Industry Advocates Launch Round 2021 Education Site

The new site,, offers a variety of resources to help providers prepare for Round 2021, including bid calculators based on new lead item pricing system.

The American Association for Homecare (AAHomecare), the Council for Quality Respiratory Care (CQRC), and the VGM Group have banded together to release, a website designed to help HME providers better prepare Round 2021.

The new site includes educational resources and tools such as bid calculators to help providers make the right decisions when enrolling and bidding in Round 2021. A key resouce on the site is its new bid calculators.

Round 2021 introduces lead item pricing, in which the single payment amount (SPA) for the lead item in each product category and competitive bidding area (CBA) would be based on the maximum or highest amount bid for the item by suppliers in the winning range. Then, the SPAs for all other items in the product category would be based on a percentage of the maximum winning bid for the lead item.

While the competitive bidding implementation contractor (CBIC) offers a calculator, the calculator uses the CBIC ratios, but add features that include contextual information, such as rates currently in effect and results that show how bids entered will compare to rates for non-lead items in both dollar amount and by percentage. This helps providers make more informed decisions.

“HME suppliers need to know how lead item bids will impact pricing for a full range of associated products in any given category,” said Kim Brummett, vice president of regulatory affairs for AAHomecare, who led her association’s participation in the development of the calculators. “The results from their bids in this round will not only determine Medicare reimbursements; they will also influence rates for a majority of other HME payers. It’s essential that the HME community goes into this bidding round with a clear understanding of how the process works.”

“These calculators are preliminary tools to help prospective bidders understand how a bid for the lead item impacts the rest of the items (non-lead items) in the product category and how those SPAs would compare to current Medicare rates,” added Mark Higley, vice president of regulatory affairs at VGM.

The calculators take a variety of nuanced piece of information into consideration, such as:  

  • Bid ceiling verifications.
  • Calculations when capped rental is the lead item.
  • All the new repair and replacement codes included in wheelchair product categories.
  • Reviewing modifiers.
  • Reviewing calculation ratios.
  • Reviewing product categories against the previous categories and AAH recommended categories.
  • Developing formulas to disallow bids above the current bid ceilings.

That said, Higley reminded that the calculators serve as a guide; providers will still need to study the results.
“The calculators are not customized for your business and do not include considerations of your particular business operations, and are not intended, nor should be construed to be legal advice,” he said. “We recommend you consider your own business operations when using the calculators.”

A statement from AAHomecare echoed that recommendation: “These calculators are intended to be a starting point for suppliers to see how a bid for the lead item in a product category impacts all the resulting bids for the other items in the product category,” the statement read. “The bid calculators are designed for an individual business to use; they are not pre-populated with possible bids. AAHomecare recommends that suppliers fully consider all direct and indirect costs and profit margins when trying out and evaluating the results of the bid calculators.”

Brummett and the AAHomecare team are working to further enhance to the calculators, including a feature to highlight which non-lead HCPCS codes were responsible for the highest overall spend in categories based on 2017 information from CMS. This will help providers focus on the HCPCS codes in a category that could potentially impact the bottom line the most.


About the Author

David Kopf is the Publisher and Executive Editor of HME Business and DME Pharmacy magazines. Follow him on LinkedIn at and on Twitter at @postacutenews.

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