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Higley: Round 1 2017 Final Instructions

Registration closes this Friday, November 20, 2015, at 9pm EST

In order to submit a bid for Round 1 2017 of the DMEPOS Competitive Bidding Program, you are required to obtain a user ID and password to access the online DMEPOS bidding system (DBidS). If you haven’t already, you must first register in the Enterprise Identity Management (EIDM) system and then add the DBidS application to your profile. You will not be able to bid if you do not complete registration on time. To register, click here.

Update and maintain your enrollment data

To be awarded a contract, you must meet the applicable enrollment requirements by the close of the bid window – December 16, 2015.  Suppliers must maintain accurate information on their CMS-855S enrollment application with the National Supplier Clearinghouse (NSC) and in the Provider Enrollment, Chain, and Ownership System (PECOS). CMS will validate your bid data against your enrollment record in PECOS during bid evaluation. If it is not current or accurate, your bid(s) may be disqualified.

Get licensed

Supplier locations must be licensed as applicable by the state in which it furnishes, or will furnish, products and services under the DMEPOS Competitive Bidding Program.

Round 1 2017 (Recompete) bid submissions due on December 16

Get your bids completed, approved, and certified in DBidS by 8:59:59 Eastern Time on March 25, 2015. In addition, all hard-copy documents must be RECEIVED by the CBIC on or before December 16, 2015.

In addition to viewing the information on the CBIC website, suppliers are encouraged to call the CBIC customer service center toll-free, at 877-577-5331 between 9 a.m. and 7 p.m. EST Monday through Friday. Hours are extended to 9 p.m. prevailing Eastern Time during the last two weeks of the Round 1 2017 registration and bidding windows.

 

Final Steps Checklist:

  • Complete and approve Form A and certify Form B in DBidS, and send the required package of hardcopy documents in one complete package to the CBIC. Only ONE PACKAGE of hardcopy documents is required for each bidder number, regardless of how many bids (Form Bs) are submitted.
  • To ensure all documents remain together, you must indicate your bidder number on each page of the documents or your bid may not be processed. Packages must include both the required financial and non-financial documents as applicable. Your package of hardcopy documents must be RECEIVED by the CBIC on or before the close of the bid window. Late packages will not be considered, regardless of reason or mode of delivery. In addition, the CBIC will not consider faxed or e-mailed copies of the required documents. Hand-delivered packages to the CBIC document control facility before the close of bidding will be accepted. CMS strongly recommends that you send your package early by a method that can be tracked and that requires a signature upon receipt. You should check with your common carrier or courier to determine the best method of delivery.  Make sure you are submitting ALL of the required documents. See “Required Financial Documents by Business Type Chart” on the RFB link here: http://www.dmecompetitivebid.com/Palmetto/Cbicrd12017.Nsf/files/14_R12017_RFB.pdf/$File/14_R12017_RFB.pdf
  • Packages should be sent to: PALMETTO GBA COMPETITIVE BIDDING IMPLEMENTATION CONTRACTOR 2743 PERIMETER PKWY SUITE 200-400 AUGUSTA, GA 30909-6499 (Visit your DBidS status page often to check the status of your bid and receipt of your package of hardcopy documents. The status page displays receipt of all document(s) that were submitted in a timely fashion. However, it does not confirm the accuracy or completeness of the package.)

After the Bid Window Closes

  • Once the bid window closes, all bids are considered final and cannot be amended. You may continue to view your DBidS status page after the bid window closes to verify whether your bid is complete, approved, and certified by the AO or BAO.
  • Acknowledgement in DBidS of a complete bid does not mean that the bid is accurate or otherwise meets CMS’ criteria. The DBidS status page indicates whether your hardcopy document package was received on time by the CBIC. If your document was received after the bid window closes, DBidS will not acknowledge receipt of the document(s), and the “Hardcopy Document Receipt” indicator will remain “NO.”
  • It is your responsibility to ensure that you have submitted a complete bid along with an entire package of all required hardcopy documents, and that the package is received by the CBIC by the close of the bid window. Late, faxed, or e-mailed packages will not be considered, no matter the reason.
  • After bidding closes, you will be notified that your bid(s) has been preliminarily reviewed and if any competitive bidding or enrollment requirements (active PTAN, licensed, accredited, common ownership/control) were not met by the close of bidding. This evaluation gives you the opportunity to provide information that confirms the location(s) on your bid(s) met the bidding or enrollment requirements on or before the close of the bid window.
  • Authorized official and back-up authorized official(s) will receive an e-mail from the CBIC when this review is complete. You will then be able to go into DBidS to view your results.
  • You may wish to add @palmettogba.com to your e-mail contact list to ensure the CBIC e-mails are not filtered into your spam or junk mail folder. CMS reserves the right to seek clarification or corrections from a bidder if necessary.

Common FAQs

  1. Why does it appear that the Round 1 recompete single payment amounts for CPAP or power wheelchairs are higher than the “bid limit” of the Round 1 2017?

First of all, this cannot be possible. Remember the bid limit is the 2015 Medicare fee schedule. So what are they doing wrong here? Providers are taking 10 times (10X) the RR (rental) payment amount from the current Round 1 recompete. For capped rental items and power wheelchairs (that used to be paid for with a first month purchase option), the CBIC prints the first month payment as the “single payment amount.” That’s the problem here! Suppliers are not paid that amount for the entire period. They are paid 105% of the purchase price of the item whether it is capped rental (e.g., CPAP) or power wheelchairs.

Let’s do the math! Capped rental items (again think CPAP) are paid from the purchase price at 10% for three months and then 10 more months at 75% of that 10% or 7.5%. So if in Round 1 recompete the bid limit for E0601 was $1,100 and bidders bid it down to $700, CBIC would indicate a single payment amount for the first month’s rental of $70. Assuming the CPAP was paid for in 13 months the reimbursements would look like this: ($70 * 3) + (75% of $70 * 10) ($210) + ($525) = $735, or 105% of the bid purchase price.

If you want a short cut, you will note that the government pays you 10.5 times the SPA. Again, the SPA listed in the official bid fee schedule is ONLY the first three month rental amount. But: Group 2 power chairs still get 105% but the ending of the purchase option changed the payment to accelerate reimbursement from other capped rental items. The schedule is 15% for the first three months (instead of 10%). Then the amount reduces to 6% of the purchase price for 10 more months. 15+15+15 = 45% paid in the first three months. (6 * 10 months) or 60% is paid in the next 10 months. Again…105% of the bid purchase amount. It’s the same math, just front-loaded. The SPA in the official site for a $3,000 chair would be $450, which is 15%. Providers who emailed us questions thought the figure to be used would be $450 times 10 ($4,500), and that’s why their numbers were way off when comparing the Round 1 recompete SPA with the Round 1 2017 bid limit.

  1. I can’t find a model number for a HCPC code!

First of all…does the HCPC code require providing the manufacturer, make, and model information (MMM)? Of the literally dozens of calls I’ve received, none of these obscure codes were included in Form B as required MMM input items.

I received this comment from chief CBIC liaison Elaine Hensley:

Thus, if these codes do not require MMM data entered on Form B then they only require bid amounts. Suppliers must bid on all items in the product category and all bid amounts must be bona fide. If they cannot locate a manufacturer via Internet searches or through the various associations, they have the option to bid the fee schedule amount if they cannot develop a rationale to submit a bid below the fee schedule/bid limit.

This means you do NOT have to find a vendor source/model number for most of the codes! With virtually no exceptions, these are obscure codes. Bid the fee schedule and offer 1 (one) unit of capacity!

“But I’ve been told by my company to complete a spreadsheet of all codes with real model numbers just in case we are challenged for a bona-fide bid” Okay, if you really want to search for all possibilities (and you do NOT have to — see above) try this:

  • Go to https://www.dmepdac.com/
  • Click on SEARCH DMECS FOR CODES AND FEES
  • Click the choice of All HCPCS Codes (near the top)
  • Ignore “Keyword” but fill in the code here: HCPCS Code * and click GO
  • See “Click on the code to see code detail” (and do just that)
  • Then, to get a listing of manufacturers/model numbers click on:

Show reviewed products on DMEPOS Product Classification List for this code:

Even some codes from the official DPAC site come up empty — but don’t fret. For example, “Do I need to find the compressed gas oxygen model and there appears to be none for E0424?

(EQUIPMENT: E0424 STATIONARY COMPRESSED GASEOUS OXYGEN SYSTEM, RENTAL; INCLUDES CONTAINER, CONTENTS, REGULATOR, FLOWMETER, HUMIDIFIER, NEBULIZER, CANNULA OR MASK, AND TUBING Correct! The DMEPDAC comes up with none! The CBIC suggests the following:

In this situation where there is no true “manufacturer” of the tanks from whom you are purchasing and/or leasing, I suggest entering the information for the company from whom you receive your gaseous oxygen systems.

Others have successfully in previous rounds entered the component model numbers of this assembly. Hence a model number for a regulator and flowmeter and humidifier et al were entered.

Example:  “What about the HCPCS CodeE0585 NEBULIZER, WITH COMPRESSOR AND HEATER?” Yes, no one offers these. Remember: These obscure codes have little if no impact at all upon your composite bid! Bid one cent less than the Medicare fee schedule (bid limit).  Don’t fret about them.

  1. Explain the composite bid and how your worksheets help me determine which codes “are important.”

First of all click here to read the Round 1 2017 Bid Preparation Worksheet Instructions regarding how to use the worksheets. The Word document is listed under the VGM Fall Seminar Series Reference Material section. You will see the worksheets below this link. There are also many “tools” on this page to assist you with your final bidding. Please review closely!

  • The metropolitan bidding areas in the worksheets are in alphabetical order. Each of the metro areas is identical as to the HCPCS codes within each category. However each metro area is unique with regard to the historical utilization, code weight and bid limit.
  • The bid limits are at the current 2015 fee schedule — and NOT the previous Round 1 recompete single payment amounts! Open a spreadsheet and select a CBA of interest.
  • In the “Your Bid Amount” column (M) there is a “fail-safe” feature: If you include a typo (too common in previous rounds) that is either above the current Bid Limit/Fee Schedule for any HCPC item in any category, or more than 55% below the Bid Limit, it will turn RED. This is not suggesting a bid for any code will be disqualified for being non “bona-fide” but more so to prevent the accidental input of, for example, $1.00 versus $100.
  • Also note the “Undiscounted Composite Bid For Category” amount (in $) under Column L. This is the weight of each item times the current fee schedule/bid limit and then summed. If you wish to achieve a category discount of 30%, you would need to have this undiscounted composite bid amount reduced by 30%. The worksheet allows you to see this “bottom line” as you input your bid amounts. The far right column indicates “how much” each of the product codes will move the composite bid.
  • If the individual code is significant (that is it moves the composite bid more than 5% it is notated in RED). With the exception of the TENS category, most of the codes in the categories are insignificant. Some are less than 1/10th of one percent. A few are even less. Look for the codes in RED first and concentrate on these items. Insignificant codes can generally be discounted at minor amounts (even one cent) without lowering the overall composite bid.
  1. Do you have the previous bid rates from Round 1 recompete and Round 2 available? 

Previous bid rates (“single payment amounts”) from the last two programs are located on my website. I am not suggesting that you emulate the previous amounts (by discount percentage), but it is a common ask. I also want to remind all bidding companies that the worksheets (VGM’s and the official CBIC documents) all include the 2015 upper bid limit. This is “your starting point.” It is the 2015 fee schedule (example: a month of rental oxygen is $180.92). Your starting point is NOT the current payment amount from Round 2 (e.g. $90.00 monthly oxygen). Also — remember the SPAs from previous Rounds are ONLY the first month (of three) rental payments for DME. (Oxygen remains separate as a rental month.) See the above FAQ about how to compare this first month rental amount to the overall purchase (of which you offer a bid).

  1. What do these mean? Are the “allowed units” the rental months?
2014 Beneficiary Count (Number of unique Medicare beneficiaries in the CBA that received the product in CY 2013) 2014 Allowed Units (Number of units for the CBA and HCPCS code paid by Medicare in CY 2013)

The only “allowed units” that are measured in rental months are the oxygen payment classes. Take a look at the official CBIC bid preparation worksheets at www.dmecompetitivebid.com or my worksheets at www.vgmncbservices.com (they are identical). The left column is the “beneficiary count.” Think of this number as the total number of unique patients (measured by Social Security numbers). These patients are all FFS traditional Medicare beneficiaries who have one or more claims to the MACs for monthly oxygen service. So this is the “body count.”

The number of paid months in calendar year 2014 follows to the right. Notice that in virtually every CBA the multiple of months paid compared to the unique patient count is about 7 or 8X. This is because most HMEs do not get reimbursed for a full 12 months. Patients die. Claims are challenged. Or audited. Rule of thumb: Take your traditional Medicare oxygen census and times it by 7. That is your current “capacity.” You do not have to enter it as your bid capacity (and you have heard me orate on this topic below — keep your offered capacity on Form B bid sheet BELOW what you can currently offer…). Oxygen is the only category that “works” like this. All others are “counted in units.” Think setups. If unique patient A receives a hospital bed, as it was approved and delivered and set up and that patient dies in month 2 — this counts as “1 unit.” If the same patient is still at home at the end of the year in that bed it still counts as “1 unit.”

Take a close look at the amount of units in 2013 for your area. It is frequently half of the number of unique patients. Many claims are not paid. So don’t count your patients, look at what was paid. And offer a small percentage of that. For major codes, offer no more than 5% of the category. For codes that have a historical paid utilization of under 100, offer 2. Less than 30? Offer 1. There is no floor or ceiling on capacity offers. You can offer 5% and receive half the business. Keep those capacities low!!

  1. What about the questions that inquire as to whether I can increase my capacity?

These questions, effectively, do not affect your bid. The CBIC asks about units per category (a few high use codes) that you delivered to all patients, and then what percentage of these were delivered to traditional FFS Medicare patients. You can answer thee by estimates. With regard to what increase you could offer by percentage, this is NOT related to your Form B offering by capacity units. You can input 10% and only offer 5%. They are not tied. Also, if you have never supplied the product and or did not have a Round 2 contract, your unit count for Medicare patients would be 5% or 10% of 0 is still zero. The CBIC knows this. Don’t fret. Input 5% and move on.

7. What about if we have last minute questions or problems?

Easy. Email me at mark.higley@vgm.com or text me at 319.504.9515. The CBIC customer service center has a toll-free line at 877-577-5331 between 9 a.m. and 9 p.m. prevailing Eastern Time, Monday through Friday. In any case, I’ll be there up until the bid window closes.

Good luck!!