Medicare Competitive Bidding

Healthcare Professionals Support

Like most healthcare providers, you probably have questions about the new Medicare competitive bidding program. For instance, how it will affect your Medicare patients, where and what is a CBA, what homecare providers can provide products and services under competitive bidding, and what you can do to ensure your enteral nutrition patients have uninterrupted homecare provider service.

What is the Medicare Competitive Bidding Program?

The Centers for Medicare and Medicaid Services (CMS) implemented a new competitive bidding program that required durable medical equipment products and services (DMEPOS) providers to bid on the right to service patients within certain competitive bidding areas across the United States. 

Only certain DMEPOS providers that met CMS criteria were eligible to become Medicare contracted providers. The goals of competitive bidding were to limit the number of service providers, reduce CMS administrative costs, reduce the cost of products and services covered by Medicare, and ensure quality.

Starting in January 2011, CMS plans to limit the number of durable medical equipment providers in nine competitive bidding areas (CBAs) around the country. Medicare beneficiaries either living in, or visiting a CBA, will be required to use a Medicare-contracted provider to receive their enteral nutrition supplies.

Where are the competitive bidding areas?

There are nine Medicare competitive bidding areas. They are:

  1. Cincinnati-Middletown (Ohio, Kentucky and Indiana)
  2. Cleveland-Elyria-Mentor (Ohio)
  3. Charlotte-Gastonia-Concord (North Carolina and South Carolina)
  4. Dallas-Fort Worth-Arlington (Texas)
  5. Kansas City (Missouri and Kansas)
  6. Miami-Fort Lauderdale-Palm Beach (Florida)
  7. Orlando-Kissimmee (Florida)
  8. Pittsburgh (Pennsylvania)
  9. Riverside-San Bernardino-Ontario (California)

Apria Healthcare is proud to announce it has been awarded Medicare contracts in all nine CBAs to provide enteral nutrition products and services. For more information about our services in your area, please use the Branch Locator to find the branch nearest you.

Who can supply enteral nutrients under competitive bidding?

Only home healthcare providers who have been offered, and have signed, a formal contract with CMS will be permitted to supply tube feeding products and services to Medicare patients in your CBA. If a provider was not awarded a contract in the enteral nutrients category, it will no longer be eligible to supply these products under competitive bidding after the program takes effect in January 2011. All patients will need to be served by a contracted supplier by that date.

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How will competitive bidding affect my enteral nutrition patients?

Newly referred Medicare patients must begin using a contracted provider for competitively bid products starting January 2011. For many of your patients, there might not be a change in their current provider, if that provider won a bid and became a Medicare-contracted provider for enteral nutrients. All non-contracted homecare providers of enteral nutrients will no longer be eligible to supply these products to your patients. Competitive bidding Medicare contracts for enteral nutrients have a three-year term.

What if my patient is a Medicare Part B beneficiary?

If your patient is a Medicare Part B primary beneficiary in a CBA, he/she will be required to use a Medicare contracted provider. If your patient's current provider won a contract in your CBA, he/she may not have to change providers. However, if your patient's provider was not awarded a Medicare contract as a provider of enteral nutrients (i.e., tube feeding), he/she must choose another service provider.

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Does competitive bidding affect patients with Medicare Advantage or
Medicare as a secondary payor?

Competitive bidding affects only those patients where Medicare Part B is their primary payor. Patients with Medicare Advantage, Medicare secondary, managed care, or commercial payors are not affected.

How can I help my Medicare patients make sense of competitive bidding?

As a referring healthcare provider with a practice location in a CBA, you can serve a vital role in helping your Medicare patients select a tube feeding provider that can meet their needs and meet the requirements of the new Medicare program. If the Medicare beneficiary resides in, or is visiting, a CBA in which he or she needs to obtain a competitive bid item, you will most likely be the one to direct them to a contract provider.

Where can I refer my patients if they have questions about the competitive bidding program?

Patients may learn more about transitioning providers, report an issue, or simply ask CMS a question about competitive bidding; and they can email the Centers for Medicare and Medicaid Services at dmepos_qa@cms.hhs.gov. They can also visit www.cms.hhs.gov/CompetitiveAcqforDMEPOS for more information. Please contact the Apria branch nearest you for more information, by using the Branch Locator feature of this website.

Where can I find out more information about the Medicare Competitive Bidding Program?

You can learn more about the Medicare Competitive Bidding Program and get up-to-date information at www.apriamedicarecontracts.com.

 

 

Apria Healthcare stands ready to help you through this process

Apria is ready to assist and support all Medicare patients in the competitive bidding areas. With more than 30 years of nutrition expertise and a clinical staff of registered dietitians available to work with you, we are one of the leading home tube feeding providers in the U.S., servicing more than 25,000 enteral nutrition patients each month, Apria has over 500 branches nationwide, ensuring there's a branch near you. Call Apria Healthcare's dedicated enteral nutrition support team toll-free at 866.396.0619, or visit us at www.apria.com.

 

Contact us today to learn how we can help bring your TPN and tube feeding patients home, or click here to make a referral.