Page 12 - HME Business, May 2019

News / Trends / Analysis
Industry Advocates Launch Round 2021 Education Site
The new site, dmecbpeducation.com, offers a variety of resources to help providers prepare for Round 2021, including bid calculators based on new lTead item pricing system.
CBIC Alerts
Commonly Owned,
Commonly Controlled
Providers
he American Association for Homecare (AAHomecare), the Council for Quality Respiratory Care (CQRC), and the VGM Group have banded together to release dmecbpeducation.com, a website designed to help HME providers better prepare Round 2021.
The new site includes educational resources and tools such as bid calculators to help providers make the right decisions when enrolling and bidding in Round 2021. A key resouce on the site is its new bid calculators.
Round 2021 introduces lead item pricing, in which the single payment amount (SPA) for the lead item in each product category and competitive bidding area (CBA) would be based on the maximum or highest amount bid for the item by suppliers in the winning range. Then, the SPAs for all other items in the product category would be based on a percentage of the maximum winning bid for the lead item.
While the competitive bidding implementation contractor (CBIC) offers a calculator, the dmecbpeduca- tion.com calculator uses the CBIC ratios, but add features that include contextual information, such as rates currently in effect and results that show how bids entered will compare to rates for non-lead items in both dollar amount and by percentage. This helps providers make more informed decisions.
“HME suppliers need to know how lead item bids will impact pricing for a full range of associated prod- ucts in any given category,” said Kim Brummett, vice president of regulatory affairs for AAHomecare, who led her association’s participation in the development of the calculators. “The results from their bids in this round will not only determine Medicare reimbursements; they will also influence rates for a majority of other HME payers. It’s essential that the HME community goes into this bidding round with a clear understanding of how the process works.”
“These calculators are preliminary tools to help prospective bidders understand how a bid for the lead item impacts the rest of the items (non-lead items) in the product category and how those SPAs would compare to current Medicare rates,” added Mark Higley, vice president of regulatory affairs at VGM.
The calculators take a variety of nuanced piece of information into consideration, such as: Bid ceiling verifications.
• Calculations when capped rental is the lead item.
• All the new repair and replacement codes included in wheelchair product categories.
• Reviewing modifiers.
• Reviewing calculation ratios.
• Reviewing product categories against the previous categories and AAH recommended categories.
• Developing formulas to disallow bids above the current bid ceilings.
That said, Higley reminded that the calculators serve as a guide; providers will still need to study the
results.
“The calculators are not customized for your business and do not include considerations of your partic-
ular business operations, and are not intended, nor should be construed to be legal advice,” he said. “We recommend you consider your own business operations when using the calculators.”
A statement from AAHomecare echoed that recommendation: “These calculators are intended to be a starting point for suppliers to see how a bid for the lead item in a product category impacts all the resulting bids for the other items in the product category,” the statement read. “The bid calculators are designed for an individual business to use; they are not pre-populated with possible bids. AAHomecare recommends that suppliers fully consider all direct and indirect costs and profit margins when trying out and evaluating the results of the bid calculators.”
Brummett and the AAHomecare team are working to further enhance to the calculators, including a feature to highlight which non-lead HCPCS codes were responsible for the highest overall spend in catego- ries based on 2017 information from CMS. This will help providers focus on the HCPCS codes in a category that could potentially impact the bottom line the most.
12 HMEBusiness | May 2019 | hme-business.com
Management Solutions | Technology | Products
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status to determine if they are commonly owned or commonly controlled, and to understand the bidding guidelines related to those classifications.
CBIC outlined the two types:
• Commonly owned suppliers are those where one or more of them has an ownership interest of at least five percent in the other. CMS defines “owner- ship interest” as “the possession of equity in the capital, stock, or profits of another supplier.”
• Commonly controlled suppliers are those where one or more of a supplier’s owners are also an officer, director, or partner of another supplier.
Commonly owned and commonly controlled suppliers cannot compete against themselves when submitting bids in the same competitive bidding area (CBA) and product category combination.
When registration opens, commonly owned and commonly controlled suppliers must register one time with one Provider Transaction Access Number (PTAN), which is their primary location in the DMEPOS Bidding System (DBidS).
When the bid window opens, commonly owned and commonly controlled suppliers must submit one bid that includes all commonly owned or commonly controlled locations that would furnish the lead item and all non-lead items in
the same competition.
The legal business name (LBN) for the primary location will auto-populate in DBidS, on the Business Organization section of Form A. This LBN must be the same LBN on any bid surety bonds. If awarded
a contract, the Centers for Medicare & Medicaid Services (CMS) will contract with the legal business entity identified by the LBN for the primary location.
CBIC stressed that commonly owned and commonly controlled supplier organizations that submit separate bids for the same competition will have their bids for the competition disqualified.
Providers must maintain accurate information on their CMS-855S with the NSC and in PECOS. CBIC told providers that they should:
• Review their current Medicare enrollment record on the Provider Enrollment, Chain, and Ownership System (PECOS) for ownership interest or managing control information.
• Complete the appropriate sections of the CMS-855S enrollment application to update any information under their current Medicare supplier billing number, if applicable.
Providers needing assistance on the CMS-855S enrollment application should visit the National Supplier Clearinghouse (NSC; palmettogba.com/ NSC) website or call the NSC at (866) 238-9652.
he Competitive Bidding Implementation Contractor (CBIC; dmecompetitivebid.com) is calling on providers to review their enrollment