The DMEPOS Competitive Bidding Process

DME Billing Services - Recently DMEPOS services have come in the lime light for Medicare
enforcement community for cases of fraud and misuse.  This has led to audits, investigations and
enforcement actions. Further, this has also led to the implementation of the Medicare re-contracting
and re-credentialing process for all DMEPOS suppliers. CMS is also instituting the DMEPOS
competitive bidding program (CBP) for certain DMEPOS services provided in specific geographic
areas (CBAs). Section 302 of the Medicare Modernization Act of 2003 (MMA) set the requirements
for a new Competitive Bidding Program for certain Durable Medical Equipment, Prosthetics,
Orthotics, and Supplies (DMEPOS). The MMA requires that competitive bid payment amounts be
used to replace the current Medicare DMEPOS fee schedule payment amounts for selected items in
selected areas or CBA’s. The competitive bid payment amounts are determined by using bids
submitted by DMEPOS suppliers. The intent of the Competitive Bidding Program is to set more
appropriate payment amounts for DMEPOS items, which will result in reduced beneficiary out-of-
pocket expenses and savings to taxpayers and the Medicare program. The first phase of the DMEPOS
CBP will begin for services provided on and after 1/1/11.  And that date onwards, beneficiaries with
Original Medicare who obtain competitively bid items in CBAs must obtain these items from a
contract supplier in order for Medicare to cover and pay for these services.

The CBP applies to the following item groups

 Oxygen, oxygen equipment, and supplies

 Standard power wheelchairs, scooters and related accessories
 Complex rehabilitative power wheelchairs and related accessories (Group 2 only);
 Mail-order diabetic supplies
 Enteral nutrients, equipment, and supplies
 Continuous positive airway pressure devices and respiratory assist devices and related
supplies and accessories
 Hospital beds and related accessories
 Walkers and related accessories
 Support surfaces (group 2 mattresses and overlays in Miami-Fort Lauderdale-Pompano
Beach, FL, only)

The CBA’s include the following geographic areas:

 Charlotte-Gastonia-Concord, NC-SC
 Cincinnati-Middletown, OH-KY-IN
 Cleveland-Elyria-Mentor, OH
 Dallas-Fort Worth-Arlington, TX
 Kansas City, MO-KS
 Miami-Fort Lauderdale-Pompano Beach, FL
 Orlando -Kissimmee, FL
 Pittsburgh, PA
 Riverside-San Bernardino-Ontario, CA
For Further Details:

Website: DME Billing Services at http://www.dmebilling.org/

Call us: 1-800-595-0823

Fax us: 1-800-371-0398

Email: danny.roberts@imperiamedicalbilling.com