MEDICARE COMPETITIVE BID PROGRAM
WILL REDUCE YOUR BENEFITS! |
Many of our patients are unaware that as of January 2012, Medicare has begun implementing a competitive bid process for their home medical equipment and related services that will significantly reduce what products and services are made available to them.
Due to the Patient Protection & Affordable Care Act of 2010 (ACA), the Centers for Medicare & Medicaid Services (CMS) is expanding the bid program to the Oregon and Washington region.
Essentially, this program will require Medicare beneficiaries to receive equipment and services from exclusive suppliers who have submitted and “won” lowest cost bids. Medicare beneficiaries will no longer have the option of what supplier they may obtain services from, and will see a dramatic reduction in product availability.
In 2010, CMS implemented this program in nine metropolitan areas awarding contracts to inexperienced, out-of-state and bankrupt companies. These suppliers had no intention or ability to serve Medicare patients, and were intent on bidding below actual costs to eliminate future competitors or to sell the contract as a commodity. This not only led to unsustainable bid rates, but forced many small businesses to permanently close their doors while monopolizing your benefits in favor of national suppliers.
Among these fatal flaws include:
Non binding bids: bidders are not required to fulfill bids and encourages unsustainable bid rates without holding suppliers accountable.
Flawed pricing system: the CMS program is designed to incentivize lowest cost bids which further limit patient access to higher quality medical equipment and services.
Bid skewing: the current CMS program relies on what is called “composite bids”. This provides strong incentives for bidders to provide “low ball” bids that will be unaffordable for a majority of suppliers.
Severe lack of transparency: Despite the requests of numerous Members of Congress, CMS continues to deny explanation of quality protections or performance obligations are evaluated as well as how utilization estimates or bid awards are determined.
To date, over 30 patient advocacy groups, 244 expert economists, and more than 145 Members of Congress have publicly condemned the CMS program citing numerous flaws that will directly impede patient’s access to essential medical care. Unfortunately, the CMS administration has decided to implement the program despite serious flaws that will jeopardize your benefits.
The American Association of Homecare (AAHomecare) has worked extensively with auction experts to design an alternative to the CMS bid program known as Market Based Pricing. This alternative would allow increased patient choice and small business protections while providing similar savings to the Medicare program.
It is important that you contact your Members of Congress
and tell them to fix the Medicare Competitive Bid Program
Congressional Hotline (toll-free): 1-888-845-2757
***Ask your Congressional Senators and Representative to introduce legislation for a Market Based Pricing alternative!***
For additional information concerning the competitive bid program,
please visit our National Legislative Issues page!
AN IMPORTANT MESSAGE TO PHYSICIANS& PROVIDERS |
If you were not already aware, CMS is implementing an Internet-based Medicare provider enrollment process, known as the Provider Enrollment, Chain and Ownership System (PECOS). For any service or item to be covered by Medicare, it must be ordered by a physician or a practitioner who a) is eligible to order such items, b) is enrolled in PECOS, and c) for DMEPOS items, must be indicated in PECOS as specialty eligible to order DMEPOS items for Medicare beneficiaries, reference (SSA section 186(r) and 1842 (b)(18)(c)).
If you are not enrolled in the Medicare program, or if you enrolled more than 5 years ago and have not submitted any updates or changes to your enrollment information in 5 years, you do not have an enrollment record in PECOS.
The Centers for Medicare & Medicaid Services (CMS) previously announced that, beginning January 3, 2011, if certain Part B billed items and services require an ordering/referring provider and the ordering/referring provider is not in the claim, is not of a profession that is permitted to order/refer, or does not have an enrollment record in the Medical Provider Enrollment, Chain and Ownership System (PECOS), the claim will not be paid.
***CMS has recently announced that automated edits will not be turned on effective January 3, 2011. CMS is working to resolve enrollment backlogs and other system issues and will provide ample advanced notice to the provider and the beneficiary communities before they begin any automatic nonpayment actions. It is expected that sometime in 2011 the PECOS requirement will become effective, so it is very important that physicians enroll as soon as possible. To continue to order DMEPOS for Medicare beneficiaries you will need to enroll in the Medicare program or "revalidate" your Medicare enrollment information.***
For additional information regarding the Medicare enrollment process, including Internet-based PECOS, please visit: http://www.cms.hhs.gov/MedicareProviderSupEnroll
