Competitive Bid pricing will expand to all suppliers on January 1, 2016. This mandate is a directive of the 2015 End Stage Renal Disease and Prospective Payment System final rule posted on November 6, 2014.
If you supply respiratory equipment, enteral nutrition, mobility equipment (from walkers to power chairs), infusion equipment, TENS units, support surfaces, commodes, patient lifts, seat lifts, NPWT, or hospital beds you are affected by this rule, and now is the time to prepare for how these changes will impact your business.
Per the ruling, fee schedule amounts for items and services that are subject to competitive bidding will be adjusted on a regional level. The US will be broken down into a total of eight regions where this logic will be applied, including rural areas. Pricing will be adjusted based on how your area is classified within your respective region (rural or non-rural), but one thing is for certain, reimbursement is slated to decrease across the board.
In our recently aired webcast on January 13th, we partnered with HME News to deliver a better understanding of this complex ruling. We provided our attendees with an example of what pricing might look like after the expansion from this rule. Using the pricing adjustment logic explained in the final rule and current Single Payment Amount (SPA) data, we were able to determine what the new Regional SPA might look like for suppliers in a hypothetical location (Bartlesville, OK) post roll out. The results showed a 47% reduction in the reimbursement rate for oxygen concentrators in that area.
A realistic calculation is an essential tool to prepare your business for these future changes. Now is the time to examine your processes, re-negotiate contracts with your vendors, and/or reallocate staff resources to eliminate inefficiencies in your system. MiraVista can equip you with tools you need to progress through this process.
If you missed the event and would like to get the full details for how this ruling is to be implemented, the event is still available on-demand in digital format.
Additionally, we will be hosting the second part of this series on February 11th to discuss the bundled payment demonstration. The bundled payment provision will directly affect the way that CPAPs and Standard Power Wheelchairs are reimbursed in up to 12 demonstration areas and will set a precedent that will likely impact other products in the future. Register for the bundle that includes coverage of Part 1 and Part 2 of this series here.
See the HME News write up of the January 13th webinar here.