Medicare’s next competitive bidding round: How to get ready 

YARMOUTH, Maine – With key details finalized for the next round of Medicare's competitive bidding program (CBP), providers should start preparing now, industry experts say. From credit requirements to licensure and operational readiness, here’s what you need to know. 

Your business credit report is critical 

The only financial document required to participate in the next CBP round is a business credit report with a numerical credit score or rating. Andrea Stark, Medicare consultant and reimbursement specialist for MiraVista, advises providers to prepare by pulling their credit reports now to understand where they fall in CMS’s five-tier system. Providers must rank in one of the top three tiers to avoid disqualification. (See CMS’s scoring system on page 209 of the final rule.)  

“Anything you pull more than 90 days from the bid window opening can’t be used, but at least you’ll know where you stand," she said. "Then going forward, make sure you’re not making any decisions that will negatively impact your credit,” she said.  

CMS will publish detailed credit report requirements in its Request for Bids Instructions before the bid window opens, which is tentatively scheduled for late summer or early fall. Providers will need to pull their official credit reports no sooner than 90 calendar days of the bid window opening. 

Licensure: Position yourself to win 

CMS plans to announce the number of contracts per product category in late spring or early summer, but experts expect fewer providers will be awarded contracts. That means providers looking to scale should ensure they meet licensure requirements in all states they plan to serve, experts say. 

“If you plan on being a bid winner, you’re going to want to have licensure in as many states as possible,” said Kelly Grahovac, general manager of The van Halem Group, during a recent webcast. “You need to make sure you’re considering strategically where you are currently licensed and what that looks like on a larger scale.” 

Review, model and build efficiency 

Ronda Buhrmester, senior director of payer relations and reimbursement for VGM & Associates, recommends providers take these steps now: 

• Review accreditation and enrollment compliance. CMS will now require annual resurvey and reaccreditation (though it has said a provider’s cycle will not begin until the expiration of their current reaccreditation three-year cycle if issued prior to the final rule effective date). “Make sure you have everything you need in place so you’re ready for a site visit at any time,” Buhrmester said. 
• Perform scenario planning and financial modeling. 
• Strengthen operational efficiency. “We know rates will drop, not increase,” she said. “So, where can I tighten up any steps? Take a 30,000-foot view and see where you’re duplicating processes – or even consider outsourcing some of that.” 
• Stay informed. 

Expect paperwork burdens 

Contract suppliers should be aware of additional documentation requirements. During the initial three-month contract period, they must obtain medical necessity documentation from non-contracted suppliers. If unsuccessful, they have six months to secure new orders and documentation. (CMS notes the six-month grace period does not apply to off-the-shelf (OTS) braces, which were part of the last CBP round.) 

“If you’re awarded a contract, it’s another layer (you have to go through),” Grahovac said.