Overview of New Medicare Competitive Bidding Program for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) – The first in a series of articles on the implementation of this program. (Revised June 2, 2008)
Standard power wheelchairs, scooters, and related accessories;
- Complex rehabilitative power wheelchairs and related accessories;
- Mail-order diabetic supplies;
- Enteral nutrients, equipment, and supplies;
- Continuous positive airway pressure (CPAP), respiratory assist devices (RADs), and related supplies and accessories;
- Hospital beds and related accessories;
- Negative pressure wound therapy (NPWT) pumps and related supplies and accessories;
- Walkers and related accessories;
- Support surfaces (Group 2 mattresses and overlays (Miami MSAs only)).
Traveling Beneficiaries As previously mentioned, any beneficiary obtaining competitive bidding items in one of the CBAs is affected by the rules of the Medicare DMEPOS Competitive Bidding Program. Beneficiaries who reside in a CBA and travels outside their CBAs may obtain competitive bid items and the supplier will be paid the single payment amount under the program.
In addition, beneficiaries who do not reside in CBAs and who travel to CBAs are also affected. If they require competitive bid items, they must obtain competitive bid items from a contract supplier for that CBA. In such instances, Medicare will pay that contract supplier the DMEPOS fee schedule amount.
The following table details how DMEPOS supplies may be acquired, given different scenarios:
| If a beneficiary permanently lives in' | And travels to' | Type of supplier a beneficiary may go to' |
| A competitive bidding area | A competitive bidding area | A beneficiary must get competitively bid items from a contract supplier located in the competitive bidding area to which he/she traveled. |
| A competitive bidding area | An area NOT covered by the competitive bidding program | A beneficiary may get items from any Medicare-enrolled DME supplier, and the supplier will be paid by Medicare as if it were in the beneficiary's competitive bidding area. |
| An area NOT covered by the competitive bidding program | A competitive bidding area | A beneficiary must get the competitively bid item from a contract supplier in the competitive bidding area. If the beneficiary does not use a contract supplier, the noncontract supplier must ask him/her to sign an Advance Beneficiary Notice. Medicare will not pay for competitively bid items furnished by noncontract suppliers. |
| An area NOT covered by the competitive bidding program | An area NOT covered by the competitive bidding program | A beneficiary may get items from any Medicare-enrolled DMEPOS supplier. |
CMS is conducting extensive outreach to Medicare beneficiaries who reside in the CBAs and will be offering to help them identify contract suppliers.
If DMEPOS suppliers or referral agents are unsure whether a beneficiary resides in a CBA and is affected by this program effective July 1, they can make that determination by comparing the ZIP code of the patient's residence to the list of ZIP codes for the CBAs, which is available at
http://dmecompetitivebid.com/Palmetto/Cbic.nsf/docsCat/DMEPOS%20Competitive%20Bidding%20Areas%20Zip%20Codes?opendocument on the Internet.
Payment Payment for contract DMEPOS items will be the single payment amounts that were announced by CMS on March 20, 2008 (versus the current fee schedule determination of payment) for:
- Noncontract Suppliers that provide item to traveling beneficiaries.
Additional Information DMEPOS suppliers should note that previous articles have explained the program in more detail as it relates to DMEPOS suppliers. MLN Matters article SE0714, 'Pre-Bidding Activities for the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program,' is available at
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0714.pdf on the CMS Web site. Also, MLN Matters article MM5574, 'Program Instructions Designating the Competitive Bidding Areas and Product Categories Included in the CY 2007 DMEPOS Competitive Bid Program,' is available at
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5574.pdf on the CMS Web site.
CMS has released a new Chapter 36 of the Medicare Claims Processing Manual. This chapter is part of CR5978 and contains the initial, official manual instructions for this program. The MLN Matters article related to CR5978 is available at
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5978.pdf on the CMS Web site.
In addition, all providers may find more detailed information at
http://www.dmecompetitivebid.com on the Internet and at
http://www.cms.hhs.gov/DMEPOSCompetitiveBid/ on the CMS Web site.
As this is the first in a series of MLN Matters articles on this issue, further articles will be released in the very near future.
Disclaimer: This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.