Medicare Compliance & Reimbursement

DME bidding could have your patients limping home.

The next time a patient leaves your office wearing a cast on her leg, your physician may be unable to provide her with a pair of crutches, thanks to a new Medicare program.

The Centers for Medicare & Medicaid Services (CMS) is close to imposing competitive bidding on all suppliers of durable medical equipment, prosthetics, orthotics & supplies (DMEPOS), officials told a Sept. 20 provider Town Hall meeting.

A forthcoming final rule would require all DMEPOS suppliers to bid for the right to supply Medicare patients. Separately, CMS has unveiled quality standards that all DMEPOS suppliers must follow, and soon suppliers must be accredited. These changes will be a disaster for orthopedists and other doctors who currently supply DMEPOS in their offices, Delray Beach, FL consultant Jean Acevedo told the meeting.

"This is going to be devastating for patients. They could literally not be able to walk out of the doctor's office with the crutches unless the doctor wants to give them away," which would be a kickback, Acevedo said.

The Medicare Payment Advisory Commission also told CMS to exempt physicians from competitive bidding in a recent letter. But CMS officials told the town hall that the Medicare Modernization Act gives them no leeway to exempt some DMEPOS suppliers. "We do understand the impact," one official said.

More: Also, at the Town Hall, CMS officials revealed that:

· CMS will soon be putting out a long-awaited "dissemination notice" explaining how you'll be able to obtain the National Provider Identifiers (NPI) for providers who refer patients to you. For now, you're not required to share your NPI with anyone. Also, CMS will soon address the issue of "surrogate" Unique Physician Identification Numbers.

· As each Medicare Administrative Contractor (MAC) takes over for a few carriers in its region, it will consolidate local coverage determinations (LCDs) into one LCD per region. The MAC will work with its carrier advisory committee to make sure each LCD is as close to existing policies as possible.