Competitive Bidding Durable Medical Equipment Prosthetics,

100 - Competitive Bidding Durable Medical Equipment Prosthetics, Orthotics and Supplies (DMEPOS) Single Payment Amounts (Rev. 2682, Issued: 04-05-13, Effective: 07-01-13, Implementation: 07-01-13) Section 1847 (b)(5) of the Social Security Act mandates that a single payment amount be established for each item in each competitive bid area based on the bids submitted and accepted for that item. Section 1847(a)(6) of the Act requires that this payment basis be substituted for the fee schedule payment basis otherwise applied under section 1834(a) of the Act for DME, section 1834(h) of the Act for off-the-shelf orthotics, or section 1842(s) of the Act for enteral nutrients, equipment and supplies, as appropriate. For the Round One Rebid, the DME MACs will make payment based on the new competitive bidding single payment amounts effective for claims with dates of service on or after January 1, 2011. The CMS issues instructions for implementing the single payment amounts and/or updating the payment amounts quarterly for competitive bidding items. The following files will be provided to the DME MACs and the Pricing, Data Analysis and Coding (PDAC) Contractor via CMS’ mainframe telecommunication system in order to implement a competitive bidding round: a Healthcare Common Procedure Coding System (HCPCS) category file, a bid pricing file, a ZIP Code file, and a contract supplier file. All four files will contain data only for the current competitive bidding round. The DME MACs will make manual updates to the competitive bidding files, as instructed through Recurring Update Notifications. The following files will be provided on a quarterly basis to the DME MACs and the Pricing, Data Analysis and Coding (PDAC) Contractor via CMS’ mainframe telecommunication system: HCPCS category file, bid pricing file, and ZIP Code file. These files will only contain the changes for that quarter. Upon successful receipt of the mainframe files, DME MACs will send notification of receipt via e-mail to price_file_receipt@cms.hhs.gov, stating the name of the files received and the entities for which they were received (e.g., DME MAC name). Following program implementation and on an as needed basis, updates to the contract supplier file will be accomplished via an Excel file emailed directly from the Competitive Bidding Implementation Contractor (CBIC) to the DME MACs. Upon successful receipt of the files, the DME MACs will send notification of receipt via email stating the name of the file received and the entities for which they were received (e.g., DME MAC name) to the CBIC. E-mails should be sent to cbic.dmemac@palmettoGBA.com at the CBIC. The DME MACs shall manually update the contract supplier file with the changes by adding and/or end dating each supplier record. Public use files containing the competitive bidding HCPCS categories, single payment amounts and ZIP Codes are available on the CBIC Website at http://www.dmecompetitivebid.com/palmetto/cbic.nsf.