DMEPOS Competitive Bidding Program and New Regulations

DMEPOS Competitive Bidding Program and New Regulations

DEMPOS stands for Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS). The DEMPOS competitive bidding program was set by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). In order to become Medicare contract suppliers, under the DMEPOS Competitive Bidding Program, DMEPOS suppliers compete with each other by submitting bids to provide certain items in competitive bidding areas (CBAs). The act requires that single payment amounts (SPAs) substitute the current Medicare DMEPOS fee schedule payment amounts for preferred DMEPOS items in specific areas of the country. The SPAs are found out with the help of bids submitted by DMEPOS suppliers.

For Medicare objective, durable medical equipment (DME) known for equipment that:

  • Can endure multiple usages
  • Is used primarily and customarily to cater a medical purpose
  • Generally is not helpful to a person in the healthy condition
  • Is convenient for home usage

The DMEPOS Competitive Bidding Program has been an important instrument to support Medicare set market-based payment rates for DMEPOS items. Additionally, this helps to prevent the abuse as well as fraud in Medicare and also saves money for taxpayers and beneficiaries. Since its implementation, the program has saved billions of dollars, although providing access to quality services and products.

The DEMPOS Competitive Bidding Program contract was expired in December 2018 and from January 1, 2019, there is a momentary gap in the program that Centers for Medicare & Medicaid Services (CMS) expects will last till December 2020. Though there is a temporary gap CMS has come up with round 2021 updates. Some of the round 2021 updates are as follows.

CBAs

CMS is centralizing the CBAs, which were added 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 transferring some items to various smaller product categories to include the lead item pricing methodology. There are about 16 types of products, which are included in Round 2021 are as follows.

  • Enteral Nutrition
  • Commode Chairs
  • Negative Pressure Wound Therapy (NPWT) Pumps
  • OTS Back Braces
  • Transcutaneous Electrical Nerve Stimulation (TENS) Devices
  • Hospital Beds
  • Patient Lifts and Seat Lifts
  • Walkers
  • Standard Manual Wheelchairs
  • Nebulizers
  • Standard Power Mobility Devices
  • Continuous Positive Airway Pressure (CPAP) Devices and Respiratory Assist Devices (RADs)
  • Non-Invasive Ventilators
  • OTS Knee Braces
  • Oxygen and Oxygen Equipment
  • Support Surfaces (Groups 1 and 2)

Apart from above mentioned updated there are around eight more updates such as lead item pricing, national mail-order, essential financial documents evaluation, single payment amounts, bid surety bonds, review of bid disqualification, licensure and accreditation requirements for bidders, and round 2021 precluded suppliers.

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