The Competitive Bidding Program by Medicare was launched to improve the overall value of Medicare and the money of the taxpayers used in the facilities. The program sets prices through competition, ensuring that the patients’ items are of quality and licensed. It also allows only accredited suppliers to bid who must meet the standards set by Medicare. The overall process helps in reducing fraud and abuse of the Medicare system.
What Is DMEPOS Competitive Bidding Program?
Congress mandated the DMEPOS Competitive Bidding Program in 2003 through Medicare Prescription Drug, Improvement, and Modernization Act (MMA). The Act required Medicare to replace its then methodology of fee schedule payment for selected Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items with a competitive bidding process.
The program oversaw that suppliers in a competitive bidding area (CBA) compete with each other by submitting bids on a selection of products. The program evaluated the bids based on the eligibility, bid price, and the supplier’s financial stability. Successful bidders then are awarded the contractors who are Medicare suppliers and offer the best price while meeting the economic standards and applicable quality of the products.
It is vital that the contractors are to agree to accept the assignment on all claims for the items they bid. They are also required to pay the bid price. The amount for an item is derived from the median of all the bids considered winners.
The Competitive Bidding Program for Round 2021 began on January 1, 2021. The bidding was applicable for only off-the-shelf knee and back braces. The program required the patients of Original Medicare to get the competitively bid back and knee braces off-the-shelf from a competitive supplier in the competitive bidding area. However, there are provisions for exceptions.
What Happens If A Patient Requires An Item Of A Specific Brand?
If a patient needs DMEPOS items not mentioned in the competitive bidding program, then the doctor must prescribe the brand in writing. It is only accepted when it can be established that there can be an adverse medical outcome without using the specific brand. In the document, the doctor must record why the brand is needed and how it can avoid a negative outcome. The contractor in such a situation is then required to:
- Give the patient the specific brand of an item.
- If the supplier doesn’t have or cannot get it for the patient, then they must help in finding another contractor who can provide it.
- Work with the doctor to find an alternative and then get the prescription revised.
How To Get The Item Repaired Or Replaced?
When a patient owns a competitively bid DMEPOS item and needs to repair or replace the parts, they can contact any Medicare-enrolled supplier. Even a non-contract supplier can help repair and replace the parts. But the supplier must be Medicare enrolled so the patient can get the reimbursement for the repaired or replaced parts from Medicare. However, Medicare will not pay for any replacement or repair covered by the warranty of the item’s supplier.
Can The DMEPOS item Be Received from Doctor or Hospital?
Typically you should get the item from a contract supplier registered with Medicare. However, there are exceptions like:
- The doctor or the treatment facility gives the equipment as part of the clinical service during the treatment despite not being a contract supplier.
- The doctor or the hospital gives the item when the patient is admitted or on the day of release from the hospital. It can be done even when the provider is not a contract supplier.
How To Ensure Your Facility Is Benefitting From The DMEPOS Competitive Bidding?
If you are into Durable Equipment facility service and Medicare contracted supplier, then all these new rules can be confusing. In such a scenario, the best way to navigate the system is to get help from an outsourcing medical and billing partner such as 24/7 Medical Billing Services to ensure your revenue management is in place. It even won’t be the last thing to run into losses due to claim rejections as a Durable Equipment provider.
24/7 Medical Billing Services has the best team related to Durable Equipment who can take care of all the revenue issues and claim management. You can contact us today to know more.