How National Expansion Will Work

CMS will expand competitive bidding nationally starting Jan 1, but do you understand how it plans to implement that rollout?

CMS’s final rule to expand competitive bidding nationally phases in a new reimbursement rates for non-CBAs over six months across eight regions divided across the contiguous 48 states beginning Jan. 1, 2016.

CMS will phase in the bid program expansion over course of 2016. As part of the program, CMS took zip codes in the eight regions and classified them as rural or non-rural. An un-weighted average of all of the single payment amounts (SPAs) from the CBAs in each of the eight will be used to determine a regional single payment amount (RSPA) for each covered item, with claims in the rural zip codes receiving a 10 percent increase.

From Jan. 1, 2016 to June 30, 2016, reimbursement for affected product categories will be based on 50 of the current, un-adjusted fee schedule, plus 50 percent of the RSPAs. Then, on July 1, 2016, the rates will drop to fully implement the bidding-derived rates, HME billing firm MiraVista LLC reports.

For example, based on that model, a provider in the Mideast region could expect to see an oxygen concentrator (E1390) that currently has a $178.23 reimbursement rate, go down to $134.21 on Jan. 1, 2016 (a 25 percent decrease), and then go down to $90.18 on July 1, 2016 (a 49 percent decrease), according to AAHomecare.

This article originally appeared in the November 2015 issue of HME Business.

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