NEW YORK, March 21, 2019 /PRNewswire-PRWeb/ -- Looking back, the impact of competitive bidding program found the number of DME suppliers providing items for adjusted rates falling by 11% in certain areas in the year 2017. The decrease followed an 8% decline in the number of suppliers in the year 2016, in fact, the first year the rates of payment were reduced in the "Non-bid" locations.
By replacing a standard fee schedule, the competitive bidding program aimed to save Medicare money on DME. The Government Accountability Office (GAO), in July 2017 report, noted genuine concerns among the beneficiary advocacy groups and trade organizations about the decrease of access to equipment on the patient's part. Sustainable access to DMEPOS items and services, new rules that simplify the bidding process by adopting a number of market-oriented reforms was the need of the hour!
As a result, from January 1, 2019, Medicare beneficiaries will be receiving DMEPOS items from any Medicare-enrolled supplier. Until such time, with the new CBP contracts going into effect, when the competitive bidding process will resume, it will surely be under new program rules.
Under the "The lead item pricing" methodology that has been proposed by CMS, the bidding activity on each item/ HCPCS code in a product category for a competitive bidding area will be replaced by a single bid system. CMS will be calculating a single payment amount for that lead item in the CBA based on the highest bid amount within the winning bids rather than opting for the median of the winning bids.
It is quite evident, that during the competitive bidding gap, any willing DME provider has the opportunity to jump in the Medicare market. For the next couple of years, it opens up market-oriented opportunities for both bid winners and non bid winners to have more Medicare customers under its belt. With the new CMS guidelines, there is an opportunity to make money with more consumers, if the right billing efforts are in place to secure the reimbursements.
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As a one-stop DME billing company, Sunknowledge guarantees an instant reduction of operational costs by 70% for its clients. Their rates start at $7 per hour for dedicated resources and the company claims to offer the best productivity metrics in the whole RCM world. They have a superior team that performs task-specific jobs in eligibility verification, prior authorization, denial management and accounts receivable. With customized reporting standards that meet a business's immediate requirements, excellent references across the industry and strong account management best practices, Sunknowledge is here to stay!
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