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.
Round 2 expands Competitive bidding to 100 additional CBAs
The Round 1 Recompete (R1RC) of Competitive Bidding
Round 2 Recompete (R2RC) of Competitive Bidding
Round 1 2017 (R12017) of 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
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
Some Important changes to note:
Learn more about the standardized electronic claiming and coding for home infusion.
Learn more about TRICARE and The Veterans Health Administration (VA).
Need overviews on the details of Medicare? Have specific questions?
Recommendations for the type of criteria the provider should research.