How Medicare Changes May Affect Patient Care

Below are a few frequently asked questions and answers about this new process.

Q: What is the “competitive bidding” program for durable medical equipment and services?

A: Competitive Bidding is a program for certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) requiring competitive bid payment amounts be used to replace the current Medicare DMEPOS fee schedule payment amounts for selected items in selected areas.   In these areas, consumers will be required to use the approved Medicare suppliers for certain products.  The approved suppliers in each area will have the right to serve Medicare beneficiaries for a three-year period.

Q: What is a competitive bidding area (CBA)?

A: A CBA is a zip code-defined geographic area subject to competitive bidding, generally a major city and the suburban areas surrounding it.

Q: What are the round 1 competitive bidding areas?

A:

• Cincinnati – Middletown (Ohio, Kentucky and Indiana)
• Cleveland – Elyria – Mentor (Ohio)
• Charlotte – Gastonia – Concord (North Carolina and South Carolina)
• Dallas – Fort Worth – Arlington (Texas)
• Kansas City (Missouri and Kansas)
• Miami – Fort Lauderdale – Pompano Beach (Florida)
• Orlando (Florida)
• Pittsburgh (Pennsylvania)
• Riverside – San Bernardino – Ontario (California)

Q: When does competitive bidding begin?

A: In the CBAs, all new Medicare patients will need to begin using a contracted supplier for competitively bid products. These changes began on January 1, 2011.

Q: Which products are included in competitive bidding?

A:

• Oxygen Supplies and Equipment
• Standard Power Wheelchairs, Scooters, and Related Accessories
• Complex Rehabilitative Power Wheelchairs and Related Accessories (Group 2)
• Mail-Order Replacement Diabetic Supplies
• Enteral Nutrients, Equipment and Supplies
• CPAP, RADs, and Related Supplies and Accessories
• Hospital Beds and Related Accessories
• Walkers and Related Accessories
• Support Surfaces (Group 2 mattresses and overlays) in Miami

Q: Why did Medicare create the competitive bidding program?

A: The program will reduce out-of-pocket expenses for Medicare beneficiaries and save the Medicare Program money while ensuring beneficiaries continue to receive quality products from accredited suppliers.

Q: What is the definition of a “contracted supplier”?

A: A contracted supplier is a supplier who has gone through the Medicare approval process for competitive bidding and has been awarded a contract to supply items in a Product Category for a specific CBA for the three year contract term.

Q: What is the definition of a “non-contracted supplier”?

A: A non-contracted supplier is a supplier that is not contracted by Medicare to furnish items in a Product Category for a specific CBA under the competitive bidding program.

Q: Are some items “grandfathered"?

A: Non-contract suppliers that are renting competitively bid durable medical equipment (DME)* or oxygen and oxygen equipment at the time the DMEPOS Competitive Bidding Program is implemented may choose to become grandfathered suppliers for these items.  Grandfathered suppliers were required to give Medicare notification by November 17, 2010 to be a part of the grandfathering process.   At this time, grandfathering only applies to rented DME items.

Q: How should I communicate changes related to competitive bidding and inform my patients about these changes?

A: Medicare has created a Fact Sheet to provide more details and help facilitate a patient discussion about these changes.

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More Resources

DME Competitive Bidding

DMEPOS Competitive Bidding Overview