Clock starts ticking on nationwide bid program

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Tuesday, February 25, 2014

WASHINGTON – CMS announced Feb. 24 that it seeks public comments on how to take its competitive bidding program for DME nationwide on Jan. 1, 2016.

“While the methodology will be proposed in future rulemaking, CMS is first requesting comments on several aspects that it would consider in developing a methodology to adjust DMEPOS fee schedule amounts or other payment amounts in non-competitive areas based on the DMEPOS competitive bidding payment information,” CMS states in a fact sheet.

Specifically, the agency seeks comments on:

  • Do the costs of furnishing various DMEPOS items and services vary based on the geographic area in which they are furnished?
  • Do the costs of furnishing various DMEPOS items and services vary based on the size of the market served in terms of population and/or distance covered or other logistical or demographic reasons?
  • Should an interim or different methodology be used to adjust payment amounts for items that have not yet been included competitive bidding? For example, items such as transcutaneous electrical nerve stimulation (TENS) devices have only been phased into the nine Round 1 areas thus far.
     

CMS also seeks public comment on whether it should consider simplifying the payment rules under competitive bidding for certain DME and enteral nutrition by making one monthly payment for all related items and services needed each month.

“Medicare allows additional payments for numerous supplies and accessories furnished for use with beneficiary-owned DME and eternal nutrition equipment,” CMS states. “Complicated claims processing systems and edits are needed to count rental months, prevent duplicate payments for thousands of separately coded items, and track utilization of ongoing replacements of supplies and accessories.”

Specifically, the agency seeks comments on:

  • Are lump sum purchases and capped rental payment rules for DME and enteral nutrition equipment still needed?
  • Are there reasons why beneficiaries need to own expensive DME or enteral nutrition equipment?
  • Would there be any negative impacts associated with continuous bundled payments for enteral nutrients, supplies and equipment or for certain DME?

To read CMS’s advance notice of proposed rulemaking on how to expand competitive bidding, go here:

http://www.ofr.gov/OFRUpload/OFRData/2014-04031_PI.pdf. The agency expects the notice to be published in the Federal Register on Feb. 26.