DMEPOS

All posts tagged DMEPOS

Competitive Bid Checklist for DME Providers

by admin on June 6, 2019 No comments

By: Michael Silverman

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.

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DMEPOS Round 2021 Competitive Bidding: Potential Pitfalls

by admin on March 27, 2019 No comments

2021 competitive biddingBy: Matt Fischer

With the 2021 competitive bidding round on the horizon for durable medical equipment (DME) providers, both those that are established as well as those fairly new to the industry must take note of the potential pitfalls that may be encountered when competing to become a Medicare contract supplier.

The durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program was first established by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.  Under this program, DMEPOS suppliers submit bids (i.e. applications) and compete to furnish specific items in competitive bidding areas commonly referred to as CBAs.  Additionally, suppliers are not just bidding for the rights to a particular CBA but also for a single payment amount that will replace the current Medicare fee schedule payment.  The payment will be determined by using the bids submitted.  As of December 31, 2018, all contacts have expired.  As a result, there is currently a temporary gap period.  The upcoming bidding process is loaded with requirements.  Therefore, compliance with each requirement is crucial.  Here are a few pitfalls to watch out for: 

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DME Provider Alert: Medicare Competitive Bidding is Back!

by admin on March 8, 2019 No comments

Medicare Competitive BiddingBy: Michael Silverman

Not tomorrow, but relatively soon. And with a vengeance! We knew the current Competitive Bidding Program moratorium wouldn’t last forever, and that the floodgates that opened as of the first of this year would eventually be reined in.

Indeed, on March 7, 2019 the Centers for Medicare and Medicaid Services (“CMS”) announced a new round of Competitive Bidding, which will commence on January 1, 2021 and last through December 31, 2023.

The largest changes from previous rounds of Competitive Bidding that immediately stand out are:

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Doing DME Right: Legal Considerations for DME Business Start-ups

by admin on February 26, 2019 No comments

Attorney Michael Silverman will present this live lunch n’ learn webinar for those considering starting a DME business startup or wanting to reconsider some of the legal issues involved in the DME business. He will review the laws, options and risks, and share information regarding state licensure requirements, product offerings and enrolling in Medicare as a Part B supplier.

DME Business Law

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Marketing for DME & Pharmacy Providers: Know Your Subcontractor!

by admin on November 13, 2018 No comments

marketing for dmeBy: Michael Silverman

Regulatory compliance is a mandatory investment for any healthcare business owner looking to stay out of serious and personal legal peril, let alone one hoping to keep their company viable.

Yet there is seemingly an onslaught of providers that blatantly run afoul of many of these regulations, knowingly or not, or those that believe they may have found a loophole.

Concerning the latter, there is an important mantra that such DME and pharmacy providers should remember and live by: “[W]hat a provider cannot do directly, it cannot do indirectly through an intermediary.”

Marketing for DME – What exactly am I talking about?

DME providers enrolled with CMS (should) know they cannot solicit or ‘cold call’ Medicare Part B beneficiaries, per the Federal Anti-Solicitation Statute, and that they cannot offer anything of value to a potential patient that could induce them to utilize them as a provider, in accordance with the Beneficiary Inducement Statute.

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DME Compliance Alert for Telehealth Doctors

by admin on April 11, 2018 No comments

By: Karina Gonzalez

Many DME suppliers purchase leads from marketing companies. The patients who respond to the marketing advertisements are generally not interested in travelling to their doctor’s office to obtain an order for braces, for example. This type of arrangement is seen often enough and so starts a potentially problematic arrangement with the DME company paying the marketing company.  The marketing company may then use some of these dollars to pay a telehealth company.  The telehealth company may then pay a telehealth physician for “telemedicine visit” with the patient. Ultimately, the telehealth/telemedicine physician issues and order for the braces or other supplies.The DME brace supplier then gets paid by Medicare Part C, or other healthcare plan for providing the supply to the patient.

The problem with this arrangement is that the sole source of the telehealth doctor’s reimbursement for the visit comes indirectly from the DME company.   Essentially, the DME supplier is paying the ordering physician through the marketing company for the visit with the patient.  This creates a prohibited kickback arrangement because the supplier is essentially paying the Teledoctor for the referral for braces. The telehealth company is acting as a virtual unregulated physician practice.  Providers engaged in this type of practice are not in compliance with either Federal or Florida law.

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DMEPOS Medicare Coverage & Reimbursement

by admin on March 14, 2018 No comments

DME medicareBy: Michael Silverman

Providers need to comply with all the Medicare ‘red tape’ but need not let fear of non-compliance inhibit their practice from offering Durable Medical Equipment Prosthetics & Orthotics Supplies (“DMEPOS”) to Medicare beneficiaries.

Here’s an overview of the steps providers need to take to enroll as a supplier of DMEPOS with Medicare to be eligible for Part B coverage and reimbursement:

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Consignment Closets: Still a Viable Option for DME Providers

by admin on August 24, 2011 No comments

In the age of heightened regulatory scrutiny, physicians and other health care providers often question whether “Consignment Closet” relationships are legal.  If properly structured these arrangements are not only legal but are of great benefit to patients needing valuable medical devices.  A properly structured relationship will, in all probability, withstand a regulatory challenge by the Office of Inspector General or from other regulatory authorities.

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adminConsignment Closets: Still a Viable Option for DME Providers