The Durable Medical Equipment Prosthetics Orthotics and Supplies DMEPOS Competitive Bidding Program May 2016 Competitive BiddingA Better Way to Pay Started in January 2011 for certain durable medical equipment prosthetics orthotics and ID: 686753
Download Presentation The PPT/PDF document "DMEPOS Competitive Bidding Program" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
DMEPOS Competitive Bidding Program
The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program
May 2016Slide2
Competitive Bidding—A Better Way to Pay
Started in January 2011 for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) in 9 areas of the country (Round 1)
In July 2013
The program expanded to more areas (Round 2)
The National Mail-Order Program was implementedLimits fraud and abuse in the Medicare programThe Competitive Bidding Program helps people with MedicareSave moneyGet quality equipment, supplies, and services
April 2016
Competitive Bidding Program
2Slide3
The Competitive Bidding
Program
S
uppliers submitted bids to provide certain DMEPOS
at lower prices than Medicare was payingContracts are awarded to winning suppliers to sell/rent DMEPOS Amount Medicare pays for DMEPOS is based on bidsWhen Medicare pays less, the 20% coinsurance is less
Contract suppliers mustMeet eligibility, quality, and financial standardsBe accredited by an independent organization
April 2016
Competitive Bidding Program
3Slide4
The Competitive
Bidding Program—ContinuedIn most cases, only contract suppliers canProvide competitively bid
DMEPOS
The
types of items Medicare covers doesn't change Contract supplier charge can’t exceed single payment amount based on bids received for an item
Competitive Bidding Program
April 2016
4Slide5
Round 1 Recompete Products1/1/14-12/31/16
Products
Included in
Round
1 Recompete
Respiratory equipment and related supplies and accessories including Oxygen, oxygen equipment and supplies; Continuous Positive Airway Pressure (CPAP) devices and respiratory assist devices (RADs) and related supplies and accessories; and standard nebulizersStandard mobility equipment and related accessories including
Walkers, standard power and manual wheelchairs, scooters, and related accessoriesGeneral home equipment including Hospital beds and related accessories, group 1 and 2 support surfaces, transcutaneous electrical nerve stimulation (TENS) devices, commode chairs,
patient lifts, and seat lifts
Enteral nutrients,
equipment, and supplies
Negative pressure
wound therapy pumps and related supplies and accessories
External infusion pumps and supplies
April 2016
Competitive Bidding Program
5Slide6
Round 1 2017
Required by law to recompete contracts at least once every 3 years
Current Round 1 Recompete contracts and prices expire on December 31, 2016
Contracts and prices for next period to
become effective on January 1, 2017
April 2016
Competitive Bidding Program
6Slide7
Round 2 Competitive Bidding
Contracts and prices Were effective on July 1, 2013
E
xpire June 30, 2016
Program expanded91 Metropolitan Statistical Areas
April 2016
Competitive Bidding Program
7Slide8
Products Included in Round 2*
Products Included in Round 2
Oxygen,
oxygen equipment, and supplies
Enteral nutrients,
equipment, and suppliesContinuous Positive Airway Pressure (CPAP) devices and Respiratory Assist Devices (RADs), and related supplies and accessoriesHospital beds and related accessoriesWalkers and related accessories
Support surfaces (Group 2 mattresses and overlays)Standard (power and manual) wheelchairs, scooters, and related accessoriesNegative pressure wound therapy pumps and related supplies and accessories*Changes from Round 1 to Round 2 in Bold Italics
April 2016
Competitive Bidding Program
8Slide9
National Mail-Order Program for
Diabetes Testing Supplies
Designed to
ensure
that people with Original Medicare continue to get quality supplies and save money People who choose to have diabetes testing supplies delivered to their home need to knowMedicare won't pay unless a national mail-order contract supplier is usedNational mail-order contract suppliers can’t charge more than the deductible and 20% coinsurancePeople can also choose to get supplies from any local store enrolled in Medicare
Local stores can’t charge more than the deductible and 20% coinsurance if they accept assignment
April 2016Competitive Bidding Program
9Slide10
Round 2 Recompete & National
Mail-Order RecompeteRound 2 and National Mail-Order Program
C
ontract periods expires
on June 30, 2016Round 2 Recompete and the national mail-order recompete contracts Become effective on July 1, 2016 Expire on December 31, 2018
April 2016
Competitive Bidding Program
10Slide11
Round 2 Recompete Products7/1/16-12/31/18
Products
Included in
Round
2 Recompete
Enteral nutrients, equipment, and suppliesGeneral home equipment and related supplies and accessories including Hospital beds and related accessories, group 1 and 2 support surfaces, commode chairs, patient lifts, and seat lifts
Nebulizers and related suppliesNegative Pressure Wound Therapy (NPWT) pumps and related supplies and accessoriesRespiratory equipment and related supplies and accessories includingoxygen, oxygen equipment, and supplies, continuous positive airway pressure (CPAP) devices and respiratory assist devices (RADs) and related supplies and accessories Standard mobility equipment and related accessories including
Walkers, standard power and manual wheelchairs, scooters, and related
accessories
Transcutaneous Electrical Nerve Stimulation (TENS) devices and supplies
April 2016
Competitive Bidding Program
11Slide12
The Competitive Bidding
Program— Who will be Affected?
People who have
Original Medicare
andPermanently reside in, or are visiting, a Competitive Bidding Area (CBA) and obtain competitively bid itemsTo find out if a ZIP code is in a CBA or to locate a contract supplier
Visit Medicare.gov/supplier, or Call 1-800-MEDICARE (1-800-633-4227)TTY users call 1-877-486-2048 Medicare Advantage Plans should let their enrollees know if their plan is changing
April 2016
Competitive Bidding Program
12Slide13
Doctors and Other Treating Practitioners Use of Contract Suppliers
Must almost always use contract supplier ifItems and services are included in Competitive Bidding Program where a person with Original Medicare lives
Someone is traveling to or visiting a
c
ompetitive bidding areaDoctors, treating practitioners, and hospitals can supply certain items (e.g.: walkers and folding manual wheelchairs) without being contract suppliersA nursing facility can supply directly to its own residents only if it becomes a contract supplier
April 2016
Competitive Bidding Program
13Slide14
Staying With A Non-Contract Supplier
A consumer can stay with current supplier that doesn’t have a new contract, provided that
Supplier elects to become “grandfathered”
The person with Original Medicare permanently resides in a competitive bidding area
The person with Original Medicare was renting certain equipment or oxygen when the program (or recompeted round) started
April 2016
Competitive Bidding Program
14Slide15
Grandfathering
Non-contract supplier
Must inform Medicare consumers in writing about whether they’ll
continue
renting equipmentWorks with contract supplier to get new equipment if Medicare consumers switch to a contract supplierThe choices areContinue getting services from a grandfathered supplier until rental period ends ORSwitch to a new contract supplier
April 2016
Competitive Bidding Program
15Slide16
Have Other Insurance?
Medicare may make payment to a non-contract supplier if required by primary policyNon-contract supplier must
Be accredited
Have
a valid Medicare billing numberBe eligible to receive secondary payments
April 2015
Competitive Bidding Program
16Slide17
Non-contract Supplier
A non-contract supplier generally may not provide competitively bid items in a competitive bidding area
If a non-contract
supplier
is used and no exception applies, people with Medicare aren’t responsible for payment unless the supplier issues an Advance Beneficiary Notice (ABN)By signing the ABN, the person with Medicare agrees to pay entire amount
April 2016
Competitive Bidding Program
17Slide18
Changing Suppliers Scenario
Obtaining DMEPOS items from a new contract supplier
Mildred’s permanent residence is in Miami, FL, which is a Round 1
C
ompetitive Bidding Area. She’s currently renting her Continuous Positive Airway Pressure (CPAP) device
from ABC Company, which has a Round 1 Recompete contract, but not a Round 1 2017 contract. Mildred receives a notice from ABC Company informing her that they won’t be a contract supplier after December 31, 2016, and that they also won’t be a grandfathered supplier starting January 1, 2017. Mildred must transition to a Round 1 2017 contract supplier for Medicare to help pay.
April 2016
Competitive Bidding Program
18Slide19
Getting DMEPOS When Travelling
To Competitive B
idding
A
reas (CBAs)Must generally use contract supplier for that CBAIf non-contract supplier used and no exception applies, people with Medicare aren’t responsible for payment unless supplier issues Advance Beneficiary NoticeTo non-competitive bidding areasCan use any Medicare-enrolled supplier
April 2016
Competitive Bidding Program
19Slide20
Specific Brands
Doctor must prescribe in writingMedical record must reflect needContract supplier must
Provide the specific brand or form as prescribed OR
Work with the doctor or treating practitioner to find a suitable alternative and obtain a revised prescription OR
Help locate another contract supplier that can Provide the specific brand or form as prescribed
April 2016
Competitive Bidding Program
20Slide21
Equipment Repair & Replacement
For beneficiary-owned medical equipmentAny Medicare-enrolled supplier can make necessary
repairs
For
replacement, must use a contract supplier For warranty repairs, follow the warranty rulesFor rented equipmentRepairs are included in rental payment—the supplier must fix at no charge
April 2016
Competitive Bidding Program
21Slide22
Deductible and Coinsurance
After paying the annual Part B deductible
Medicare pays 80% of the Medicare-approved amount for equipment, supplies, and services
The consumer is responsible for 20% coinsurance
Contract suppliers can’t bill for more than these amountsFor suspected overpayment or fraud, call 1-800-MEDICARE (1-800-633-4227) TTY users call 1-877-486-2048Fraud Hotline of the HHS Office of Inspector General at 1-800-447-8477
April 2016
Competitive Bidding Program
22Slide23
Points to Remember
The Competitive Bidding Program does NOT affect which doctors or hospitals a person with Medicare can use
Generally, a contract supplier must be used for Medicare to help pay
A person with Medicare may
be able to stay with their current supplier if renting from a supplier who has a new contract or elects to become “grandfathered”People in Medicare Advantage Plans should check with the plan
April 2016
Competitive Bidding Program
23Slide24
Resources
Visit Medicare.gov/supplier DMEPOS Supplier Locator Tool
Call
1-800-MEDICARE (1-800-633-4227)
TTY users should call 1-877-486-2048Doctors or suppliersAdministration for Community Living has local information resources
April 2016
Competitive Bidding Program
24