Monitoring Data Shows Adequacy of New Payment Amounts
Starting in 2011, section 1834(a)(1)(F) of the Social Security Act (the Act) required The Center of Medicare and Medicaid Services(CMS) to use competitive bidding to set payment amounts for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) for certain areas in the country. As implementation of the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) competitive bidding program has rolled out in areas across the country. The Center of Medicare and Medicaid Services (CMS) has been using real-time data monitoring to ensure that Medicare beneficiaries continue to receive the medical equipment they need. This data monitoring tracks access to items and services and a number of clinical outcome measures such as mortality, hospitalizations and emergency room visit. The DMEPOS competitive bidding program has been a great success for beneficiaries and the taxpayers by all measures.
Beginning on January 1, 2016, Section 1834(a)(1)(F) of the Act also required that the DMEPOS fee schedule amounts paid in non-competitive bidding areas be adjusted based on information from the competitive bidding program. CMS started to phase-in these new rates with a blend of 50 percent of the unadjusted fee schedule amounts and 50 percent of the adjusted fee schedule amounts on January 1, 2016. CMS is using the same monitoring system we use in competitive bidding areas to ensure beneficiaries are receiving the equipment they need.
The monitoring data posted today shows that suppliers in all areas where the adjusted DMEPOS fee schedule rates have been implemented have continued to accept these adjusted rates as payment in full, suggesting that the adjusted fee schedule rates continue to be more than adequate in covering the costs of furnishing the DMEPOS items in all areas.
The monitoring data compares the rate of assignment of claims for DMEPOS items for the first four months of 2015 that were paid at the unadjusted fee schedule rates versus the rate of assignment of claims for the same items that were paid at the new partially adjusted rates for the first four months of 2016.
The data are broken out for eight geographic regions of the contiguous United States, as well as non-contiguous areas (i.e., Alaska, Hawaii, Puerto Rico, Virgin Islands, etc., combined). The data are also broken out to compare the rate of assignment of claims for DMEPOS items furnished in rural areas versus non-rural areas. The rate of assignment of claims in 2016 continues to be very high overall in both rural and non-rural areas. Finally, the data is broken out for several different categories of DMEPOS items.