The information contained here is intended to assist Home Infusion providers, both contracted and non-contracted, in understanding Competitive Bidding program and how it effects their ability to provide and bill for home infusion services.
Overview of the DMEPOS Competitive Bidding Program
The DMEPOS Competitive Bidding Program was mandated by Congress through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). The statute requires that Medicare replace the current fee schedule payment methodology for selected Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) items with a competitive bid process.
Under the program, a competition among suppliers who operate in a particular competitive bidding area (CBA) is conducted. Suppliers are required to submit a bid for selected products. Bids are evaluated based on the supplier’s eligibility, its financial stability and the bid price. Contracts are awarded to the Medicare suppliers who offer the best price and meet applicable quality and financial standards. Contract suppliers must agree to accept assignment on all claims for bid items and will be paid the bid price amount. The amount is derived from the median of all winning bids for an item.
The Round 1 Rebid of Competitive Bidding It is termed “rebid” because Congress nullified and postponed the original Round 1 bidding process.
All Medicare Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) Competitive Bidding Program contracts expire on December 31, 2018. Starting January 1, 2019, there will be a temporary gap in the entire DMEPOS Competitive Bidding Program that CMS expects will last until December 31, 2020. For additional information, see the CMS Temporary Gap Period fact sheet.
Some Important changes to note:
Learn more about the standardized electronic claiming and coding for home infusion.
Learn more about TRICARE and The Veterans Health Administration (VA).
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Recommendations for the type of criteria the provider should research.
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