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For several years reimbursement rates for providers have been declining while the cost to provide services has been increasing. Medicare beneficiaries need to be able to access DMEPOS products and services when and where they need them. While VGM Government has been pushing for higher rates for years, this was further highlighted with COVID-19. Providers did see some relief with the CARES Act that included 75/25 blended rates in the non-rural, non-CBAs and VGM continues to advocate for this rate...

By Mark J. Higley, Vice-President, Regulatory Affairs, VGM & Associates, Inc. 

On January 15, CMS publicly shared the pivotal bid (“clearing price”) amounts for the 13 product categories that were withheld from the Round 2021 program.

As most are aware, 16 product categories were originally included in the program. Non-invasive ventilation was dropped from the competition earlier due to concerns relative to the public health emergency. Two categories...

The following is an excerpt from the offical “CMS Round 2021 DMEPOS Competitive Bidding Program Single Payment Amounts and Contract Offers” announcment. 

The Centers for Medicare & Medicaid Services (CMS) competed 16 product categories in 130 competitive bid areas (CBAs) in Round 2021 of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP), although the product category for non-invasive ventilators was removed...

Part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act included reimbursement rate changes for certain zip codes and HCPCS codes.

Let’s start with the rural and contiguous areas where the 50/50 blended rate that was initially set to expire December 31, 2020 and is now being extended beyond 2020 and for the duration of the public health emergency (PHE). This applies to beneficiaries that have a rural zip code according to Medicare FFS and the HCPCS code is part of...

As reported by AA Homecare, representatives Pat Tiberi (R-Oh) and John Larson (D-CT) and senators Rob Portman (R-OH) and Benjamin Cardin (D-MD) are planning on reintroducing the binding bids bill as early as next week. The binding bid bill (HR 4920 and S2975 in the 113th Congress), would require a proof of licensure before a suppliers can bid. It would also require a supplier to obtain a bid bond. Please find time today to message your senator and member of Congress to support any binding bid language...