What is Competitive Bidding and What Does it Mean for Me?
On October 27 of this year, the Centers for Medicare & Medicaid Services (CMS) announced the single payment amounts (SPAs) for the Off-The-Shelf (OTS) Back Braces and OTS Knee Braces product categories included in Round 2021 of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) and began awarding contracts in certain competitive bidding areas (CBAs).
If you do not know if you are located within a competitive bidding area, you may check your location here.
If you are not located within a competitive bidding area, it’s business as usual for at least the coming year…
If you are located within a CBA, certain areas have faced more significant reductions in reimbursement than others, in many localities the reduction for OTS bracing is so small that you may not need to change anything at this time. You may find a complete listing of the allowable fee schedule in your area here.
While CMS postponed the CBP for 13 categories of Home Medical Equipment (HME) due to the COVID-19 global pandemic, unfortunately, back braces and knee braces where not included in the 2021 implementation extension.
So, if you did not submit a bid and you are located within a competitive bidding area that has a significant fee schedule reduction what do you do now?
Adapting to Survive Competitive Bidding
If you are in a CB area but did not win a bid, you can still bill for single-hinge unloading knee bracing, however the brace must be “custom fit” to the patient and billed using the semi-custom HCPCS code L1843, not the Off-The-Shelf code of L1851.
Not all knee braces are approved by Palmetto GBA, the PDAC-Medicare Contractor for Pricing, Data Analysis and Coding of HCPCS Level II DMEPOS Codes, for the semi-custom HCPCS code of L1843. Thankfully, the IPS OAide-3000™ unloading knee brace is PDAC approved as BOTH L1851 and L1843, so you may bill this brace to CMS and its contractors as either an OTS or semi-custom brace! To order the IPS OAide-3000™ you may download and return the attached order form by clicking here, or online at: https://integrativepracticesolutions.com/dme/
However, if you do choose to bill the brace as a semi-custom fitment you must have a “fitting note” to document how the brace was customized to the patient, and why it was necessary to do so. To assist you in this process we have created a simple to use, complete with illustrated pictures, DME Fitting Note which you can access by request via email at: firstname.lastname@example.org
If you need a refresher course in how to apply the OAide-3000™ brace to your patients, you may find a helpful instructional video on how to fit the brace here:
Should you have any additional questions or concerns about how to adjust your standard operating procedures to comply with the upcoming competitive bidding system changes please feel free to contact us at:
Integrative Practice Solutions
Phone: (855) 854-6332
Fax: (727) 683-9536
About the Author: Lance Liberti is a nationally recognized healthcare consultant and new patient marketing professional with more than a decade of practical experience in the field. His experience spans multiple areas of practice including non-surgical spinal decompression, medically supervised weight loss, aesthetic medicine, and non-operative extremity pain management. The president and CEO of Integrative Practice Solutions, Inc. Mr. Liberti specializes in assisting health and wellness professionals integrate boutique medical services into their practices to offer non-surgical solutions to those suffering from various degenerative musculoskeletal conditions. To learn more about Mr. Liberti’s extensive experience and see examples of his work products view his LinkedIn profile here: https://www.linkedin.com/in/lanceliberti
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