decisionhealth Newsletters, Coder Pink Sheets - 2016 Issue 1 (January)
Practice management: New DMEPOS fee schedule has some steep price cuts for your patients
Subscribe or sign in to view the full article.
Article Overview
This article explains recent CMS changes to the durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) fee schedule and the broader competitive bidding framework that drove the updates. It is aimed at providers, practice managers, and suppliers who need to understand how the new pricing environment may affect patient affordability, supplier participation, and access issues across urban and rural markets. The article also places the fee schedule changes in a policy context by discussing Medicare spending, supplier concerns, and a related legislative response.
Why This Topic Matters
DMEPOS pricing affects patient cost-sharing, supplier viability, and access to commonly used equipment. Understanding the fee schedule update helps practices anticipate operational and patient-access impacts.
Article Sections
-
CMS fee schedule update and competitive bidding background
Introduces the CMS changes to the DMEPOS fee schedule and summarizes the competitive bidding program that led to the pricing adjustments. Also notes the transition to broader pricing updates across geographic areas.
-
Examples of price changes
Highlights selected DMEPOS items used to illustrate the size of the new price adjustments. The section focuses on the general effect of the updated rates in different market areas.
-
Budget and patient impact
Discusses expected implications for Medicare spending and patient out-of-pocket costs. The section frames the updates as part of broader cost and access considerations.
-
Supplier impact and access concerns
Covers supplier concerns about lower reimbursement levels, competitive bidding participation, and possible distribution challenges. It also addresses the potential effect on beneficiary access, especially in less densely populated areas.
-
Legislative and policy response
Summarizes a congressional response and related advocacy efforts tied to DME access and pricing. The section places the CMS changes within a wider policy discussion.
-
Physician-supplied DME and practice management concerns
Notes that some equipment categories are not affected in the same way and discusses lingering administrative and workflow burdens for physician practices. The section focuses on operational concerns rather than pricing alone.
What You Will Learn
- How CMS’s updated DMEPOS fee schedule fits within the competitive bidding program
- Which broad categories of stakeholders are affected by the pricing changes
- Why the update may influence patient affordability and supplier participation
- What policy and operational concerns are raised alongside the fee schedule changes
Who Should Read This
- Physicians
- Practice managers
- DMEPOS suppliers
- Billing and reimbursement staff
- Health care administrators
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com