Medicare’s Competitive Bidding Program
The Centers for Medicare and Medicaid Services (CMS, or “Medicare”) Competitive Bidding applies only to patients who have traditional fee-for-service Medicare Part B.
This program requires your Durable Medical Equipment, Prosthetics/Orthotics and Supplies (DMEPOS) providers to bid on the right to serve patients within certain Competitive Bidding Areas (CBAs) across the United States. Only qualified DMEPOS providers meeting certain CMS criteria may become Medicare contracted providers.
We are pleased to announce that Apria is a contracted Medicare provider for Oxygen and Continuous Positive Airway Pressure (PAP)/Respiratory Assist Devices (RADs) and Negative Pressure Wound Therapy (NPWT) in most Competitive Bidding Areas.
Frequently Asked Questions
What is Medicare Competitive Bidding?
Competitive Bidding is a program that was mandated by Congress requiring Medicare to solicit bids from durable medical equipment suppliers who would like to provide items and services to traditional fee-for-service Medicare Part B beneficiaries within certain geographic areas for certain products.
Medicare uses the bids to select “Contract Suppliers” and determine reimbursement amounts. Suppliers who are awarded contracts offer the most competitive price, meet eligibility, quality, and financial standards and are accredited by an independent organization.
Under Competitive Bidding, beneficiaries who reside in or travel to Competitive Bidding Areas (or CBAs) must obtain their equipment from contracted providers.
The program aims to lower the cost of Medicare expenditures and patient out-of-pocket expenses by reducing reimbursement rates for DMEPOS items in specific product categories.
Only contracted suppliers are allowed to provide a Competitive Bid product or service to Medicare beneficiaries residing in a Competitive Bidding Area. In addition, unless an exception applies (see Grandfathered Products), only contracted suppliers will receive payment from Medicare for that item.
How does Medicare’s Competitive Bidding Program affect my Medicare-covered products and services?
If you reside in a Competitive Bidding Area, your choice of providers for certain home healthcare products – including Oxygen equipment and supplies, Continuous Positive Airway Pressure (CPAP)/Respiratory Assist Devices (RADs) and supplies, and Negative Pressure Wound Therapy pumps and supplies – may be more limited than in the past.
Only those providers who have a formal contract with the government (Medicare) will be permitted to provide those lines of equipment and services to traditional fee-for-service Medicare Part B patients.
The company providing your equipment may change, but you will continue to have access to the homecare products you need.
Apria is prepared to serve new Medicare patients who need the services we are contracted for and will continue caring for patients who are already on service with us for these and other non-bid services/products.
What is a Competitive Bidding Area (CBA)?
A CBA is a ZIP Code-defined geographic area subject to competitive bidding. A state may have multiple CBAs.
To access maps of each state’s bidding areas (CBAs), please refer to the Medicare DMEPOS Competitive Bid web site at http://www.dmecompetitivebid.com.
You will see the name(s) of the CBA(s) in the state and a link to a map of each CBA and the ZIP codes included in that CBA. The same web site also allows you to identify a CBA
by zip code. Select “FIND A CBA” from the menu bar located at the top of the page. A popup window will appear. Enter the zip code and then click the OK button to view the corresponding CBA.
When did Competitive Bidding take effect?
The Medicare Competitive Bid Program has been in effect since 2011. It began in 9 areas of the country, expanded to over 100 areas in 2013 and to 130 areas in 2016.
What is the definition of a “contracted provider”?
A provider that was awarded a contract by Medicare to furnish competitively bid items, such as oxygen, CPAP, etc. in a Competitive Bidding Area (CBA).
What is a “non-contracted provider”?
A provider that is not contracted by Medicare to furnish competitively bid items in a specific Competitive Bidding Area (CBA).
Therefore, if you reside in a Competitive Bidding Area, your choice of homecare providers may be more limited when it comes to certain products, including Oxygen supplies and equipment, CPAP/RAD devices, supplies and accessories, and Negative Pressure Wound Therapy pumps and supplies.
Only those providers who have a formal contract with the government will be permitted to provide those lines of equipment and services to you as a Medicare patient (except for grandfathered items).
What does grandfathering mean?
Under the Competitive Bidding “grandfathering” provision, a non-contracted provider may continue to service existing patients with rental equipment for the remainder of the rental period.
Essential supplies used with the rental equipment (e.g., CPAP masks) will also be grandfathered during the rental period. Upon conclusion of the rental period, grandfathered patients must transition to a contracted provider to obtain their supplies.
How does grandfathering affect CPAP supplies?
If a patient is receiving CPAP supplies in conjunction with grandfathered CPAP rental equipment, the patient will need to change to a contracted provider to obtain his/her CPAP supplies when the rental equipment converts to sale after 13 months.
Is Apria a contracted provider for walkers, wheelchairs or hospital beds?
No, Apria is not contracted for these products in any Competitive Bidding Areas.
Are respiratory medications used with nebulizers affected by Competitive Bidding?
No, Competitive Bidding does not affect the respiratory medications used with nebulizers. Patients who are currently receiving respiratory medications from the Apria Pharmacy Network can continue to receive these medications from Apria without interruption. Additionally, new patients who would like to begin receiving respiratory medications from Apria, can contact the Apria Pharmacy Network at 800-638-0942.
Can patients receive walkers or wheelchairs from their doctor or hospital?
Medicare allows physicians, treating practitioners and hospitals that are enrolled with Medicare to provide walkers and folding wheelchairs to their own patients without submitting a bid and being selected as a contract supplier. Special billing instructions apply.
Which ZIP Code is used to determine if a patient is subject to Competitive Bidding?
The patient’s servicing address ZIP Code (where the patient will be using the equipment) should be used to determine if a Competitive Bid item needs to be provided by a contracted provider.
Note: The referring physician or hospital address, the consignment closet location (where equipment is provided upon discharge), or the Apria branch location (where the patient can pick up equipment) is not used to determine if an item is subject to Competitive Bidding.
What if patients travel to or from a Competitive Bidding Area?
If a patient requires a competitive bid item while visiting a Competitive Bidding Area, the patient must obtain the item from a contracted provider in the visited area.
The graphic below illustrates the rules for traveling patients under the Competitive Bidding program.