Round 2021 Competitive Bidding Details Announced
Billing, Reimbursement, Audits and Compliance
on Friday, March 8, 2019
From the desk of Mark Higley
As VGM members are likely most aware from recent webinars and legislative updates, CMS had suspended the 2019 competitive bid program as of Jan. 1 of this year. During the next two years, “any willing provider” may service traditional Medicare patients for previously competitive bid items.
Yesterday, CMS announced some details relative to resuming the program, with an effective date of Jan. 1, 2021. CMS has dubbed the program “Round 2021.”
HME providers should begin their preparations now if they intend to consider placing a bid in one or more of the 130 competitive bid areas (CBAs). As in all previous rounds, VGM stands ready to assist you in all facets of the program. Details of “in-CBA” bidding sessions, webinars, and other educational events will follow shortly.
In the meantime, please find below a summary of the new program. We have attached various links to the CMS website; we urge you to review them.
Important Round 2021 Changes:
Competitive bidding areas: CMS is consolidating the CBAs that were included in Round 1 2017 and Round 2 Recompete by conducting Round 2021 in the same geographic areas for a total of 130 CBAs.
Product categories: CMS is shifting some items to different, smaller product categories to accommodate “a lead item pricing methodology.”
As a result, the 16 product categories listed below are included in Round 2021. Items newly included in the program are off-the-shelf (OTS) back braces, OTS knee braces, and non-invasive ventilators.
- Commode chairs
- Continuous positive airway pressure (CPAP) devices and respiratory assist devices (RADs)
- Enteral nutrition
- Hospital beds
- Negative pressure wound therapy (NPWT) pumps
- Non-invasive ventilators
- OTS back braces
- OTS knee braces
- Oxygen and oxygen equipment
- Patient lifts and seat lifts
- Standard manual wheelchairs
- Standard power mobility devices
- Support surfaces (Groups 1 and 2)
- Transcutaneous electrical nerve stimulation (TENS) devices
Lead item pricing: In Round 2021, CMS is implementing the lead item pricing methodology for all items included in the product categories as established in the final rule (CMS-1691-F) published on Nov. 14, 2018. This means that rather than submitting individual bids for each item within a product category, bidders will submit only one bid for the lead item in the product category. The supplier’s bid for the lead item represents the supplier’s bid for furnishing the lead item and all other items (the non-lead items) in the product category. Bids for the lead item in the product category will be used to calculate the SPAs for all of the items within that product category. The SPA for the lead item is the maximum bid submitted for that item by bidders whose bids for the item are in the winning range in that CBA and product category combination. The SPAs for the non-lead items within the product category are determined by multiplying the lead item SPA by a relative ratio. The ratios are based on the historic differences in the fee schedule amounts for the lead item and non-lead items.
Single payment amounts: In prior rounds of the DMEPOS Competitive Bidding Program, the SPA for an item was equal to the median of the bids submitted for that item by bidders whose composite bids were equal to or below the pivotal bid for that product category in a CBA. In Round 2021, based on policies established in the final rule (CMS-1691-F) published on Nov. 14, 2018, the SPA for a lead item is equal to the maximum bid submitted for that item by bidders whose lead item bids for the product category are equal to or below the pivotal bid for that product category in a CBA.
Bid surety bonds: Section 522(a) of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) required a bid surety bond for suppliers bidding in the DMEPOS Competitive Bidding Program. Bidders must obtain a $50,000 bid surety bond from an authorized surety on the Listing of Certified Companies on the Department of the Treasury’s website for each CBA for which they submit a bid. A copy of the bid surety bond(s) must be uploaded in Connexion, the DMEPOS Competitive Bidding Program’s secure portal, by the close of the bid window.
Important note: VGM will offer these bid bonds! Additional information will be forthcoming shortly.
Round 2021: Important Dates
March 7, 2019
- CMS begins pre-bidding supplier awareness program
- CMS announces specific dates for registration and bidding
- CMS begins bidder education program
- Bidder registration period to obtain user ID and passwords begins
- Bid window opens
*Dates listed are target dates
Immediate concerns or questions?
As always, Mark Higley, VP Regulatory Affairs, is here to help! Email Mark at [email protected] or text/cell 319.504.9515.
Again…more information to follow.
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