Frequently Asked Questions
The Medicare competitive bidding program (CBP) requires all bidders to be in compliance with all state laws and requirement, for the states in which they submit bids. Some states do require DMEPOS suppliers to have a “brick and mortar” location, some do not. Medicare does not have additional “brick and mortar” requirements. For information on state licensure, check out state laws and regulations: here.
No. If a beneficiary travels/moves outside of the competitive bid area (CBA), the contract supplier is not required to provide supplies (e.g. CPAP supplies). The beneficiary must obtain those supplies from a contract supplier in the new CBA, or any Medicare supplier if the beneficiary is traveling/moving to a non-bid area. For more information, see: here.
The Centers for Medicare and Medicaid Services (CMS) requires bidders to have valid Medicare supplier numbers, be accredited by an approved accreditation organization, comply with all other Medicare requirements (e.g., surety bonds), obtain bid bonds, and submit certain financial information. It does not appear that firms with prior experience or locations have “more weight” applied to their bids.
All changes to the CMS-855S must be on file with the NSC and PECOS by the close of the bid window on September 18, 2019. That is the date by which the CBIC is validating and ensuring the eligibility requirements are met. Suppliers are encouraged to make all necessary changes to their enrollment records now, as the NSC must validate changes made in PECOS online for the data to be reflected in production and viewable by the CBIC. As far as changes of ownership occurring during or after the close of the bid window, suppliers need to notify the CBIC in writing what the changes are and who or what is involved. Notifications may be sent to us at email@example.com
These are the bid limits and they are on the CBIC websiteOn the industry website you can click on the calculator, download the category you want and the bid ceiling will auto-populate with the 2019 unadjusted fee schedule (bid limit) which is, more simply stated, 2015 fee schedule plus inflation or for new items the current 2019 fee schedule (vent and braces).
You can contact VGM Insurance to inquire or the other two referenced in the webinar for exact information. Estimates have been approximately $500 per CBA. However, it will depend on the financial strength of the company and experience in the product category and CBA.
If the bidder’s lead item bid (same as composite bid) is less than the median of composite bids, Medicare will collect on the bond from the surety firm. The surety bond company will then in turn go after the supplier for repayment of the $50,000.
The 30% of small supplier participation is a goal, not a requirement. CMS will try to reach that goal, but if there are not enough small suppliers that bid for the PC in that CBA then CMS will proceed to contract with those suppliers that are in the array. CMS will array suppliers that qualify by lowest to highest bid price. At the point where capacity is reached, they will then evaluate to see if 30% of suppliers in the array qualify as small suppliers. If not, they will go to the higher bidders who did not make the cut and add them to the list of bid winners until they reach the 30% goal.
It is the 2015 fee schedule plus inflation, also known as the unadjusted 2019 fee schedule. As an example, the oxygen concentrator has a bid ceiling of $189. That’s 2015 plus inflation. In the calculator the bid ceiling will automatically populate once you choose your CBA.
Capacity and bona fide bid have nothing to do with each other. You enter in your capacity based on what you have provided historically and what you anticipate you could provide. CMS (CBIC) will review your bid, look at the suppliers’ historic claims volume, evaluate financials and may alter your capacity based on this analysis. The bona fide bid has to do with your bid price on the lead item and the bids then calculated to non-lead items. CMS will evaluate these based on what the $$ submitted is and whether it is feasible for you to provide at the bid rate. If they question your bid amount, you will be asked to substantiate the bid price and how it impacts the non-lead item. You will not be disqualified based on what you enter as capacity alone.
CMS will not release market share data per CBA. This has never been released in the past.
That the eventual 130 CBAs will set the prices for their areas. Hence the program affects all.
Disqualification criteria are limited to not meeting the basic Medicare requirements (having a Medicare billing number and being in compliance with all Medicare requirements, including accreditation and licensure requirements, financial requirements and bid price). Not having a contract in previous rounds is not a reason for disqualification.
The CBIC will average your 2018 and 2019 claims for the lead item to determine your historical capacity in the CBA you are bidding in. CMS has also indicated they will look at a supplier’s historical capacity in other bid areas, based on the paid claims for that CBA. See the fact sheet here.
There is not a minimum capacity. There is a chance CMS will raise your capacity based on your historical performance and not inform you! A supplier cannot be disqualified for this.
If you did not win a contract in previous rounds, you will have no Medicare FFS historical capacity that CMS can evaluate. You can list what you feel you are capable of supplying. You can also list what you have historically provided outside of FFS Medicare. CMS will evaluate this and your financials and adjust based on their rules. You cannot be disqualified for low capacity alone.
Yes, small suppliers have the same chance to win a bid as larger suppliers. CMS sets the criteria that all bidders must meet, regardless of size.
Download a bid calculator for a product category you are interested in, choose the CBA you wish to bid in. The bid ceiling will auto-populate. Enter your bid amount for the lead item and the calculator will fill in the bid price for all non-lead items that you are submitting as a result of your bid on the lead item. The calculator tool allows you to determine your bid price for a product category, it does not show you what you might be paid as this will be determined once the bids are evaluated and arrayed to determine where capacity is reached and the maximum winning bid is determined.
Any Medicare DME supplier can do repairs, but for HCPCS codes included in the bid program, the payment rate will be at the SPAs for that bid area. The actual repair HCPCS code is not included in competitive bidding.
The bid ceiling is the unadjusted 2019 fee schedule. The bid ceiling for NIV and knee and back braces is the current 2019 fee schedule. The bid limit is only applied to the lead item in each product category (in total 16 HCPCS).
The bid bond is a one-time requirement per CBA you wish to bid in. Once you purchase a bond, it is only needed through 90 days post contract award. There is no renewal. This is not the same as the bond requirement for enrollment as a DMEPOS supplier.
Financial thresholds have nothing to do with claims experience. Claims experience is only used to evaluate your capacity in a product category and CBA. Click here for the link to the financial requirements.
While you can bid above your historical capacity, CMS will not give you credit for it unless it believes your financials can support that expansion. It makes more sense to bid based upon your historical capacity. There is no penalty for a “wrong” capacity. It is only used in conjunction with your financials for CMS to determine the number of contractors necessary to serve the bid area. There is no guarantee of any volume based on your capacity, you still must compete against other contractors.
There is not, but CMS will decrease any to a maximin of 20%. There is no minimum. You should evaluate your previous capacity and bid accordingly.
No there is not. The bid bond is at risk only if you are in the lower half by bid price of all contract offers. The contract offer from the CBIC will indicate if your bid price was below the median price and if you are at risk.
No, however they will only be paid the SPA rate determined by competitive bidding.
Any HCPCS included in Competitive Bidding will be impacted at the Medicaid level. The requirement is that states will only get the federal match in their Medicaid programs up to what Medicare would have paid. For those codes not paid by Medicare, they should not be impacted.
Capacity is only used by CMS to determine how many bidders to offer contracts to. There is no guarantee of any volume. Suppliers still have to compete in the market, with all the other contractors.
Any supplier bidding in a CBA in a state must meet ALL licensure requirement in the state. If a state requires bricks and mortar to obtain a license, then you must have one to be able to get a license and bid.
Areas outside of CBAs will adopt the CB prices once they are rolled out.
The law requires CMS to award contracts to “multiple suppliers,” and CMS has implemented that via regulation to mean at least 5, unless there are not that many. If that is the case, CMS’s rule says at least two suppliers, if those 2 can satisfy the capacity.
By email notice during the post bid window evaluation period.