Your Guide to Medicare's Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program

Your Guide to Medicare's Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program PDF

Author: U. S. Department Human Services

Publisher: CreateSpace

Published: 2013-10

Total Pages: 32

ISBN-13: 9781493511594

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Medicare's Competitive Bidding Program for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) changes the amount Medicare pays for certain DMEPOS items and makes changes to which suppliers Medicare will pay to supply these items to you. The first phase of the program is already in effect in 9 areas of the country. Starting July 2013, Medicare is scheduled to expand the competitive bidding program to more areas. The program replaces the outdated, inflated fee-schedule prices Medicare is currently paying with lower, more accurate prices. Under this program, suppliers submit bids to provide certain medical equipment and supplies at a lower price than what Medicare pays for these items now. Medicare uses these bids to set the amount it will pay for those equipment and supplies under the competitive bidding program. Qualified, accredited suppliers with winning bids are chosen as Medicare contract suppliers. The program: Helps you and Medicare save money; Ensures that you have access to quality medical equipment, supplies, and services from suppliers you can trust; Helps limit fraud and abuse in the Medicare Program. If you have Original Medicare, live in one of the competitive bidding areas, and use equipment or supplies included under the program (or get the items while visiting a competitive bidding area), you generally must use Medicare contract suppliers if you want Medicare to help pay for the item. If you live in one of the areas where the program is expanding and you're renting oxygen or certain other durable medical equipment (DME) at the time the program starts, you'll be able to continue renting these items from your current supplier if that supplier becomes a contract supplier or decides to participate in the program as a "grandfathered" supplier. If you live in (or get these items while visiting) these areas and don't use a Medicare contract or a grandfathered supplier, Medicare won't pay for the item, and you may have to pay full price. It's important to know if you're affected by this program to make sure Medicare will help pay for your item and to avoid any disruption of service. The competitive bidding program applies to Original Medicare only. If you're enrolled in a Medicare Advantage Plan (like an HMO or PPO), your plan will notify you if your supplier is changing. If you're not sure, contact your plan. Also available in Spanish.

Medicare: Issues for Manufacturer-Level Bidding for Durable Medical Equipment

Medicare: Issues for Manufacturer-Level Bidding for Durable Medical Equipment PDF

Author: Kathleen M. King

Publisher: DIANE Publishing

Published: 2012-10-19

Total Pages: 29

ISBN-13: 1437988490

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In 2009, Medicare spent approx. $8.1 billion on durable medical equipment (DME), prosthetics, orthotics, and related supplies for 10.6 million beneficiaries. DME includes items such as wheelchairs, hospital beds, and walkers. Medicare beneficiaries typically obtain DME items from suppliers, who submit claims for payment for these items to Medicare on behalf of beneficiaries. The Centers for Medicare & Medicaid Services (CMS), an agency within the Dept. of Health and Human Services (HHS), has responsibility for administering the Medicare program. Medicare and its beneficiaries -- through their out-of-pocket costs -- have sometimes paid higher than market rates for various medical equipment and supplies. To achieve Medicare savings for DME and to address DME fraud concerns, Congress required CMS to phase in a competitive bidding program (CBP) for DME suppliers in selected competitive bidding areas (CBA). In CBP, suppliers submit bid prices in the amounts they are willing to accept as payment to provide DME items to Medicare beneficiaries. CMS then enters into contracts with select DME suppliers to provide DME items at the prices determined by CBP. In contrast to CBP's supplier-level approach, some health care purchasers use a manufacturer-level approach to buy DME items directly from DME manufacturers to obtain savings by leveraging their purchasing power. CMS has not been required to develop a manufacturer-level approach. This report provides information on health care purchasers that currently use a manufacturer-level approach and on issues that would need to be addressed if CMS implemented such an approach. It describes (1) efforts used by some non- Medicare purchasers to reduce DME spending by contracting with DME manufacturers or using purchasing intermediaries, and (2) issues that CMS might face if required to implement a DME manufacturer-level approach with broad authority to do so. Figures and tables. This is a print on demand report.

Medicare

Medicare PDF

Author: Kathleen M. King

Publisher: DIANE Publishing

Published: 2010-06

Total Pages: 65

ISBN-13: 1437926851

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In 2007, Medicare spent $8.3 billion for durable medical equipment (DME) and related supplies. To reduce spending, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) required that the Centers for Medicare and Medicaid Services (CMS) phase in a competitive bidding program (CBP) for DME and other items. DME suppliers began bidding in round 1 of the CBP in May 2007. After contracts were awarded, the Medicare Improvements for Patients and Providers Act of 2008 was enacted in July 2008. This report examined: (1) the results of CBP round 1; (2) the major challenges CMS had in conducting CBP round 1; and (3) the steps CMS has taken to improve future CBP rounds. Charts and tables.

Medicare

Medicare PDF

Author: United States. Government Accountability Office

Publisher:

Published: 2004

Total Pages: 42

ISBN-13:

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CPT '98

CPT '98 PDF

Author: American Medical Association

Publisher: American Medical Association Press

Published: 1997

Total Pages: 664

ISBN-13:

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Enhancing Patient Engagement in Pulmonary Healthcare

Enhancing Patient Engagement in Pulmonary Healthcare PDF

Author: Marilyn L. Moy

Publisher: Springer Nature

Published: 2020-07-31

Total Pages: 299

ISBN-13: 3030448894

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This book examines the most up-to-date strategies that can be used to enhance the healthcare professional-patient interaction to influence positive behavior change and improve treatment adherence in pulmonary healthcare. This book is written by experts in the field who couple their experience with practical strategies (the art) with evidence-based theory (the science). Chapters discuss global concepts such as motivational interviewing on improving engagement and how to apply strategies to specific situations (for examples: smoking cessation, promoting physical activity, inhaler adherence, supplemental oxygen use, and non-invasive ventilation) commonly experienced on the front lines of caring for patients with pulmonary disorders. The textbook raises awareness of direct approaches and recent technological advances that healthcare professionals can use to support positive behavior change in their day-to-day clinical practice. Effective, patient-tailored self-management interventions are discussed, including the evidence for these interventions and ways to personalize the strategies to each patient’s unique needs. This book is an ideal guide for healthcare professionals working with patients experiencing chronic pulmonary conditions, including pulmonologists, primary care physicians, physician assistants, nurses, trainees, and the many allied health professionals involved in delivering care such as respiratory therapists, pharmacists, and behavioral psychologists. The concepts of this book can also be applied to the management of other chronic diseases such as coronary artery disease and diabetes mellitus.

The Promise of Assistive Technology to Enhance Activity and Work Participation

The Promise of Assistive Technology to Enhance Activity and Work Participation PDF

Author: National Academies of Sciences, Engineering, and Medicine

Publisher: National Academies Press

Published: 2017-09-01

Total Pages: 503

ISBN-13: 030945784X

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The U.S. Census Bureau has reported that 56.7 million Americans had some type of disability in 2010, which represents 18.7 percent of the civilian noninstitutionalized population included in the 2010 Survey of Income and Program Participation. The U.S. Social Security Administration (SSA) provides disability benefits through the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. As of December 2015, approximately 11 million individuals were SSDI beneficiaries, and about 8 million were SSI beneficiaries. SSA currently considers assistive devices in the nonmedical and medical areas of its program guidelines. During determinations of substantial gainful activity and income eligibility for SSI benefits, the reasonable cost of items, devices, or services applicants need to enable them to work with their impairment is subtracted from eligible earnings, even if those items or services are used for activities of daily living in addition to work. In addition, SSA considers assistive devices in its medical disability determination process and assessment of work capacity. The Promise of Assistive Technology to Enhance Activity and Work Participation provides an analysis of selected assistive products and technologies, including wheeled and seated mobility devices, upper-extremity prostheses, and products and technologies selected by the committee that pertain to hearing and to communication and speech in adults.