Pay attention to bid calculators, say poll respondents

Friday, April 12, 2019

YARMOUTH, Maine – Nearly 80% of the respondents to a recent HME Newspoll say they have used or plan to use new bid calculators developed by industry stakeholders to help them formulate their bids for Round 2021.

That’s encouraging, as stakeholders like AAHomecare and VGM Group developed the bid calculators to help providers navigate lead-item pricing, which will make its debut in the next round of Medicare’s competitive bidding program.

“It appears CMS is attempting to confuse the industry, so that providers will underbid so as to not be left out of this round,” wrote a respondent, one of the 45% of respondents who haven’t used the calculators yet but who plan to. “The current bidding calculators seem accurate, but lead-item pricing I believe will play into CMS’s plan to reduce pricing and provider numbers again. What happened to being paid a fair price for a needed service?”

To use the calculator, providers select their competitive bid area and the lead item to get the “bid ceiling” for that item. Then they enter their bid price for the lead item to get the prices for the non-lead items. The calculator also provides the percentage and dollar change from the submitted bid to the average 2019 fee schedule amounts for all items.

When stakeholders debuted their calculators on in late March, they advised providers to take note of how their bids for lead items affected the amounts for non-lead items. Providers must bid significantly higher than the current amounts for the lead item to avoid a domino effect of significant decreases for non-lead items.

“We will be careful to evaluate the entire category to ensure that we understand the financial ramifications,” wrote a respondent, one of the 34% of respondents who have used the calculators. “(Lead-item pricing) was intended to be easier, but in reality, it might be just as complicated if not more for providers. We’re also trying to digest how to handle lead items that are rentals.”

Twenty one percent of respondents say they haven’t used the calculators and didn’t say that they plan to, to which one respondent reacted: “Pay attention people!”