Competitive bidding analysis

Sunday, July 15, 2007

Providers selected as winning bidders may opt out of the program at any time prior to signing a contract with CMS. Once a supplier agrees to become a contract supplier, however, he must comply with the contract and Medicare program rules. These requirements include:

• A contract supplier must furnish a competitively bid item to any Medicare beneficiary with a permanent residence in the competitive bidding area (CBA) or who is visiting the CBA and who requests service from the contract supplier.

• A contract supplier must furnish a brand-specific item upon a written physician order, documenting that the item is necessary to avoid adverse health consequences for the beneficiary. A supplier unable to furnish the brand-specific item may deliver an alternative item that meets the beneficiary’s need, so long as he gets a written physician order for the alternative item. If the physician does not revise the written order and the contract provider is unable to furnish the brand specific item, the provider may assist the beneficiary in locating another contract provider who can furnish the item.

• A contract provider may not discriminate against Medicare beneficiaries. He must furnish the same range of products and services to Medicare beneficiaries that he furnishes to other customers in a CBA.

• A contract provider must submit a quarterly report designating the manufacturer, make and model number of products he furnishes to Medicare beneficiaries. CMS will post this information on the Internet to allow beneficiaries to make an informed choice of provider.

• A contract provider unable to continue to offer competitively bid items at the single payment amount may be considered to be in breach of his contract. If the provider has breached his contract, CMS might take action against the supplier, including terminating the supplier’s contract. CMS reserves the right to take other action such as precluding the provider from participating in the competitive bidding program or terminating his supplier number.