Where Does the Industry Go from Here? Competitive Bidding Reform...

Posted on in Billing/Reimbursement

WATERLOO, IA – Ok…The industry now has had time to digest the ESRD Final Rule and its impact. Where does the industry go from here?

The good news is that there is a two-year gap period before the next round of Bidding (until Dec. 31, 2020). This will allow providers time to work with their creditors and have a two-year period of relative stability.

 The bad news is there is a two-year gap period before the next round of bidding, which will delay any increase in rates that potentially could come from a new bidding process (that includes changes such as maximum bid, bid bonds, lead item bids, and others).

So, what do we do during this two-year period? We can’t get complacent – as stakeholders, we have to work at the federal level and at the state level. At the federal level we focus on legislation and regulatory action to address:

  • Non-Rural – Continue to advocate for higher reimbursement rates in areas deemed Non-Rural by CMS.
  • Competitive Bid – Prepare for CB Round 3. Provide input to CMS on proper product category definition, lead price analysis, capacity reforms, bona fide bidders, etc.
  • Budget Neutrality – Encourage legislation in 2019 for budget neutrality offset for oxygen.
  • CRT- Build on efforts in 2018 and gain momentum as we navigate through 2019.

At the state level, we need providers in coordination with state associations focused on the next two years.

  • Licensure – Level the playing field with out-of-state bidders and drop shipment of DME.
  • State Tax Exemption – While many states exempt state tax on DME, many do not, and some exempt only certain DME items.
  • State Medicaid / MCO Rates – Work with state legislators and DHHS on proper rates for DME.

We have a full plate of issues both at the federal and state levels. To accomplish our goals in 2019 and 2020 we are going to need strong state associations and provider involvement. Effective collaboration and joint efforts are vital. Now is not the time to rely on others to get it done; rather, use the available resources through our advocacy groups, and join with others to succeed for the future of the DMEPOS industry.

John E. Gallagher is vice president, Government Relations, VGM & Associates, Waterloo, Iowa.

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