GlucoCom is one of a few select companies
to be chosen by The Centers for Medicare & Medicaid Services (CMS) to supply Mail-Order
Diabetic Testing Supplies in CMS's Competitive Bidding Program
Information About the Medicare DMEPOS Competitive Bidding Program
You may have heard that Congress changed the way that Medicare will determine how much
it pays for certain durable medical equipment and supplies (DMEPOS) and who can
furnish these items in certain areas of the country. Starting in January 2011, you'll begin to see the effect of a
new Competitive Bidding Program in certain areas of the country. Here's what you
need to know about this new program.
Who will be affected by the new Competitive Bidding Program?
The new Competitive Bidding Program applies to you if your permanent residence is
in a zip code that is part of a Competitive Bidding Area (CBA), or if you get certain
items while visiting a CBA. Your permanent residence is the address where Social
Security mails your benefits check. The following areas will be initially affected:
- Charlotte-Gastonia-Concord, NC-SC
- Cincinnati-Middletown, OH-KY-IN
- Cleveland-Elyria-Mentor, OH
- Dallas-Fort Worth-Arlington, TX
- Kansas City, MO-KS
- Miami-Fort Lauderdale-Miami Beach, FL
- Orlando-Kissimmee, FL
- Pittsburgh, PA
- Riverside-San Bernardino-Ontario, CA
To find out if your zip code is included in a CBA, call 1-800-MEDICARE (1-800-633-4227).
TTY users call 1-877-486-2048. You can also search CBAs and zip codes by visiting
www.medicare.gov on the web.
What is the Competitive Bidding Program?
The new Competitive Bidding Program lets Medicare use competitive bids submitted
by suppliers to determine the amount Medicare pays for certain medical equipment
and supplies. The program will help save you money; ensure that you can get quality
medical equipment, supplies and services; and help limit fraud and abuse in the
Medicare program.
How does this new program work?
Under the new Competitive Bidding Program, suppliers who do business in a Competitive
Bidding Area (CBA) must submit a bid in order to be awarded a contract to sell to
people with Medicare. Contracts are only awarded to those suppliers who offer
the best price; who meet Medicare's eligibility, quality and financial standards;
who are accredited by an independent accrediting organization; and who agree to enter into a special agreement with Medicare. These suppliers
are called "contract suppliers."
In most cases, only contract suppliers will be able to provide Medicare beneficiaries
with certain items and file claims with Medicare for payment. Contract suppliers
can't charge more than the single payment amount set by Medicare based on the bids
received for an item, and this price can't be higher than the current Medicare (fee
schedule) allowed amount.
How do I know if my equipment or supplies are included in the Competitive Bidding
Program?
Nine product categories are included in the Competitive Bidding Program:
- Oxygen supplies and equipment
- Standard power wheelchairs, scooters, and related accessories
- Complex rehabilitative power wheelchairs and related accessories
- Mail-order diabetic supplies
- Enteral nutrients, equipment, and supplies
- Continuous Positive Airway Pressure (CPAP) devices and Respiratory Assist Devices
(RADs) and related supplies and accessories
- Hospital beds and related accessories
- Walkers and related accessories
- Support surfaces (Group 2 mattresses and overlays) (in Miami-Fort Lauderdale
Beach only)
To check if an item you use is included in the program, call 1-800-MEDICARE (1-800-633-4227)
or visit www.medicare.gov
on the web. TTY users call 1-877-486-2048.
Do I have to get any new supplies or equipment that I need from
a contract supplier?
If the equipment or supplies ordered by your physician or treating practitioner
are included in the Competitive Bidding Program where you live, you must get your
equipment or supplies from a contract supplier.
If you travel to or visit an area that is included in the Competitive Bidding Program
and need to get equipment or supplies that are part of the Competitive Bidding Program
for that area, you must get those items from a contract supplier for that area.
What if I need a specific brand of item or supply?
If you need a specific brand of equipment or supplies, or you need the item in a
specific form, your doctor must prescribe the specific brand or form in writing.
Your doctor must also document in your medical record that you need this specific
brand or form for medical reasons.
Your contract supplier will fill your doctor's prescription as written. If the item
isn't available through the contract supplier (e.g., the supplier does not carry that product), the supplier will either work with your doctor or treating practitioner
to find an appropriate alternative, or help you locate another contract supplier
who can meet your needs.
How will I know if my supplier is a contract supplier?
To see a list of the contract suppliers in your area or to check if a supplier you
use is included in the program, call 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov
on the web. TTY users call 1-877-486-2048. A Supplier Locator Tool on www.medicare.gov will help you locate a DMEPOS contract
supplier in your area.
Do I have to change doctors?
No. The Competitive Bidding Program does not affect which doctors you can use.
Do I have to change suppliers if my current supplier was not
awarded a contract?
You may have to change suppliers to continue having Medicare pay for your item,
but the earliest you would have to change would be January 2011.
Does the Competitive Bidding Program change the way I get my
equipment repaired or replaced?
For medical equipment you own, you can use any Medicare-enrolled supplier to make
necessary repairs or get replacement parts for the equipment. If your item needs
to be completely replaced, you will need to get the replacement item from a contract
supplier.
Do I still have to meet my deductible and pay my 20% coinsurance?
Yes. You are still required to meet your annual deductible. After you have paid
your annual Part B deductible, Medicare pays 80% of the Medicare-approved amount
for equipment, supplies and services, and you are responsible for a 20% coinsurance.
It is important to remember that for any equipment or supplies that are included
in the Competitive Bidding Program, the contract supplier cannot charge you more
than the 20% coinsurance and any unmet annual deductible. If you suspect that you
are paying more coinsurance than the Medicare allowed amount, you can call 1-800-MEDICARE
(1-800-633-4227) or call the Fraud Hotline of the HHS Office of the Inspector General
at 1-800-447-8477.
