Medicare CPAP reimbursement cut 47% for DMEs

[Pad A Cheek]

Hi all. There is a process that has been in effect for a few years now. It is a government program poised to reduce the Medicare and Medicaid reimbursement (and in some cases fraud )to DMEs for a variety of products. CPAP is one of the products they have targeted. This program is called Competitive Bidding and it is requiring DMEs to bid for the Medicare and Medicaid contracts in targeted areas. Each year more targeted areas are included. This is a complex issue and the DMEs have to jump through a series of hoops to qualify to bid at all.
The DMEs have been fighting for a different form of pricing called Market Pricing Program (MMP) but so far have not been successful.
Yesterday it was announced that the CPAP reimbursement cuts will be substantial for the Single Payment Amount.

Here is the article. http://www.sleepdt.com/cpap-takes-47-me ... ement-cut/

It is worth watching how this unfolds as it may already be affecting many of us on the forum, and will most likely affect us all eventually.

I just wanted to share with those who may be interested.

Karen

[DreamStalker]

I think Den linked to a different story, same topic on another thread.

The writing is clearly on the wall. Medicare and the whole healthcare system is collapsing under the fascist fraud that has sustained it up until now.

[chunkyfrog]

This may pull the local prices in line with those of online suppliers, but another scenario is more likely:
I see the local providers will just cop out of Medicare, and we will ALL buy online--or go without.

[DreamStalker]

This may pull the local prices in line with those of online suppliers, but another scenario is more likely:
I see the local providers will just cop out of Medicare, and we will ALL buy online--or go without.

Indeed.

http://www.forbes.com/sites/brucejapsen ... -medicine/

My PCP became one of the ten about 1.5 years ago.

[xyz]

I just now clicked on the OP's link shown after the words
"Here is the article."

My anti-malware app (Symantec NIS 2012) displayed:
"An intrusion by efebebek.com was blocked.
Web attack: red exploit kit website.
Risk: high"

It is _possible_ that the website that the above post points to (http://www.sleepdt.com) has been compromised and that malware has been installed. Perhaps it is better to avoid that site until it has been checked out.

Or it could be a false positive by my anti-virus.

[chunkyfrog]

I would trust the OP implicitly; but anyone can be fooled.

[xyz]

Technically, this has _nothing to do_ with the OP.
Whether he was "fooled" or not fooled.

It has _everything_ to do with the _website_ that the link points to.

If you understand the the technical issues.

[StuUnderPressure]

I just now clicked on the OP's link shown after the words
"Here is the article."

My anti-malware app (Symantec NIS 2012) displayed:
"An intrusion by efebebek.com was blocked.
Web attack: red exploit kit website.
Risk: high"

It is _possible_ that the website that the above post points to (http://www.sleepdt.com) has been compromised and that malware has been installed. Perhaps it is better to avoid that site until it has been checked out.

Or it could be a false positive by my anti-virus.

My AVG AntiVirus also blocked it.
I won't be clicking on that link again.

[DreamStalker]

Here is the quoted text to Karen's link if you have Windoze and are getting xyz's malware warning (I use linux and did not get any malware warning):

CPAP Takes 47% Medicare Reimbursement Cut

DME providers in 91 major metropolitan areas received unwelcome news this week in the form of a 47% Medicare reimbursement cut to the CPAP single payment amount (SPA). The cut comes courtesy of competitive bidding, a nationwide program mandated by the Medicare Modernization Act of 2007, and administered by CMS.

A full-face mask used with PAP device will now garner a $99 SPA. Click here for the full list of SPAs affecting sleep-related equipment. Click here for the official CMS press release/announcement.

While providers reportedly began receiving competitive bidding contract offers from CMS as early as yesterday (1/31), a full list of contracted suppliers will not be released until spring 2013. New SPAs for CPAP and related accessories will officially go into effect by spring 2013.

By law, CMS can extend competitive bidding rates nationwide, and many advocates expect that to happen. Self dispensing sleep labs, and/or physicians who sell CPAP equipment, are also subject to competitive bidding and its new rate structure.

Home care providers throughout the country swiftly criticized the round two rates. “The sky really is falling,” said Michael Hamilon, executive director, Alabama Durable Medical Equipment Association. “Those rates are unsustainable, and most of the equipment can only be provided by buying the cheapest piece of junk on the market and offering really poor service.”

“The existing program is not fair to the millions of patients who depend on these services for life itself,” added Joel D. Marx, chairman of AAHomecare, and a DME provider in Cleveland. “They will lose access and quality. They will suffer unfairly due to the tragic misguided implementation of a deeply flawed program.”

DME providers continue to fight competitive bidding in hopes of replacing it with an industry-favored market pricing program (MPP). Advocates at the American Association for Homecare plan to push the replacement measure as part of a debt ceiling package that Congress will discuss in May.

On the same day as CMS released the new SPAs, the American Academy of Sleep Medicine publicized a new “spring course” that offered clinical and practical guidelines for providing DME. The course is aimed at physicians and support staff. “As long as they need to go through the same competitive bidding program as the HME industry is currently going through,” said Helen Kent, RRT, CEO of Progressive Medial, Carlsbad, Calif, “I say go for it.”

As for the new competitive bidding rates, Kent shares the frustration of many providers. “With a cut of 47% to CPAP/Bi-Level, I can’t even afford to grandfather in the Medicare patients that I am currently servicing,” she said. “Looks like CMS will be able to get rid of lots of mom and pops in this industry. Who is next?”

[Pad A Cheek]

Thank you Dreamstalker,

I probably should have done it that way originally. I appreciate the assistance.

Karen

[jnk]

In an attempt to put an end to the bad DMEs who used to take advantage of everyone, policy is now being implemented that is sure to keep any good DMEs from being able to afford to deal with the very patients who need their help the most.

Yep.

That kinda thing almost makes sense to a lot of the people who work in gov'ment.

[DreamStalker]

In an attempt to put an end to the bad DMEs who used to take advantage of everyone, policy is now being implemented that is sure to keep any good DMEs from being able to afford to deal with the very patients who need their help the most.

Yep.

That kinda thing almost makes sense to a lot of the people who work in gov'ment.

It's just a part of the systemic collapse ... just as Orlov predicted.

All rebirths require the death of the previous age. But you already know that cuz you got a book that tells you all about it.

[needingu]

Padacheek.
I guess we make the equipment last as long a possible

[RogerSC]

Well, could be they're making up for it in volume. Just got 5 nasal pillows and 10 filters, plus a climateline hose and a mask from my DME on Medicare with supplement. So what they're losing on each one they're making up for in volume *smile*?

[jnk]

. . . all about it.

Except the day and hour.