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Oh, Oh! CMS Cuts CPAP Reimbursement In 9 Competitive Bidding Areas.
Sleep Review e-magazine is full of pertinet xPAP/OSA articles this issue!
CMS Cuts CPAP Reimbursement in Nine Competitive Bidding Areas
CMS announced last week that starting January 1, 2011, its competitive bidding program will cut reimbursement for continuous positive airway pressure (CPAP) devices by, on average, 34%, in nine cities. The cuts mark the first round of Medicare’s competitive bidding program, which will be used to determine the price Medicare pays for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).
The program replaces Medicare’s existing fee schedule amounts with market-based prices.
The first round of cuts will go into effect for beneficiaries in Charlotte, Cincinnati, Cleveland, Dallas, Kansas City, Miami, Orlando, Pittsburgh, and Riverside.
Beneficiaries living in the nine first round communities who use certain medical equipment and supplies may have to choose a new Medicare contract supplier if they want to have Medicare help pay for an item. According to CMS, Medicare will work with local partners and health care providers to inform beneficiaries about the changes.
Currently, CMS is mailing contract offers to winning bidders and expects to complete the contracting process in time to announce the contract suppliers in September. Small suppliers—those with gross revenues of $3.5 million or less—make up about 48% of the suppliers that will be offered contracts.
The competition for round two of the competitive bidding program, which will expand the program to an additional 70 metropolitan statistical areas, will begin in 2011. Additional areas of the country will be added after 2011.
More information on single payment amounts for CPAP can be found .....
Comment on this article at Sleep Review’s Facebook page.
http://www.sleepreviewmag.com/sleep_report%5C2010-07-07_01.asp?frmN...
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Some of the others articles:
PROVENT Therapy Shown to Be Clinically Effective in Treating OSA
Sexsomnia Common in Sleep Center Patients - this one ought to catch a lot of attention!
Probe Shows Suppliers Not Meeting Guidelines for Submitting CPAP Claims
CPAP Therapy Restores Brain Tissue in Adults with Sleep Apnea
Views: 83
Replies to This Discussion
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Permalink Reply by Mike on
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I've been following this story for awhile now, and my first impression is that this won't be good for us patients. it's going to take incentives away from companies to get into the DME business and try to do it right, and favor whomever is able to provide the least common denominator service: i.e., drop-ship a CPAP machine and never hear from them again.
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Permalink Reply by Judy on
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Yep, the minute I read about the initiation of competitive bidding in trial markets I developed a bad, bad feeling about what was going to happen to CPAP patients if CMS followed thru w/actually initiating the trial.
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Permalink Reply by Mary Z on
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On the other hand when we read what insurance actully pays for CPAP supplies that can cost 1/2 the price over the Internet, some competitive bidding might be good. I hope it doesn't turn out to be a bad thing for us. Medical supplies have always had an unnecessarily high markup.
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i too have a bad feeling about this. i hope Mary's right and this will just take trim some of the fat out of the government's health care spending. but i think it will backfire because they probably equate CPAP machine supplies with canes and wheelchairs and other stuff that requires little to no ongoing support.
Mary Z said:On the other hand when we read what insurance actully pays for CPAP supplies that can cost 1/2 the price over the Internet, some competitive bidding might be good. I hope it doesn't turn out to be a bad thing for us. Medical supplies have always had an unnecessarily high markup.
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