First Impressions

Medicare Set-Aside Blog on April 4, 2008 | Posted by

The new competitive bidding program initiated by Congress was primarily intended to reduce the rates for some of the most expensive home-based equipment and services. As Medicare’s solvency continues to be a major concern, Congress has been implementing policies that will delay a depletion in funds. However, last Friday, DME providers in the first ten competitive bidding regions received letters from the Centers for Medicare and Medicaid Services (CMS) explaining whether they had been offered a contract, been disqualified from bidding, or bid outside of the bidding range for a product. Those DME providers that did not receive contracts for a given Medicare item or service are shut out of the Medicare program for three years. Hundreds of DME providers are claiming they were improperly disqualified. Average DME companies receive approximately half of their business from Medicare beneficiaries. Therefore, being disqualified as a Medicare provider can have serious consequences for established DME providers including layoffs and possibly dissolution of the company itself. The American Association of Homecare is going forward with attempts to devise some sort of appeal process or legal remedy for DME providers who have been disqualified.

So far the competitive bidding program has begun implementation in ten cities: Charlotte, N.C.; Cincinnati, Ohio; Cleveland, Ohio; Dallas-Ft. Worth, Texas; Kansas City, Mo; Miami, Fla.; Orlando, Fla; Pittsburgh, Pa.; Riverside, Calif., and San Juan, P.R. Another 70 cities have been targeted for the program in 2009. 

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