Your Guide To Medicare’s Durable Medical Equipment, Prosthetics, Orthotics, & Supplies DMEPOS Competitive Bidding Program
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.
About
24/7 Medical Billing Services:
We
are a medical billing company that offers ‘24/7
Medical Billing Services’ and support physicians, hospitals, medical
institutions and group practices with our end to end medical billing solutions.
We help you earn more revenue with our quick and affordable services. Our
customized Revenue Cycle Management (RCM) solutions allow physicians to attract
additional revenue and reduce administrative burden or losses.
Contact:
24/7
Medical Billing Services
Tel:
+1 888-502-0537
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