The Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program (DMEPOS CBP) was mandated by congress in 2003 as a way to improve the effectiveness of the Medicare methodology for setting DMEPOS payment amounts. The goal is to reduce beneficiary out-of-pocket expenses, saving the Medicare program money while ensuring patient access to quality items and services.
Under the program a competition among suppliers who operate in a particular Competitive Bidding Area (CBA) is conducted. Suppliers submit bids for selected products and contracts are awarded to the entities who submit the best price and meet applicable quality and financial standards. Pricing for devices vary between CBAs and contract suppliers must agree to accept assignment on all claims for bid items and will be paid the single payer amount for the beneficiary’s CBA. There will be no contracts awarded for product categories other than off-the-shelf (OTS) back braces and OTS knee braces.
Round 21 of the DMEPOS will begin on January 1st, 2021 and will extend through December 31st, 2023. Want to learn more about Competitive Bidding? Visit the DMEPOS homepage.
A CBA is an area where only DMEPOS CBP contract suppliers may furnish competitively bid lead and non-lead items to beneficiaries, unless an exception is permitted by regulations. CBAs are based on metropolitan statistical areas that include major cities and their surrounding areas. There are 130 CBAs established in Round 2021.
Local Coverage Determination (LCD) is the decision by a Medicare Administrative Contractor (MAC) regarding if a particular item or service is covered on a contractor-wide basis by the Social Security Act.
The LCD process has recently been modernized to serve as a roadmap for MACs, providing greater transparency, consistency and patient engagement. The changes align with process changes already underway as a result of the 21st Century Cures Act of 2016. Notable changes include requirements for public communication regarding new LCD determinations 45 days before the effective date.
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