Road to Round 2021: New calculator highlights ‘bid ceiling,’ comparisons

Stakeholders say it’s more robust than CMS’s calculator
 - 
Friday, March 29, 2019

WASHINGTON – Stakeholders have updated an industry website dedicated to competitive bidding information with a calculator to help HME providers formulate their bids for the next round of the Medicare program.

The calculator, which can be found at www.dmecbpeducation.com, is part of a larger effort by stakeholders to educate providers about Round 2021, an effort that will also include webinars.

“Lead-item pricing can look simple, but it’s not,” said Cara Bachenheimer, chair of the government affairs practice at Brown & Fortunato. “The key message for providers is: ‘Don’t just look at the lead item; you must also look at non-lead items.’ That’s what this calculator is all about.”

To use the calculator, users select their competitive bid area and the lead item to get the “bid ceiling” for that item. Then they enter their bid price for the lead item to get the prices for the non-lead items. The calculator also provides the percentage and dollar change from the submitted bid to the average 2019 fee schedule amounts for all items.

Stakeholders acknowledge that CMS has its own calculator, but because it doesn’t provide the “bid ceiling” or comparisons to the current prices, it forces providers to formulate bids in a vacuum, they say.

“I’m not dissuading providers from looking at (CMS’s calculator), but ours is a much more useful tool,” said Mark Higley, vice president of regulatory affairs at the VGM Group.

Having the “bid ceiling” on hand while formulating bids is key, stakeholders say. In 2016, CMS increased the “bid ceiling” from the previous bid ceiling to the higher 2015 fee schedule amounts for products already in the program.

“If you look at the current SPA and submit something relative to that, every single non-lead item goes down from the current SPAs—it’s scary,” said Kim Brummett, vice president of regulatory affairs at AAHomecare. “To preserve the non-lead items, you have to bid higher than before on the lead items.”

Stakeholders will also focus a chunk of their education efforts specifically on the new product categories for non-invasive ventilators, and knee and back braces. They point out, for example, that the “bid ceiling” for the lead items in these categories—as well as for codes that have been added to the existing manual and power mobility categories—is the 2019 fee schedule amounts for those items.

“There are at least 1,200 suppliers who do orthotics only who have never been in a bid program,” Brummett said.

CMS expects to begin accepting bidder registrations and open the bid window in June.