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Medical Coding News Archives

Deadlines Fast Approaching for DMEPOS Providers

 
August 25, 2009:

Providers of durable medical equipment, prosthetics, orthotics, and supplies have to keep their eyes on a few dates in the next couple of months if they want to maintain their Medicare privileges or participate in the Medicare DMEPOS competitive bidding program.

All suppliers will have to be accredited by the end of September, those participating in the competitive bidding program must meet licensure requirements by sometime in October and must register in a government security program, and other suppliers will have to obtain a surety bond by early October to maintain Medicare privileges.

The Medicare Modernization Act of 2003 (MMA), section 302, established requirements for a new competitive bidding program for certain DMEPOS. The legislation required that competitive bid payment amounts be used to replace the current Medicare DMEPOS fee schedule payment amounts for selected items in selected areas. Bid payment amounts will be determined by using bids submitted by DMEPOS suppliers. The competitive bidding program will enable CMS to set more appropriate payment amounts for DMEPOS items with an eye toward reducing beneficiary out-of-pocket expenses and generating savings to taxpayers and the Medicare program.

On July 15, 2008, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) made partial changes to the Medicare DMEPOS competitive bidding program to include instructions mandating a rebid competition for round 1 to take place in 2009. The Centers for Medicare & Medicaid Services (CMS) issued an interim final rule with comment period on January 16, 2009. This rule incorporated into regulations only those provisions of MIPPA related to the DMEPOS competitive bidding program that are self-implementing and necessary to conduct the round 1 rebid competition. The rule became effective on April 18, 2009.

All DMEPOS providers are required to be accredited by the appropriate accrediting body by September 30, 2009, as per the Medicare Modernization Act requirements, or their Medicare Part B billing privileges can be revoked on October 1, 2009.

Suppliers participating in the 2009 round 1 rebid of the DMEPOS competitive bidding program will also be required to register in the CMS security system known as the Individuals Authorized Access to the CMS Computer Services (IACS). This requirement includes suppliers that bid in the first round of competition in 2007 and are interested in competing in the round 1 rebid.

Suppliers should verify that they have provided the National Supplier Clearinghouse (NSC) with a current CMS-855S (03/09) and indicated any changes made concerning their authorized official(s) information and correspondence mailing address that may have occurred since their last CMS-855S submission.

CMS has indicated that bidding will begin in October 2009. In addition to completing the CMS-855S, DMEPOS suppliers submitting a bid for a product category in a competitive bidding area (CBA) must meet all DMEPOS state licensure requirements and other applicable state licensure requirements, if any, for that product category for every state in that CBA.

In addition, certain DMEPOS suppliers will need to obtain and submit a surety bond by the October 2, 2009, deadline or risk having their Medicare Part B billing privileges revoked.

Round 1 rebid product categories are the same as those originally selected for the initial round in 2007 with the exception of negative pressure wound therapy (NPWT), which is excluded from the round 1 rebid, and group 3 complex rehabilitative wheelchairs, which are excluded from the round 1 rebid as well as all subsequent rounds of competition.

Karen M Prescott, CMM, CPC, CPC-I, CCS-P, PCS
Clinical/Technical Editor

 

 
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