Five industry leaders collaborated on the DME CBP website: the American Association for Homecare, the Council for Quality Respiratory Care, VGM & Associates, and the Healthcare Nutrition Council. AAHomecare continues to say that there are underlying flaws with the bidding program that CMS has not addressed such as evaluating CMS’ methodology for determining bid rates and the fact that there was significant variation in bid rates for the exact same product billing codes across various bidding areas. Additional information on this can be found here. OTS Knee Braces: This calculator will allow you to input your own book of business to see the impact your chosen bid price has on your revenue. After the expiry of the bid submission period, the recipient of the bids then selects the bidder with the lowest or best terms for the RFP. Contract suppliers must agree to accept assignment on all claims for bid items and will be paid the single payment amount for each HCPCS code in a product category. The bid calculators available on this page are intended to provide the following information for prospective bidders: Calculations of all SPAs in a product category based on the bid for the lead item (a tool that’s also available on CBIC’s website).. An approximation of how the SPAs compare to the current 2019 Medicare rates. The program is consistent with Congress’ original intent of creating a program that is based on competition and market prices while maintaining beneficiary access to quality items and services. WASHINGTON, DC – As part of its continuing collaboration with CMS, AAHomecare staff met with CMS officials on June 4 to review in detail the comments submitted in response to the Advance Notice of Proposed Rulemaking (ANPRM) for the expansion of the Medicare bidding program. Bid Smart Summit Breaks Down Competitive Bidding *Updated June 7, 2019 with link to presentation. In 2017, AAHomecare submitted a letter to Health and Human Services outlining six reform proposals, rationale for each reform, and where the Administration has the regulatory authority to make the changes. Both the HME Industry and numerous consumer groups supported past legislation for MPP. Interested vendors send their bids for consideration within a specified period. AAHomecare analyzed the top 25 HCPCS codes for each region and CBAs. Learn more at: aahomecare.org, The CQRC is a coalition of the nation’s seven leading home oxygen therapy provider and manufacturing companies with the mission to protect access to the home respiratory care benefits in the Medicare program. Washington, DC –– A new website has been launched to prepare durable medical equipment (DME) suppliers for Medicare's Round 2021 of the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) competitive bidding program (CBP). The Medicare Modernization Act of 2003 (MMA) requires the amounts paid under the competitive bidding program be less than the amounts payable under the existing payment schedule. In August 2018, CMS released the ESRD/DMEPOS Proposed Rule which included several reforms for the Competitive Bidding Program. The bids are sealed to increase confidentially of each vendor’s proposal. Additionally, AAHomecare and other leading HME stakeholder organizations are developing an online educational resource on the next round of bidding to help the HME community navigate changes in the program. It is published under the responsibility of the Secretary General of the OECD to bring information on this topic to the attention of a wider audience. To calculate your bid price: Time x Rate x Frequency x 4.3 (you multiply by 4.3 because this is the number of weeks in a month). AAHomecare: DMEPOS Competitive Bidding Improvement Act FAQs. The current flawed design has caused enormous disruptions to Medicare beneficiaries who require home medical equipment, services, and supplies and for the supplier companies who serve them. When the survey report is finalized, we will also use it on Capitol Hill in support of both near- and long-term improvements for Medicare reimbursement policy. Posted On: May 31, 2019 by AAHomecare in: Press Releases. 241 18th Street South, Suite 500. Washington, DC –– A new website has been launched to prepare durable medical equipment (DME) suppliers for Medicare's Round 2021 of the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) competitive bidding program (CBP). VGM & Associates is a member service organization committed to providing business solutions to community-based DMEPOS providers throughout the U.S. For more than 30 years, VGM has provided its members with access to products, services and support to enable them to do business better in an ever-changing business landscape. June 16, 2014 . The American Association for Homecare has worked with Congress and Medicare to address flaws in the competitive bidding program for durable medical equipment, some of which are discussed in a new Government Accountability Office (GAO) report. In 2003, the Medicare Modernization Act authorized the Centers for Medicare & Medicaid Services (CMS) to develop a program for home medical equipment (HME) to find market-based prices to replace the current fee-for-service prices. The bid calculator, and all information on this web site, are not intended, nor should it be construed to be legal advice. – AAHomecare recommends CMS to permanently exempt CRT manual accessories from Competitive Bidding pricing. •    CBA, Rural, and Regional Area Maps by State•    AAHomecare Letter to HHS Secretary Price ‘17 •    Letter from 167 Economists to Chairman Stark ’10 •    Letter from 244 Economists to President Obama ’11 •    Dobson DaVanzo Patient Access Impact Report Executive Summary•    AAHomecare Summary of OIG CB Licensure Violations Report ’16•    UC Health Comments on CB Issues ’16 •    Moran Company CB Evaluation Report ’16 •    Letter from 31 Patient Advocacy Groups Supporting MPP ’12 •    Market Pricing Program Section-by-Section Summary •    Congressional Letter to OIG Regarding Lack of CB Transparency ’14 •    National Minority Quality Forum Report Assessing CB Impact on Diabetic Beneficiaries ’15 •    American Association for Diabetes Educators Study on CB Impact ’16•    True Cost of HME Study•    ESRD/DMEPOS Final RuleAAHomecare Letter to HHS Secretary Price ‘17 •    Letter from 167 Economists to Chairman Stark ’10 •    Letter from 244 Economists to President Obama ’11 •    Dobson DaVanzo Patient Access Impact Report Executive Summary•    AAHomecare Summary of OIG CB Licensure Violations Report ’16•    UC Health Comments on CB Issues ’16 •    Moran Company CB Evaluation Report ’16 •    Letter from 31 Patient Advocacy Groups Supporting MPP ’12 •    Market Pricing Program Section-by-Section Summary •    Congressional Letter to OIG Regarding Lack of CB Transparency ’14 •    National Minority Quality Forum Report Assessing CB Impact on Diabetic Beneficiaries ’15 •    American Association for Diabetes Educators Study on CB Impact ’16•    True Cost of HME Study•    ESRD/DMEPOS Final Rule. The bid calculators are designed for an individual business to use; they are not pre-populated with possible bids. Not all products or items are subject to competitive bidding. AAHomecare Talks Competitive Bidding with CMS. 114-10) that prohibits speculative bidders from participating in Competitive Bidding by requiring binding bids and state licensure. The next round of the competitive bidding program is upon us. The DMEPOS Competitive Bidding Program was mandated by Congress through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). The House and Senate sent letters to the Administration urging critically needed relief.On November 1, 2018, CMS released the ESRD/DMEPOS Final Rule which finalized what had been proposed, including: •    Temporary halt of the CBP as of 1/1/19—any willing supplier may supply equipment in CBAs under the 12/31/18 SPA plus the CPI inflation increase until the program begins again•    Raise the Single Payment Amount to the maximum winning bid—changing the payment policy from the median price to the clearing price (highest bid amount of contracts offered to meet projected beneficiary demand)•    Implement lead item bidding—methodology that requires suppliers to submit a bid on one item in a product category•    Refine product categories—subdividing several product categories, which is to be determined through sub-regulatory guidance•    Modifying oxygen reimbursement—splitting portable O2 into two separate classes (gas and liquid), increasing the portable liquid O2 rate to the OGPE rate, and adding a new class for portable liquid contents exceeding 4 LPM, all of which will be budget neutral by offsetting to all O2 contents and equipment. To use this calculator, select your product category, enter a bid price for the lead item, and click calculate to see the new payment amounts for all the non-lead items in the category. This website is a collaboration between leading industry trade organizations to help prepare Durable Medical Equipment Suppliers for Medicare's next round of the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) competitive bidding program by compiling publicly available information in one place. Thanks to the tireless work of AAHomecare, VGM, and numerous other industry stakeholders, we appear to have a program that approaches fair and can begin to lift the industry back into its vitally important role of being a key contributor to the home care solution for the healthcare crisis. In January 2016, CMS began applying pricing derived from the highly populated Competitive Bidding Areas (CBAs) to all areas of the country without properly taking into account the increased cost of supplying DME items in non-bid areas, slashing pricing by upwards of 50%. Comments, Testimony & Official Statements, educational resource on the next round of bidding, CBA, Rural, and Regional Area Maps by State, AAHomecare Letter to HHS Secretary Price ‘17, Letter from 167 Economists to Chairman Stark ’10, Letter from 244 Economists to President Obama ’11, Dobson DaVanzo Patient Access Impact Report Executive Summary, AAHomecare Summary of OIG CB Licensure Violations Report ’16, Letter from 31 Patient Advocacy Groups Supporting MPP ’12, Market Pricing Program Section-by-Section Summary, Congressional Letter to OIG Regarding Lack of CB Transparency ’14, National Minority Quality Forum Report Assessing CB Impact on Diabetic Beneficiaries ’15, American Association for Diabetes Educators Study on CB Impact ’16, Use market clearing price to determine the Single Payment Amount (SPA) for any item included in Competitive Bidding, Use historical claims data to determine supplier capacity, Increase transparency of the Competitive Bidding program, Reform Competitive Bidding product categories, Apply uniform payment rules for transitioning DMEPOS Competitive Bidding beneficiaries, Remove CMS’ authority to move forward with Continuous Positive Pressure Airway (CPAP) and Standard Power Mobility Devices (PMD) bundled payments. These calculators are intended to be a starting point for suppliers to see how a bid for the lead item in a product category impacts all the resulting bids for the other items in the category. AAHomecare advocates for home medical equipment providers and manufacturers in Washington, D.C., as well as with state Medicaid authorities and other major payer groups. AAHomecare recommends … Competitive bidding areas (CBAs) in multi-state MSAs have been defined so that there are no multi-state CBAs. "AAHomecare is a one-stop-shop for the most accurate, timely, and relevant news available to the DME supplier community. Website features interactive calculator tool. Another problem with competitive bidding is that it ultimately results in pricing war between suppliers; a war that reduces their profit margins. Suppliers and prospective bidders from across the country will be able to utilize the website’s enhanced bid calculators to estimate how bids on lead items will impact rates for other related items in 16 bidding categories. AAHomecare is engaging the Administration and Capitol Hill to address these issues and explore opportunities for reform through sub-regulatory guidance and legislation in the Lame Duck session and the 116th Congress. That said, AAHomecare believes competitive bidding is bad policy and if an opportunity arises in the future for a legislative fix, "we'll do what we can to make it happen," Ryan said. The statute requires that Medicare replace the current fee schedule payment methodology for selected DMEPOS items with a competitive bid process. Then they enter their bid price for the lead item to get the prices for the non-lead items. H.R. To use the calculator, users select their competitive bid area and the lead item to get the “bid ceiling” for that item. Oxygen Learn more at: cqrc.org, The Healthcare Nutrition Council is an organization representing the manufacturers of enteral nutrition formulas, parenteral nutrition solutions, supplies and equipment. The day-long summit featured presentations and Q&As with AAHomecare’s Kim Brummett (pictured), Mark Higley of VGM, and Cara Bachenheimer from Brown and Fortunato, who also serves as AAHomecare’s General Counsel. 4920 – Frequently Asked Questions. CMS Considers Adding Ventilators to Competitive Bidding Program. It will also serve as a platform for webinars and events intended to educate prospective bidders about the process. These cuts, based on the application of outdated provisions in the 1997 Balanced Budget, threaten patient access to oxygen products in rural areas at a time when seniors and other vulnerable patient populations face increased risk of respiratory challenges in the wake of the COVID-19 pandemic. “(The competitive bidding program has) negatively affected beneficiaries’ access to DME services and supplies, adversely impacted case managers’ ability to coordinate DME for patients, and placed an additional strain on suppliers to deliver quality products without delay,” states the report, completed in conjunction with AAHomecare. AAHomecare officials believe results from the survey will make a strong impression on CMS staff as they consider public policy related to the bidding program and other related issues. These competitive bidding rates will then be used by CMS to set the rates in the non-competitive bidding areas in the rest of the country. With the recent introduction of H.R. Thursday, November 15th, 2018 . These cuts intensified beneficiary access problems caused by Competitive Bidding. OTS Knee Braces: This calculator will allow you to input your own book of business to see the impact your chosen bid price has on your revenue. May 31, 2019. CMS also proposes adding ventilators to the CBP per MedPAC’s 2018 Report to Congress. American Association for Homecare. The current competitive bidding rates put financial pressure on suppliers and, ultimately, hurts the vulnerable seniors and the disabled who rely on DME products and services.” Beginning the week of July 18, Dobson DaVanzo & Associates, LLC will disseminate this cost study survey free for all providers to participate. Competitive Bidding Calculators : OTS Back Braces: This calculator will allow you to input your own book of business to see the impact your chosen bid price has on your revenue. Contracts are awarded to the Medicare suppliers who offer the best price and meet applicable quality and financial standards. In addition to extending relief to rural and non-contiguous areas impacted by the program, it proposed temporarily suspending the bid program to make meaningful improvements. However, the failure to fully address reimbursement rates for suppliers in the gap period before the next round of bidding is unacceptable, and there are concerns about how the program changes for lead item bidding and refined product categories will be implemented. Registration for Competitive Bidding Round 2021 is Open – Bid Calculators Evolving. Posted on July 4, 2014 May 29, 2020 by K. Kuhn. If a supplier charges $1.00 per part, with a production cost of $0.90, that’s a 10% margin. The American Association for Homecare has long advocated for meaningful reforms to the Centers for Medicare and Medicaid’s (CMS’) DMEPOS Competitive Bidding program to improve its functionality and sustainability. CMS proposed to make several positive changes, such as increasing the bid ceiling to the 2015 unadjusted fee schedule and expanding the appeals process for breach of contract actions. DME Competitive Bidding Program Education. June 16, 2019. Bids are submitted electronically through a web-based application process. CMS and Capitol Hill need understand how moving forward with the next round of the Competitive Bidding Program for HME will hinder our industry’s ability to support patients and reduce hospital burdens during the COVID-19 pandemic and its aftermath. The year prior, 167 of them wrote a letter to then-Chairman Pete Stark (Health Subcommittee, Ways & Means) asserting that “the program over time may degenerate into a ‘race to the bottom’ in which suppliers become increasingly unreliable, product and service quality deteriorates, and supply shortages become common.”. The Competitive Bidding program has drawn widespread criticism from numerous patient advocacy groups, and 244 of our country’s most highly regarded economists and auction experts wrote a joint letter to President Obama stating that the program is plagued with “bureaucratic inertia”. Bids are evaluated based on the supplier’s eligibility, its financial stability and the bid price. WASHINGTON, D.C. (August 24, 2016)—Yesterday, AAHomecare submitted comments on CMS-1651-P, a rule from CMS that proposes to make some adjustments to the Competitive Bidding Program. 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