CMS issues final rule on bidding, bundling

Monday, November 3, 2014

WASHINGTON – Late Friday afternoon, CMS released its final rule for DME payment adjustments and it looks basically unchanged from the proposed rule.
HME industry stakeholders are currently analyzing the final rule, which will be published in the Nov. 6 Federal Register. CMS issued its proposed rule July 11.
The final rule defines changes in methodology to adjust fee schedule amounts for DME in areas where the competitive bidding program has not been implemented. The major provisions:
• Adjust fee schedule amounts for items and services based on regional prices limited by a national ceiling (110% of the average of regional prices) and floor (90% of the average of regional prices)
• Adjust fee schedule amounts for non-contiguous areas based on the average of competitive bidding pricing from these areas or the national ceiling, whichever is higher.
The regulation also calls for implementing monthly bundled payments in certain bid areas for standard power wheelchairs and CPAP devices, along with supplies, accessories, maintenance and repairs.
The rule does not finalize and update reflecting guidance on what training is needed to provide custom fitted orthotics for providers who are not certified orthotists.

CMS fact sheet