Medicare spend in 2012?

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05/02/2013

For those of you uninitiated in the to-do list of an HME News editor, the first week in May is when she has to submit half a dozen or so Freedom of Information Act (FOIA) requests with the Pricing, Data Analysis and Coding (PDAC) contractor to update the HME Databank.

The Databank features a listing of the top Medicare providers by total reimbursement for 231 codes (Provider Share can be filtered by state, city or zip) and a listing of fee-for-service reimbursement for 426 codes included in competitive bidding (Product Share can be filtered by state and county).

We’ll update the Databank in September with 2012 data.

Each year for Provider Share, I keep a running list of code requests. We consider the 231 codes in there some of the most popular codes—you know, E1390, E0260, E0601, A4253 and K0823. So it was interesting to see that many of the codes that users have requested fall under urologicals, wound care, orthotics, ostomy and enteral.

Were the users requesting these codes already doing business in these markets and looking for data? Or were they requesting these codes looking to enter these markets and looking for data? I wish I had taken note.

We’ll add dozens of codes in these areas to the Databank as part of this year’s update.

Speaking of this year’s update, it should be pretty interesting. Last year, with the 2011 data, we got our first glimpse of the HME industry post-competitive bidding. Round 1 of the program went into effect Jan. 1, 2011. This year, with the 2012 data, we’ll have a better look at the continuous impact of competitive bidding on Medicare spend.

For Riverside County in California, one of the areas included in Round 1, Medicare spend for E1390 decreased from about $4.8 million in 2010 to about $3.3 million in 2011.

In Mecklenburg County in North Carolina, which includes Charlotte, Medicare spend for E1390 decreased from about $2.6 million in 2010 to about $1.7 million in 2011.

What happened in 2012?

Stay tuned.