Medicare replacement schedule

[chunkyfrog]

So documentation will be required:
What kind? Macro images of your nose blisters? Video of the 50 db face farts?

[rcooper]

My supplier just called to let me know that the mask I ordered can't be replaced unless the one I have is leaking, regardless of age. Used to be 1 per 3 mos. Mask straps now 1 per 6 mos, but only if replacement needed. Filters can't be replaced unless you have no open packages left

Can you even begin to imagine how much cost this kind of addle-brained government interference adds to the supplier, which has to be passed on to us?

[chunkyfrog]

Of course, if you have a brick, there is no way to document leaks--they are not recorded!
Just tell them it leaks --really bad, wakes the neighbors, scares the cat, sets off the car alarm.
They have to take your word for it.

[mcdover]

My supplier just called to let me know that the mask I ordered can't be replaced unless the one I have is leaking, regardless of age. Used to be 1 per 3 mos. Mask straps now 1 per 6 mos, but only if replacement needed. Filters can't be replaced unless you have no open packages left

Can you even begin to imagine how much cost this kind of addle-brained government interference adds to the supplier, which has to be passed on to us?

Your supplier is 100% correct. Medicare made a rule change that basically states that supplies cannot be replaced unless they no longer function correctly. The new rule is extremely ambiguous as CMS gives no guidelines on what constitutes this. Gone are the days where your current mask is a year old and you just call up your DME and they send you one. I'm sure there are DMEs out there that are willing to, but they are playing with fire.

As far as adding costs to the supplier, you are 100% correct, but you are wrong about passing those costs to the consumer. CMS sets the pricing, so nothing can be added. I'm afraid that the day is coming soon, that Medicare insurance will not be widely accepted as it is now, and the suppliers that do take it, will only offer the cheapest products made.

[jencat824]

My hubby's DME said today after next month no DME In this area can accept 'straight medicare', those will have to get from a DME in California. I live in Indiana, just across the river from Kentucky! I think this had something to do with the provider bid?

Anyone heard this strange rumor? McDover any input?

Jen

[chunkyfrog]

Click on the link in my signature; and type in your Zip code, enter.
then select CPAP, RAD's, etc. and enter again.
The list that comes up will be all suppliers in a 10-mile radius who accept Medicare.
You can change the area in the box on the right to get more choices.
Look for the green "P" to indicate those who have agreed to accept Medicare allowed amount as full payment.
(You pay 20%, while Medicare pays 80%--after your part B deductible, of course!)
The data may not be fully up-to-date, so you need to call to verify if a business is a provider or a "preferred" provider.
Sadly, if you are in the DMEPOS areas, you are pretty much bent over a stump.

[mcdover]

My hubby's DME said today after next month no DME In this area can accept 'straight medicare', those will have to get from a DME in California. I live in Indiana, just across the river from Kentucky! I think this had something to do with the provider bid?

Anyone heard this strange rumor? McDover any input?

Jen

What they are talking about is competitive bidding. You must live in an area affected by this. In a nutshell, effective July 1st Medicare beneficiaries must get their medical equipment from a contracted, winning bid DME provider. If your current DME did not win a contract, you have to find one that did. I seriously doubt you will have to use a company that's across the country, lots of companies got contracts. Sad thing is, most of them are the ones that people complain about the most.

[LSAT]

Is this another 'benefit' of Obamacare?

[idamtnboy]

Is this another 'benefit' of Obamacare?

Nope. Goes back to W's reign 10 years ago. ACA did mandate the process be sped up some.

Here's some background info from CMS.gov. http://www.cms.gov/Medicare/Medicare-Fe ... titivebid/

PROGRAM OVERVIEW

Section 302 of the Medicare Modernization Act of 2003 (MMA) established requirements for a new Competitive Bidding Program for certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS). Under the program, DMEPOS suppliers compete to become Medicare contract suppliers by submitting bids to furnish certain items in competitive bidding areas, and the Centers for Medicare & Medicaid Services (CMS) awards contracts to enough suppliers to meet beneficiary demand for the bid items. The new, lower payment amounts resulting from the competition replace the Medicare DMEPOS fee schedule amounts for the bid items in these areas. All contract suppliers must comply with Medicare enrollment rules, be licensed and accredited, and meet financial standards. The program sets more appropriate payment amounts for DMEPOS items while ensuring continued access to quality items and services, which will result in reduced beneficiary out-of-pocket expenses and savings to taxpayers and the Medicare program.

Under the MMA, the DMEPOS Competitive Bidding Program was to be phased in so that competition under the program would first occur in 10 areas in 2007. As required by law, CMS conducted the Round One competition in 10 areas and for 10 DMEPOS product categories, and successfully implemented the program on July 1, 2008, for two weeks before the contracts were terminated by subsequent law.

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) temporarily delayed the program in 2008, terminated the Round One contracts that were in effect, and made other limited changes. As required by MIPPA, CMS conducted the supplier competition again in 2009, referring to it as the Round One Rebid. On January 1, 2011, CMS launched the first phase of Medicare's competitive bidding program in nine different areas of the country for nine product categories.

MIPPA also required the competition for Round Two to occur in 2011 in 70 additional metropolitan statistical areas (MSAs) and authorizes competition for national mail order items and services after 2010. The Affordable Care Act of 2010 expanded the number of Round Two MSAs from 70 to 91 areas and mandates that all areas of the country are subject either to DMEPOS competitive bidding or payment rate adjustments using competitively bid rates by 2016.

CMS is required by law to recompete contracts for the DMEPOS Competitive Bidding Program at least once every three years. The Round One Rebid contract period for all product categories except mail-order diabetic supplies expires on December 31, 2013. CMS is conducting the Round One Recompete in the same competitive bidding areas as the Round One Rebid.

[MagsterMile]

Chunky Frog; thanks for the tip and link to finding the closest supplies too me. I see one is 2 1/2 miles away and another is 3 1/2 miles away. My normal supplier is > 10 miles away so they aren't listed as a supplier. If I find out that the one >10 miles away is an approved supplier, can I still go there anyway. As much as I complain about her I really like her and think she cares about her patients. I hate to lose that relationship and break a new person in.

[chunkyfrog]

Just be sure to call and verify whatever you find on the site.
They seem to be a bit lax in updating the list.

[MagsterMile]

ChunkyFrog: Me again....I will call them. can you let me know where to find info. on E0471 (VPAP) rental item? I don't think it's capped but I'm not sure. Thankx Also, just found out my DME didn't pass the bid. If my E0471 is not capped, maybe I won't have to change suppliers?

[chunkyfrog]

I don't know about that item, but I'm pretty sure it's capped on Medicare.
It is a couple steps up from plain Jane cpap.
One other thing, your current supplier may be "grandfathered in" (just for you), since they are already serving you.
Check on that. I saw something to that effect in the Social Security Q&A.

[CPAPsupplierinPhilly]

If your current supplier did not win a bid for CPAP underTraditional Medicare, they can still be your supplier as long as there are open rental months
on your CPAP (up to month 13). Your may also receive supplies from the "grandfathered" supplier until all rentals are billed. Once the 13th billing is paid,
the Unit is yours but you must find a contracted supplier for future supplies.

The expected start date for the new program is July 1, 2013. However CMS has reduced the number of suppliers versus round one and Congress is getting nervous
that there will be supply shortages and delays in getting equipment to patients and may push this date back. Also, many of the supply winners are small companies who do not have the purchasing
power to increase their credit line with manufacturers/whoesaleres who, in turn, are concerned that the reduced reimbursements will make the suppliers credit risks.

[squid13]

How are we suppose to know weather my supplier won or lost. If they lost then I have to go with who ever won if I'm on Medicare, is that right.?