Did you hear that Competitive Bidding is being eliminated and everyone can start doing DME again? While it’s not being totally eliminated, Competitive Bidding will be suspended nationwide from 1/1/2019-12/31-2020, while a new program is being prepared. Many pharmacies will be able to start dispensing things previously deemed ineligible if the pharmacy was in one of those competitive bidding zones.
Another date to pencil in, is 01/01/2020. As this is when the CURES Act will go into full force, which requires all state Medicaid programs to follow all Medicare requirements, including fee schedules and possibly accreditation.
Now, what’s the big deal here? If Competitive Bid is suspended how will that actually help Pharmacies and DME facilities that are listening to us today?
Pharmacies, especially pharmacies in those 99 Competitive Bid Zones have been locked out of a lot of different products. There’s are only 10 items, but they are 10 big items. Starting January 1, 2019 pharmacies can start dispensing these products. AND even though the fee for product will not change initially, it does appear that the reimbursements are going to go “UP”!
What’s the first thing a pharmacy needs to do if they wish to jump on the band wagon and take advantage of this rule suspension?
First the facilities and pharmacies need to know the status of their PTAN with the National Supplier Clearinghouse (NSC). So, do you have a Medicare Part B PTAN, and is it active or exempt?
Everyone will fall into one of four bins: Exempt Pharmacies, Accredited facilities, Pharmacies with a pharmaceutical PTAN only, and then everyone else will falls into the last bin. Most pharmacies are going to be in the first two groups, either Exempt or Accredited. In the end those with a PTAN will have an easier time bringing on more DMEPOS products to their pharmacy for their patients, while those without a PTAN, those in the last bin, will have a lot of work ahead of them as they will need to start from scratch.
No matter which bin you fall into, look at your current DMEPOS products, and determine if you wish to add additional products. Once you check the acquisition costs and the current fee schedule for reimbursements to ensure the product is profitable- if need be start doing those additional trainings and complete the necessary licensing requirements now. If the pharmacy is exempt, add the items with support documentation to the CMS 855S application now. If the pharmacy is accredited, contact your accreditation organization to find out whether you will need to be surveyed for these products and if there is a fee to add them now.
Revision July 19, 2020
All Medicare Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) Competitive Bidding Program contracts expired on December 31, 2018. As of January 1, 2019, there is a temporary gap in the entire DMEPOS Competitive Bidding Program that CMS expects will last until December 31, 2020. For additional information, please see the Temporary Gap Period (PDF) fact sheet.
On March 7, 2019, CMS announced plans to consolidate the competitive bidding areas (CBAs) included in the Round 2 Recompete and Round 1 2017 DMEPOS Competitive Bidding Program into a single round of competition named Round 2021. Round 2021 contracts are scheduled to become effective on January 1, 2021, and extend through December 31, 2023.
For more information, please visit the Competitive Bidding Implementation Contractor (CBIC) website.