the proper process to follow. Changing base equipment that renders the accessories unusable due to incompatibility is a justifiable reason to replace the accessory.
Note: Most supplies used with PAP devices are dispensed in three-month amounts. With the exception of humidifiers and certain filters, these supplies are regarded as interchangeable between devices. Thus, the supplies obtained in December should be sufficient to meet the beneficiary’s needs until the next quarter, at which time the new supplier may provide and bill for a three-month supply.
| 03/04/2011 |
If a patient using a continuous positive airway pressure (CPAP) device switches to a contract supplier during the 90-day trial period required by the Local Coverage Determination (LCD), does the contract supplier need to get the compliance data from the original provider?
The Grandfathering for Rented DME fact sheet indicates that the current supplier and the new contract supplier must coordinate the pickup and delivery of the equipment so that service to the beneficiary is not disrupted. The current supplier should provide copies of all supporting documentation, such as the physician order or Certificate of Medical Necessity (CMN) when applicable, to the new contract supplier. The CPAP compliance data would be an example of supporting documentation. The contract supplier needs to obtain all documents and information necessary to demonstrate adherence to coverage requirements set forth in statute, regulation, rule, or national or local coverage determinations.
For more information, please view the Grandfathering for Rented DME fact sheet, by selecting a round from the left hand navigation pane, then selecting Fact Sheets under Educational Information.
| 03/04/2011 |
When a patient renting capped rental DME from a non-contract supplier switches to a contract supplier, a new 13-month rental payment period begins. Does the 90-day trial period required by the Local Coverage Determination (LCD) start over as well?
No, assuming the patient met the coverage requirements during the initial 90-day trial.
| 03/04/2011 |