Medicare's Competitive Bidding Program : DME (Durable Medical Equipment)

Medicare's Competitive Bidding Program

by Connie Taylor on 08/30/16

Some of you may have already had a situation where you walked into a medical equipment supplier for a piece of equipment your doctor prescribed only to be told the supplier couldn't bill Medicare for that item anymore.  You were then sent to another provider, probably in a different town or county, who would be able to help you.  This was due to Medicare's Competitive Bidding Program.

 
I will try to explain what this Program means.  All of the information I'm about to give you is from Medicare's website. (www.cms.gov) To begin with, Medicare's Competitive Bidding Program only applies to Traditional Medicare participants and home medical equipment & supplies.  How do you know if you have Traditional Medicare?  If you go to the doctor's office and hand them a red, white and blue insurance card with your name and Medicare number on it, you have Traditional Medicare. 

The Competitive Bidding Program was first introduced in 2003 under the "Medicare Modernization Act".  Prior to Competitive Bidding starting, any provider with a Medicare supplier number could submit claims to Medicare. After Competitive Bidding started, any supplier who wanted to provide equipment (like hospital beds or oxygen) to Medicare patients had to submit a bid to Medicare. From those suppliers, Medicare gave contracts to only a few.  The first round of bidding went into effect on July 1, 2013.  

The second round of Competitive Bidding went in to effect on July 1, 2016. Medicare added more equipment to the list that only contracted suppliers could provide.

I realize that all of this sounds pretty grim, but there are ways around it.  Medicare Advantage plans are NOT included in Competitive Bidding.  This is something to consider when Medicare has it's open enrollment in the fall.  Your local insurance representative will be able to help you pick out a plan that is right for your needs. 

You can also ask your medical equipment supplier which Medicare Advantage plans are easiest to work with if you should have a need for equipment or supplies.  We at Plaza Home Care are always happy to try and help someone with questions.  

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