In addition to the brochure and information sheet downloads found on the homepage of this website, below are a few frequently asked questions and answers that may be helpful to you in educating your colleagues and patients about this new process.
It is a new Medicare program involving bids from competing providers in certain areas of the country. The providers bid to secure the right to serve Medicare beneficiaries for a three-year period.
A CBA is a zip code-defined geographic area subject to competitive bidding.
- Greater Cleveland/Elyria/Mentor, Ohio area
- Greater Charlotte/Gastonia/Concord, North/South Carolina area
- Greater Cincinnati/Middleton, Ohio/Kentucky/Indiana area
- Greater Dallas/Ft. Worth/Arlington, Texas area
- Greater Kansas City, Missouri/Kansas area
- Greater Orlando/Kissimmee, Florida area
- Greater Miami/Ft. Lauderdale/Palm Beach, Florida (Dade, Broward, Palm Beach counties) area
- Greater Pittsburgh, Pennsylvania area
- Greater Riverside/San Bernardino/Ontario, California area
In the CBAs, all newly referred Medicare patients will need to begin using a contracted provider for competitively bid products. These changes are scheduled to become effective on January 1, 2011*. In most cases, currently served patients may continue to be served by their current provider if both the patient and provider agree.
*Effective date is subject to change
Oxygen, CPAP, Bi-Level, enteral nutrition supplies and pumps, diabetes supplies, complex power wheelchairs, standard power wheelchairs, hospital beds, walkers and support surfaces (Miami only).
Competitive bidding aims to obtain products and services at the lowest price.
A provider awarded a contract by Medicare to furnish items in a Product Category for a specific CBA under the competitive bidding program. The contract term is three years.
A provider that is not contracted by Medicare to furnish items in a Product Category for a specific CBA under the competitive bidding program.
First, “grandfathering” means that a non-contract provider chooses to continue to service existing patients for as long as their medical need exists. This is an active decision between the provider and the patient. Inexpensive or routinely purchased (IRP) items like walkers, capped rentals like CPAP/Bi-Level or hospital beds, or oxygen for which payment was made on a rental basis prior to implementation of the competitive bidding program can be grandfathered. Essential supplies like CPAP masks required for use with this equipment will also be grandfathered. Medicare has created a helpful Fact Sheet on grandfathered items.
Medicare has created a helpful Fact Sheet to help you aid this discussion.
For additional information, Medicare has set up a dedicated website that may answer additional questions not listed above.