Come January 2021, if a DME provider has not been awarded a CMS contract to supply a competitively bid item to a Medicare beneficiary that resides in a competitive bid area it will be unable to do so.
Suppliers looking to participate in the latest rendition of CMS’ Competitive Bidding Program need to act now to try and secure a bid.
Otherwise, once implemented, only DME providers that have won a bid for that specific item in that geographical bid area can service Medicare beneficiaries residing therein.
Here’s a ‘to-do’ list for providers looking to participate with a competitive bid, and the latest timeline updates from CMS.
DME Suppliers Looking to Participate Need to:
1. Be licensed, as applicable, in each state and accredited for each type of DME it wants to provide;
2. Review and update enrollment records to accurately reflect licensure and accreditations;
3. Have a surety bond in place for each and every competitive bid area;
Note: this bond is in addition to the general $50,000 surety bond that every DME supplier participating in Medicare Part B must have in order to initially enroll;
4. Ensure acceptable financial documents are in place to justify the bid;
5. Be prepared to bid on the lead item only of each product category.
This is perhaps one of the largest changes to previous rounds of the Competitive Bidding Program. A DME provider is to bid only on the lead item HCPCS code, submitting the lowest acceptable reimbursement in which they will be able to furnish such lead item supplies under the Competitive Bidding Program. The lead item bid amount, in turn then drives the reimbursement rate for each non-lead item HCPCS code in that supply category. Non-lead items are not separately bid upon.
For example: the lead item for CPAP related equipment is the CPAP device itself, HCPCS code E0601. A DME supplier looking to participate in Competitive Bidding for CPAP devices and related equipment would only bid on the CPAP device (E06001); that bid amount, in turn, would then determine the reimbursement for the non-lead items in the CPAP equipment category, such as masks, cushions, and filters.
There is a great ‘bid calculator’ tool put out by leading industry associations that have banded together to educate suppliers, which allows prospective bidders to see exactly how the lead item supply bid amount directly effects and corresponds with the non-lead item supplies reimbursement.
6. Timely register for access to the CMS online bidding system so that all requested information and documentation can be uploaded, and successfully submit one or more bids.
Latest Competitive Bidding Timeline from CMS
Registration window opens for the DMEPOS Bidding System, DBidS, and Connexion, the program’s secure portal
Bid window opens
DBidS registration closes (Connexion registration always remains open)
Covered document review date for bidders to upload financial documents in Connexion
Bid window closes
- Fall 2019*
Preliminary bid evaluation notification
- Summer 2020*
CMS announces single payment amounts and begins contracting process
- Fall 2020*
CMS announces contract suppliers
Implementation of Round 2021 contracts and prices * Dates listed are target dates
While the three-year Competitive Bid Contract does not become effective until January 2021, the actual bidding window is just around the corner – DME providers looking to participate must prepare now!