Now Available: New Webcast for National Mail
We will be issuing more webcasts later in the bidder education program. The upcoming webcasts will address topics such as financial documentation requirements, how bids are evaluated, and how to submit a bid in the online bidding system, DBidS. As each webcast is posted, we will announce its availability with an e-mail update. If you have not already done so, please register on the CBIC website to receive these announcements and other updates about the competitive bidding program.
Source: thecre.com
Video: Medicare Competitive Bidding for DMEPOS Simplified
Time is Running Out to Register for DMEPOS Competitive Bidding : Bid News
If you are a supplier interested in participating in the Round 2 and national mail-order competitions of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program and have registered an authorized official (AO) but not a backup authorized official (BAO), the Centers for Medicare & Medicaid Services (CMS) strongly recommends that a BAO register no later than Thursday, January 12th. It is important to do it now so that the BAO will be able to assist the AO with approving end user (EU) registration. The establishment of a BAO is encouraged, if your company has someone who can occupy the BAO role, to avoid any disruption in the bidding process once the 60-day bid window opens. The individual in the BAO role can also assume the AO role if for some reason the AO can no longer fulfill his or her bidding responsibilities; if there is no BAO and the AO leaves the company, all end users associated with the company will lose access to the bidding system.
Source: thecre.com
DME Suppliers & Medicare Competitive Bidding Financial Requirements
If you are a DME supplier preparing to submit a bid for products covered under the competitive bid program, CMS is strongly urging companies to submit accountant-prepared (compiled) financial statements that meet the requirements set for by the qualifying bid guidelines. In Round 1 of the bidding process, many suppliers were disqualified for submitting non-compliant financials.
Source: somersetblogs.com
Expand Competitive Bidding in Medicare
Establish a Medicare Competitive Bidding Committee, composed of individuals from the private sector with acquisition experience and experts in competitive bidding. Since proper implementation of competitive bidding is complex and technical, the committee— rather than government staff at the Centers for Medicare & Medicaid Services —would oversee the process. The committee would monitor the market response to ensure product quality and access, and have authority to add and/or subtract goods and services subject to competitive bidding. For instance, it might be possible to extend competitive bidding to outpatient radiological examinations such as CT scans or MRIs.
Source: americanprogress.org
“Comment on Cramton and Katzman: Medicare Competitive Bidding Lowered E” by Thomas J. Hoerger
In contrast to Cramton and Katzman’s assertion that Medicare encountered serious problems with its pilot competitive bidding program, Thomas Hoerger of RTI International cites his early evaluations that suggested strikingly positive results.
Source: bepress.com
Medicare Expanding Competitive Bidding
The bidder education program launched today is designed to guide suppliers through the competitive bidding process and will feature numerous enhancements such as improved Request for Bids instructions, updated fact sheets, and a series of webcasts that suppliers will be able to view at their convenience. Information and materials may be found at www.dmecompetitivebid.comand a toll-free help line (1-877-577-5331) is available to assist bidders with questions and concerns.
Source: hcmatters.com
Is Rick Santorum a Conservative Health
Furthermore, Santorum has positioned himself to the right of Mitt Romney on Medicare reform. Whereas both Romney and the new Ryan-Wyden plan appear to endorse a form of competitive bidding in which private insurers would compete with traditional government-run Medicare to serve retirees, Santorum supports competitive bidding without the inclusion of a “public option,” as Igor Volsky and Scott Keyes have documented. At a town hall meeting in Iowa on January 2, Santorum stated that he “liked” the Ryan-Wyden plan, but had “a problem with the public option part that Ron Wyden has insisted upon.”
Source: think-buzz.com
CMS Says Medicare Competitive Bidding Program For Durable Medical Equipment Might Save $1B In 2009
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Source: wordpress.com
Medicare Expands Competitive Bidding Program (DMEPOS)
Under the program, DMEPOS suppliers compete to become Medicare contract suppliers by submitting bids to provide certain items in competitive bidding areas (CBAs). The new, lower payment amounts resulting from the competition replace the fee schedule amounts for the bid items in these areas. The first phase of the program was successfully implemented for nine product categories in nine areas of the country on Jan. 1, 2011. To date, CMS monitoring data have shown a successful implementation with no changes in beneficiary health status. Today, CMS released the detailed schedule for Round 2 bidding. Registration will begin on December 5, and the 60-day supplier bidding period will begin in late January of 2012. Round 2 expands the program to 91 additional metropolitan areas, and the new prices are expected to take effect on July 1, 2013. A National Mail Order Competition to help bring down prices for mail order diabetic supplies will coincide with the Round 2 timeline. The bidder education program launched today is designed to guide suppliers through the competitive bidding process and will feature numerous enhancements such as improved Request for Bids instructions, updated fact sheets, and a series of webcasts that suppliers will be able to view at their convenience. Information and materials may be found at www.dmecompetitivebid.comand a toll-free help line (1-877-577-5331) is available to assist bidders with questions and concerns.
Source: myedutrax.com
Medicare Competitive Bidding Threatens Access to Seating and Mobility Products
I know this could also be posted under the CareCure Legislative forum, but since it is specific to the seating and mobility equipment that you are passionate about I thought it would be appropriate to post it here in the Equipment forum. For those Forum members in the US, Medicare is pursuing a cost savings strategy of competitively bidding critical DME devices including major categories of manual and power wheelchairs as well as wheelchair seat cushions. The details of the Competitive Bidding Program are complicated, but it is clear that government bidding of these individualized, specialty items will no doubt limit choice and make access to top performing seating and mobility products more difficult. I have been involved in industry lobbying efforts to try and convince Medicare officials of the negative impact such a bidding program will have on individuals who rely on high performance wheelchairs, but it seems clear that many top level government officials see wheelchairs and seat cushions as commodity DME items, not realizing the critical importance these devices have on those who rely upon them for both mobility and skin protection. Perhaps the most scary part of Medicare pursuing this strategy is that the negative impact won’t only be restricted to the Medicare market. We are already seeing many state Medicaid programs and private insurance programs grab on to lower payments rates and access restrictions that resulted from a Round 1 pilot program of Competitive Bidding. And this is before the Medicare bidding program becomes a national program in 2013. I can’t see any scenario where the Medicare Competitive Bidding program will not ultimately limit your access and choice to critical seating and mobility equipment. It is not too late to convince Medicare officials and Members of Congress that this is a bad program – but to accomplish this we need individuals who use and rely upon this equipment to add your voice to lobbying efforts. Here is a great posting on the ROHO blog site from Bob Vogel about how to engage with your Members on Congress on this important topic. Your Members of Congress work for you. They are your elected officials. Part of their job is to listen and respond to your concerns. I encourage you to make your voice heard with the same passion that you show in participating in this Forum! http://blog.therohogroup.com/index.p…-and-senators/ Thank you! Tom Borcherding The ROHO Group tomb@therohogroup.com
Source: rutgers.edu
Healthcare Economist · Bring Market Prices to Medicare
Authors also propose to eliminate the 25% tax on premiums. According to MedPAC, “Plans that bid below the benchmark also receive payment from Medicare in the form of a “rebate.” The law defines the rebate as 75 percent of the difference between the plan’s actual bid (not standardized) and its case mix-adjusted benchmark. The plan must then return the rebate to its enrollees in the form of supplemental benefits or lower premiums” The rebate structure gives plans a disincentive from lowering their bids since they only recover a share of the cost decreases.
Source: healthcare-economist.com
More Information on the Medicare Competitive Bidding Program
I know a lot of you are thinking that because you are not on Medicare, this stuff does not affect you. Well, it does. A lot of insurance companies follow Medicare guidelines so other insurance companies can start doing this same thing. My friend Mary’s husband works for a very large corporation and his company switched insurance policies the first of the year. Mary’s daughter has an intellectual disability and uses the Omni Pod pump and the Dexcom CGMS. The Omni Pod is one of the easiest pumps to use and she is able to use it without having to make complicated decisions on what she should bolus. Although Mary makes the important management decisions for her daughter, her daughter having a pump that she is able to use and give herself meal boluses with ease is something that is very important to both of them. A CGMS is a very important part of her control and Mary does not have to worry 24/7 about her daughter having severe lows. They were informed that their new insurance follows Medicare guidelines and they will not cover the Omni Pod or the Dexcom. Now Mary has to start her year off fighting to try and keep the Omni Pod and Dexcom for her daughter.
Source: kellywpa.com
Medicare Expands Competitive Bidding Program
The Hill: Medicare Says Competitive Pricing Will Save $28B Medicare is dramatically expanding a program that it says will save billions of dollars and serve as a model for other cost-cutting efforts. The Centers for Medicare and Medicaid Services (CMS) on Friday announced the second round of a program that uses competitive bidding to set prices for certain medical products. Medicare now uses competitive bidding in nine cities and will expand to 91 areas, according to the Friday announcement. In its first six months, the nine-city competitive bidding program has saved roughly $130 million, CMS officials said. The agency expects to save $28 billion over the next 10 years, roughly a third of which would be savings to patients (Baker, 8/19).
Source: kaiserhealthnews.org
Pursuing common solutions
There are promising elements to the proposal unveiled this month by Rep. Paul Ryan of Wisconsin and Sen. Ron Wyden of Oregon. But what is really promising is that a Republican and a Democrat — respected legislators within their respective parties — are pursuing a common solution to a serious problem that has been used to score political points.
Source: montereyherald.com
The second change relates to the calculation of allowable pension costs for cost-finding purposes. Two different methodologies are necessary to appropriately address the goal of each. The wage index is used to measure a hospital’s labor costs across areas, while cost-finding procedures determine the actual costs incurred at individual hospitals. The current maximum amount of defined benefit pension costs claimed for cost-finding purposes, as detailed in Section 2142.5 of the Provider Reimbursement Manual (PRM), is based on actuarial accrued liability, normal costs and unfunded actuarial liability. To be allowable, costs must be computed in accordance with the Employee Retirement Income Security Act of 1974 (ERISA). The current period liability for pension cost also must be funded. Finally, funding in excess of a current period liability can be carried forward and recognized in a future period.
PPO (Favored Provider Business) is comparable to the HMO when it comes to network limitation. The PPO solution provides far more versatility than HMOs. Workers can use any medical doctor within the network. This package deal also provides the benefit of reducing the price of service. PPOs also possess a co-payment and coinsurance technique. The deductibles with the insurance coverage package deal need to be the higher when the worker wants to reduced the top quality charge. Greater deductibles demand far more from pocket cash, however the positive aspects are substantially far better than the previous strategy.
The original Medicare program has two parts: Part A (Hospital Insurance), and Part B (Medical Insurance). Only a few special cases exist where prescription drugs are covered by original Medicare, but as of January 2006, Medicare Part D provides more comprehensive drug coverage. Medicare Advantage plans, also known as Medicare Part C, are another way for beneficiaries to receive their Part A, B and D benefits. All Medicare benefits are subject to medical necessity. Part A: Hospital Insurance Part A covers inpatient hospital stays (at least overnight), including semiprivate room, food, tests, and doctor’s fees. Part A covers brief stays for convalescence in a skilled nursing facility if certain criteria are met: 1. A preceding hospital stay must be at least three days, three midnights, not counting the discharge date. 2. The nursing home stay must be for something diagnosed during the hospital stay or for the main cause of hospital stay. 3. If the patient is not receiving rehabilitation but has some other ailment that requires skilled nursing supervision then the nursing home stay would be covered. 4. The care being rendered by the nursing home must be skilled. Medicare part A does not pay for custodial, non-skilled, or long-term care activities, including activities of daily living (ADL) such as personal hygiene, cooking, cleaning, etc. The maximum length of stay that Medicare Part A will cover in a skilled nursing facility per ailment is 100 days. The first 20 days would be paid for in full by Medicare with the remaining 80 days requiring a co-payment (as of 2009, $133.50 per day). Many insurance companies have a provision for skilled nursing care in the policies they sell. If a beneficiary uses some portion of their Part A benefit and then goes at least 60 days without receiving facility-based skilled services, the 100-day clock is reset and the person qualifies for a new 100-day benefit period. Part B: Medical Insurance Part B medical insurance helps pay for some services and products not covered by Part A, generally on an outpatient basis. Part B is optional and may be deferred if the beneficiary or their spouse is still actively working. There is a lifetime penalty (10% per year) imposed for not enrolling in Part B unless actively working. Part B coverage includes physician and nursing services, x-rays, laboratory and diagnostic tests, influenza and pneumonia vaccinations, blood transfusions, renal dialysis, outpatient hospital procedures, limited ambulance transportation, immunosuppressive drugs for organ transplant recipients, chemotherapy, hormonal treatments such as Lupron, and other outpatient medical treatments administered in a doctor’s office. Medication administration is covered under Part B only if it is administered by the physician during an office visit. Part B also helps with durable medical equipment (DME), including canes, walkers, wheelchairs, and mobility scooters for those with mobility impairments. Prosthetic devices such as artificial limbs and breast prosthesis following mastectomy, as well as one pair of eyeglasses following cataract surgery, and oxygen for home use is also covered. Complex rules are used to manage the benefit, and advisories are periodically issued which describe coverage criteria. On the national level these advisories are issued by CMS, and are known as National Coverage Determinations (NCD). Local Coverage Determinations (LCD) only apply within the multi-state area managed by a specific regional Medicare Part B contractor, and Local Medical Review Policies (LMRP) were superseded by LCDs in 2003. Coverage information is also located in the CMS Internet-Only Manuals (IOM), the Code of Federal Regulations (CFR), the Social Security Act, and the Federal Register. Part C: Medicare Advantage plans With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans, instead of through the original Medicare plan (Parts A and B). These programs were known as “Medicare+Choice” or “Part C” plans. Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, “Medicare+Choice” plans were made more attractive to Medicare beneficiaries by the addition of prescription drug coverage and became known as “Medicare Advantage” (MA) plans. Traditional or “fee-for-service” Medicare has a standard benefit package that covers medically necessary care members can receive from nearly any hospital or doctor in the country. For people who choose to enroll in a Medicare Advantage health plan, Medicare pays the private health plan a capitated rate, or a set amount, every month for each member. Members typically also pay a monthly premium in addition to the Medicare Part B premium to cover items not covered by traditional Medicare (Parts A & B), such as prescription drugs, dental care, vision care and gym or health club memberships. In exchange for these extra benefits, enrollees may be limited in the providers they can receive services from without paying extra. Typically, the plans have a “network” of providers that patients can use. Going outside that network may require permission or extra fees. Medicare Advantage plans are required to offer coverage that meets or exceeds the standards set by the original Medicare program, but they do not have to cover every benefit in the same way. If a plan chooses to pay less than Medicare for some benefits, like skilled nursing facility care, the savings may be passed along to consumers by offering lower copayments for doctor visits. Medicare Advantage plans use a portion of the payments they receive from the government for each enrollee to offer supplemental benefits. Some plans limit their members’ annual out-of-pocket spending on medical care, providing insurance against catastrophic costs over $5,000, for example. Many plans offer dental coverage, vision coverage and other services not covered by Medicare Parts A or B, which makes them a good value for the health care dollar, if you want to use the provider included in the plan’s network or “panel” of providers. Because the 2003 payment formulas overpay plans by 12 percent or more compared to traditional Medicare,[11] in 2006 enrollees in Medicare Advantage Private Fee-for-Service plans were offered a net extra benefit value (the value of the additional benefits minus any additional premium) of $55.92 a month more than the traditional Medicare benefit package; enrollees in other Medicare Advantage plans were offered a net extra benefit value of $71.22 a month more.[12] However, Medicare Advantage members receive additional coverage and medical benefits not enjoyed by traditional Medicare members, and savings generated by Medicare Advantage plans may be passed on to beneficiaries to lower their overall health care costs.[10] Other important distinctions between Medicare Advantage and traditional Medicare are that Medicare Advantage health plans encourage preventive care and wellness and closely coordinate patient care.[13] Medicare Advantage Plans that also include Part D prescription drug benefits are known as a Medicare Advantage Prescription Drug plan or a MA-PD. Enrollment in Medicare Advantage plans grew from 5.4 million in 2005 to 8.2 million in 2007. Enrollment grew by an additional 800,000 during the first four months of 2008. This represents 19% of Medicare beneficiaries. A third of beneficiaries with Part D coverage are enrolled in a Medicare Advantage plan. Medicare Advantage enrollment is higher in urban areas; the enrollment rate in urban counties is twice that in rural counties (22% vs. 10%). Almost all Medicare beneficiaries have access to at least two Medicare Advantage plans; most have access to three or more. Because of the 2003 law’s overpayments, the number of organizations offering Fee-for-Service plans has increased dramatically, from 11 in 2006 to almost 50 in 2008. Eight out of ten beneficiaries (82%) now have access to six or more Private Fee-for-Service plans.[14] Each year many individuals disenroll from MA plans. A recent study noted that about 20 percent of enrollees report that “their most important reason for leaving was due to problems getting care.”[15] There is some evidence that disabled beneficiaries “are more likely to experience multiple problems in managed care.”[16] Some studies have reported that the older, poorer, and sicker persons have been less satisfied with the care they have received in MA plans.[17] On the other hand, an analysis of the Agency for Healthcare Research and Quality data published by America’s Health Insurance Plans found that Medicare Advantage enrollees spent fewer days in the hospital than Fee-for-Service enrollees, were less likely to have “potentially avoidable” admissions, and had fewer re-admissions. These comparisons adjusted for age, sex and health status using the risk score used in the Medicare Advantage risk adjustment mechanism.[18][19] In December 2009 the Kaiser Family Foundation published a report that rated Medicare Advantage organizations on a five star scale. The ratings were based on data from CMS, the Consumer Assessment of Healthcare Providers and Systems (CAHPS), Healthcare Effectiveness Data and Information Set (HEDIS) data, and the Health Outcomes Survey (HOS). New plans did not receive ratings, because data were not available. Almost six out of ten (59%) of MA plans did receive ratings, and these plans represented 85% of the enrollment for 2009. The average rating was 3.29 stars. Twenty-three percent of enrollees were in a plan with four or more stars; 20% were in a plan with fewer than three stars.[20] Twenty percent of African-American and 32 percent of Hispanic Medicare Beneficiaries were enrolled in Medicare Advantage plans in 2006. Almost half (48%) of Medicare Advantage enrollees had incomes below $20,000, including 71% of minority enrollees.[21] Others have reported that minority enrollment is not particularly above average.[22] Another study has raised questions about the quality of care received by minorities in MA plans.[23] The Government Accountability Office reported that in 2006, the plans earned profits of 6.6 percent, had overhead (sales, etc.) of 10.1 percent, and provided 83.3 percent of the revenue dollar in medical benefits. These administrative costs are far higher than traditional fee-for-service Medicare.[24] [edit] Part D: Prescription Drug plans Main articles: Medicare Part D and Medicare Part D coverage gap Medicare Part D went into effect on January 1, 2006. Anyone with Part A or B is eligible for Part D. It was made possible by the passage of the Medicare Prescription Drug, Improvement, and Modernization Act. In order to receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD). These plans are approved and regulated by the Medicare program, but are actually designed and administered by private health insurance companies. Unlike Original Medicare (Part A and B), Part D coverage is not standardized. Plans choose which drugs (or even classes of drugs) they wish to cover, at what level (or tier) they wish to cover it, and are free to choose not to cover some drugs at all. The exception to this is drugs that Medicare specifically excludes from coverage, including but not limited to benzodiazepines, cough suppressant and barbiturates. Plans that cover excluded drugs are not allowed to pass those costs on to Medicare, and plans are required to repay CMS if they are found to have billed Medicare in these cases. It should be noted again for beneficiaries who are dual-eligible (Medicare and Medicaid eligible) Medicaid may pay for drugs not covered by part D of Medicare, such as benzodiazepines, and other restricted controlled substances.
Another potential witness in the case is M. Lynn Crismon, dean of the University of Texas College of Pharmacy. Crismon was a professor and member of the TMAP advisory panel in the mid-1990s when he “cultivated a financial relationship with J&J, accepting substantial fees and honoraria and soliciting research grants from the company,” according to Rothman’s report. “As a result, Dr. Crismon subverted the scientific integrity of his research and educational presentations, and biased his decision-making capacity as a member of TMAP.”
PPO (Favored Provider Business) is comparable to the HMO when it comes to network limitation. The PPO solution provides far more versatility than HMOs. Workers can use any medical doctor within the network. This package deal also provides the benefit of reducing the price of service. PPOs also possess a co-payment and coinsurance technique. The deductibles with the insurance coverage package deal need to be the higher when the worker wants to reduced the top quality charge. Greater deductibles demand far more from pocket cash, however the positive aspects are substantially far better than the previous strategy.
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Here is how to get the best Medicare Supplement Quote for your situation. 1. One Plan is the same as Every Other Plan Medicare supplement plans are regulated by each state, but every plan has to offer the same coverage as any other plan. What this means is that normally, price is the biggest consideration when comparing your quote for a Medicare Supplement policy. 2. How Long Have They Been in Business Some companies have come recently into the competitive space of Medigap insurance. Make sure that the company you do business with has a proven track record and will give you good service. 3. Use a Broker That Can Find What You Need A broker works for you, not the insurance companies. Brokers can normally help you get what you need at the lowest price.