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Preparing for the Expansion of the Competitive Bidding Program to Rural America in 2016
Presenter: Mark Higley, VGM Group, Inc.
Presentation Locations: Atlanta, Philadelphia, Las Vegas, Chicago, Nashville, Portland
Presentation Overview:
Unless mitigated by last minute legislation, HME providers throughout the entire United States must be aware of and prepare for substantial medicare Reimbursement cuts next year. In November 2014, CMS issued Final Rule 1614-F, which contains provisions to roll out competitive bid pricing in non-bid areas. While providers in these areas will not be required to submit bids, CMS will use single payment amounts (SPAs) from other nearby CBAs to set the rates for these non-bid areas, including rural areas.
Mark will clarify the new reimbursement methodology, which utilizes "regional single payment amounts" (RSPAs) among eight U.S. regions. The RSPA will be calculated using the average of current payment amounts for bid items in CBAs that are located in each region. There is an adjustment for "rural areas"; Mark will provide estimates of both the RSPA and rural reimbursement amounts applicable to each region, as well as the phase-in timeline.
In addition, to wrap up this session, Mark will examine and evaluate the likely onset of "bundling" for CPAP and power wheelchairs in 2017. Twelve markets will be affected, and the demonstration may be an indication of future programs that may or may not replace the current bidding system.
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