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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

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