decisionhealth Newsletters, Coder Pink Sheets - 2008 Issue 7 (July)
DMEPOS: Physicians can opt out of competitive bidding: Here’s how
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Article Overview
This article explains a Medicare update affecting physician and practitioner offices that furnish durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). It focuses on competitive bidding participation, special billing conditions tied to Medicare claims, the new KV modifier, affected item categories, geographic rollout of bidding areas, and supplier accreditation timing. The piece is relevant to orthopedic practices, other office-based suppliers, billing staff, and compliance teams monitoring CMS policy changes.
Why This Topic Matters
Practices that furnish DMEPOS need to understand how Medicare’s competitive bidding program changes billing and accreditation requirements so claims are not denied and office workflows remain compliant.
Article Sections
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Overview of the CMS transmittal and DMEPOS billing update
Introduces the Medicare policy update and explains that it affects office-based furnishing of DMEPOS items. It also identifies the CMS transmittal referenced in the article.
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Conditions for furnishing DMEPOS in a physician office
Summarizes the general circumstances under which physician and treating practitioner offices may continue supplying DMEPOS within a competitive bidding environment. The section covers the broad claim submission and service-timing requirements discussed in the article.
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Claim submission rules for traveling beneficiaries and competitive bidding areas
Addresses how the policy applies when patients come from different geographic areas and when suppliers are located outside a competitive bidding area. It explains that the guidance still matters beyond the local bidding market.
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Items included in and excluded from competitive bidding
Describes the broad categories of DMEPOS items referenced as part of the competitive bidding program and the categories that are excluded by law. This section helps readers understand the scope of the program without detailing item-level instructions.
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Initial competitive bidding rollout locations
Lists the metropolitan areas identified in the article where Medicare DMEPOS competitive bidding began on the stated effective date. It also notes that additional cities were scheduled to follow.
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Accreditation update for DMEPOS suppliers
Explains the article’s update on supplier accreditation timing and how it affects DMEPOS providers. The section also notes the CMS announcement referenced in the article.
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Official resources
Provides links to CMS source material and related program information mentioned in the article.
What You Will Learn
- How Medicare DMEPOS competitive bidding affects physician offices
- What broad claim and documentation topics are addressed in the update
- How the policy relates to beneficiaries from competitive bidding areas
- Which general categories of DMEPOS items are part of or excluded from the program
- What the article says about supplier accreditation timing and CMS resources
Who Should Read This
- Physicians and treating practitioners
- Orthopedic practices
- DMEPOS suppliers
- Medical billing and coding staff
- Healthcare compliance teams
Modifiers Discussed
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