Medicare Competitive Bidding Program and the Possible Effects on Wound Care

By Glenda Motta RN, MPH

Medicare is now beginning round two of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. Congress mandated this through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). This applies to a number of items used by beneficiaries on an outpatient basis. The intent is to reduce beneficiary out-of-pocket expenses and save the Medicare program money, but still ensure beneficiary access to quality items and services.

Basically, Medicare must replace the current Part B fee schedule payment method for selected DMEPOS items with a competitive bid process. Although the process is rather complex, clinicians need to be aware of how this will impact some of the equipment and wound care treatments that their patients may need.

Right now, certain designated areas in a total of 11 states are involved. Suppliers who operate in these areas are required to submit a bid electronically through a web-based application process, and then mail required documents. Bids are evaluated based on the supplier’s eligibility, financial stability, and the bid price. Contracts are awarded to the Medicare suppliers who offer the best price and meet applicable quality and financial standards. Contract suppliers must agree to accept assignment on all claims for bid items and will be paid the bid price amount.

From the list of items included in the bidding process, you can see a number of products and supplies that may impact your patients.

• Oxygen Supplies and Equipment
• Standard (Power and Manual) Wheelchairs, Scooters, and Related Accessories
• Enteral Nutrients, Equipment, and Supplies
• CPAP Devices, Respiratory Assist Devices, and Related Supplies and Accessories
• Hospital Beds and Related Accessories
• Walkers and Related Accessories
• Support Surfaces (Group 2 Mattresses and Overlays)
• Negative Pressure Wound Therapy (NPWT) and Related Supplies and Accessories

What does this mean for wound care providers? Quite possibly, many of the products you now use may no longer be available. Suppliers will substitute items that are less expensive for them to obtain. How the changes will impact patient outcomes remains to be seen. Clinicians should certainly monitor what impact, if any, that substitutions have on wound prevention and treatment.

More detailed information is available at: http://www.dmecompetitivebid.com/palmetto/cbic.nsf.

About The Author
Glenda Motta RN, MPH is a reimbursement consultant and wound care expert, publishing over 125 articles and books, serving as the President of the WOCN (1987-1989), and founding GM Associates, Inc., a healthcare marketing and reimbursement firm.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.