Competitive Bidding

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The information contained here is intended to assist Home Infusion providers, both contracted and non-contracted, in understanding Competitive Bidding program and how it effects their ability to provide and bill for home infusion services.

Overview of the DMEPOS Competitive Bidding Program

The DMEPOS Competitive Bidding Program was mandated by Congress through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). The statute requires that Medicare replace the current fee schedule payment methodology for selected Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) items with a competitive bid process.

Under the program, a competition among suppliers who operate in a particular competitive bidding area (CBA) is conducted. Suppliers are required to submit a bid for selected products. Bids are evaluated based on the supplier’s eligibility, its financial stability and the bid price. Contracts are awarded to the Medicare suppliers who offer the best price and meet applicable quality and financial standards. Contract suppliers must agree to accept assignment on all claims for bid items and will be paid the bid price amount. The amount is derived from the median of all winning bids for an item.

The Round 1 Rebid of Competitive Bidding It is termed “rebid” because Congress nullified and postponed the original Round 1 bidding process. 

  • Term:January 1, 2011 – December 31, 2013
  • Areas effected:  9 CBAs,  Click here for a full listing of the CBAs.
  • Product categories effecting home infusion providers
    • Enteral Nutrients, Equipment and Supplies
    • Click here for a full listing of the Round 1 Rebid product categories

Round 2 expands Competitive bidding to 100 additional CBAs 

  • Term:July 1, 2013 – June 30, 2016
  • Areas effected:  100 CBAs, Click here for a full listing of the CBAs.
  • Product categories effecting home infusion providers
    • Enteral Nutrients, Equipment and Supplies
    • Click here for a full listing of the product categories included in Round 2

The Round 1 Recompete (R1RC) of Competitive Bidding

  • Term:January 1, 2014 – December 31, 2016
  • Areas effected:  9 CBAs  Click here for a full listing of the CBAs.
  • Product categories effecting home infusion providers
    • Enteral Nutrients, Equipment and Supplies
    • External Infusion Pumps and Supplies
    • NOTE: TPN is statutorily excluded from Competitive Bidding

Round 2 Recompete (R2RC) of Competitive Bidding

  • Term: July 1, 2016 – December 31, 2018
  • Timeline:  Supplier registration opens Dec.18, 2014.
  • Timeline:  Click here for a detailed timeline that CMS released on Dec. 12, 2104
  • Areas effected:  117 CBAs
    • , Click here for a full listing of the CBAs.
    • NOTES: CBAs no longer overlap state boarders
  • Product categories effecting home infusion providers
    • Enteral Nutrients, Equipment and Supplies
    • Click here for a full listing of the product categories
    • NOTE:  External Infusion Pumps and Supplies are not included in the R2RC

Round 1 2017 (R12017) of Competitive Bidding

    • Term: January 1, 2017 – December 31, 2018
    • Areas effected:  13 CBAs  Click here for a full listing of the CBAs.
    • Product categories effecting home infusion providers
      • Enteral Nutrients, Equipment and Supplies
      • Click here for a full listing of the product categories
      • NOTE: Infusion Pumps, supplies and drugs are NOT included in the Round 1 2017: TPN is statutorily excluded from Competitive Bidding

Important Note:  On February 8, 2017 CMS Announces Temporary Delay of Round 2019: The Centers for Medicare & Medicaid Services (CMS) has decided to temporarily delay moving forward with the next steps of the Round 2019 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program to allow the new administration further opportunity to review the program. As a result, CMS has removed all information that was released on January 31, 2017, including information on the CMS.gov website and the Competitive Bidding Implementation Contractor (CBIC) website.

The information below is based on the details released by CMS on Jan. 31, 2017 and may change.

Round 2019 (R2019) of Competitive Bidding

    • Term: January 1, 2019 – December 31, 2021
    • Areas effected: 141 CBAs  Click here for a full listing of the CBAs.
    • Product categories effecting home infusion providers
      • Enteral Nutrients, Equipment and Supplies
      • Infusion Pumps, supplies and drugs are NOT included in the Round 2019, with the exception of insulin pumps. TPN is statutorily excluded from Competitive Bidding
      • Click here for a full listing of the product categories
      • $50,000 bid surety bond required for each CBA

 

Whether or not a patient is considered part of a CBA can be complicated.  It is partially based on the beneficiaries primary residence (the address on file with CMS, that their EOB’s are sent to).  You can enter the beneficiaries primary residence ZipCode into the CMS Supplier Locator website to determine if they reside in a CBA. 

If the beneficiaries travel you will want to make sure that you are still eligible to provide services in the areas that they travel to.  See the Traveling Beneficiary Fact Sheet for details.

Competitive Bidding Fact Sheets:

Temporary Gap in Competitive Bidding Programs beginning January 1, 2019
All Medicare Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) Competitive Bidding Program contracts expire on December 31, 2018. Starting January 1, 2019, there will be a temporary gap in the entire DMEPOS Competitive Bidding Program that CMS expects will last until December 31, 2020. For additional information, see the CMS Temporary Gap Period fact sheet.

Round 2021 (R2021) of Competitive Bidding

    • Term: January 1, 2021 – December 31, 2023
    • Areas effected:  Consolidates the competitive bidding areas (CBAs) that were included in Round 1 2017 and Round 2 Recompete. Round 2021 will include 130 CBAs.
    • Product categories effecting home infusion providers
      • Enteral Nutrients, Equipment and Supplies
      • Click here for a full listing of the product categories
      • NOTE: TPN, infusion pumps and related supplies (and drugs) are NOT included in the Round 2021
      • Timeline

Some Important changes to note:

    • Bid Surety Bonds – Bidders must obtain a $50,000 bid surety bond from an authorized surety on the List of Certified Companies on the Department of the Treasury’s website for each CBA for which they submit a bid.  Bid Surety Bond Fact Sheet
    • Lead Item Bidding – In past rounds bidders had to bid on each and every item within a product category, in this round bidders will bid on a single, lead item, for each product category.  The prevailing lead item bid will determine the payment amount for all other items in the product category. See Lead Item Pricing fact sheet and the Lead Item Pricing Calculator for more information.

 

 

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Billing and Coding

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