CMS Announces Temporary Gap Period Coming in 2024

Published in Billing, Reimbursement, Audits and Compliance on May 25, 2023

CMS finally released the notice with details regarding the competitive bidding program (CBP) and a temporary gap period. CMS has done this same process in the past prior to the 2021 CBP round.

The current round of the CBP includes certain OTS knee and back braces. The contracts began in January 2021 and are set to expire on December 31, 2023. Beginning January 1, 2024, this market becomes any willing supplier as the contracts have expired. Those suppliers that may want to accept referrals for those CB products need to remember the single payment amounts (SPA) remaining. The allowable is based on the patient’s permanent address on file with SSA. 

For example, on January 2, 2024, open to any willing supplier, if a supplier dispenses and bills for an L0650 for a patient that lives in the Minneapolis, St. Paul, MN competitive bidding area, the supplier will be reimbursed at that SPA for that CBA.

As the notice reads, there will be a formal public notice and comment rulemaking process prior to the instructions for opening the next round of CB. We will share information as we learn more details.

Download the MLN Article

If you have any questions, please contact Ronda Buhrmester, Sr. Director of Payer Relations and Reimbursement, at ronda.buhrmester@vgm.com.


TAGS

  1. billing & reimbursement
  2. cms
  3. competitive bidding

From Our Experts

Ronda Vlog: Register Today for the Upcoming Billing and Reimbursement Roadshows thumbnail Ronda Vlog: Register Today for the Upcoming Billing and Reimbursement Roadshows Ronda Buhrmester, Sr. Director of Payer Relations and Reimbursement, gives more information on the upcoming in-person billing and reimbursement roadshows. CMS Provides Additional Clarity Regarding 2024 DMEPOS Reimbursement thumbnail CMS Provides Additional Clarity Regarding 2024 DMEPOS Reimbursement The VGM Government Relations team dives deep into the current state of reimbursement, the CPI-U adjustments, blended rates, and other noteworthy changes coming in 2024. Reducing Medicare Payments for Urinary Catheters thumbnail Reducing Medicare Payments for Urinary Catheters The Office of Evaluation and Inspection, a component of OIG (Office of Inspector General) and HHS (Health and Human Services), recently released "Reducing Medicare's Payment Rates for Intermittent Urinary Catheters Can Save the Program and Beneficiaries Millions of Dollars Each Year,” a study that was performed on urinary catheters. An Open Discussion About Opportunities in the Diabetic Market, CGM Audits, and Reimbursements thumbnail An Open Discussion About Opportunities in the Diabetic Market, CGM Audits, and Reimbursements In this episode of Industry Matters, we talk with president of The van Halem Group, Wayne van Halem, and sales manager for GEMCO, Joseph Ault, about CGM audits, qualifications for reimbursement and documentation, as well as the opportunities in the diabetic market. Featured Service: The van Halem Group thumbnail Featured Service: The van Halem Group There's been a lot of questions and confusion surrounding telehealth services and how they relate to DMEPOS claims. This article by Wayne van Halem, originally featured in “VGM Playbook: Technology and the Patient Care Continuum Guide to Remote Work,” addresses whether or not telehealth services can be used to qualify a patient for an item of DMEPOS during the PHE. Return of the Audits thumbnail Return of the Audits HME Business recently wrote about the news that CMS planned to resume audits by Aug. 3 and that it took many by surprise. Then CMS said it would resume audits in a phased approach. What are the details and what can providers expect? CMS Audits Resume August 3, 2020 thumbnail CMS Audits Resume August 3, 2020 In this episode, we chat with Wayne van Halem and Kelly Grahovac of The van Halem Group about the CMS audits returning today, August 3, and what DMEPOS providers need to know. Member Q&A From The van Halem Group: New Order Requirement and Member Q&A From The van Halem Group: New Order Requirement and "Master List" I'm curious about this new order requirement. I see that Medicare updated the notice on 2/12/20, and I'm curious about the “Master List” of items that still needs a WOPD. I'm wondering if PAP equipment and supplies fall under the SWO or the WOPD. Can you help me understand?