Round 2021 & COVID-19: Not a good time to limit access, AOPA says

WASHINGTON - The single payment amounts for off-the-shelf knee and back braces under Round 2021 of competitive bidding will be about 30% to 35%, on average, below Medicare's current fee schedule, based on a preliminary analysis by the American Orthotic & Prosthetic Association.

The reductions aren't necessarily a surprise, stakeholders say, but they have new meaning during a public health emergency.

“The COVID environment business conditions are not anything like what they were when bids were submitted in good faith,” said Joe McTernan, director of coding and reimbursement services, education and programming for the American Orthotic & Prosthetic Association. “We are in the middle of a pandemic so there's already concerns about access. To now significantly limit access to only a select group of providers is a concern.”

CMS announced in late October the single payment amounts for braces in 127 CBAs, a move that the agency expects to save $600 million for the Medicare program and beneficiaries over the three-year contract period. It has now begun the contracting process and expects to name contract suppliers sometime this fall.

One thing that did surprise stakeholders: One of the three CBAs that CMS dropped from Round 2021 was Miami-Fort Lauderdale-West Palm Beach, Fla.—a region that has been fertile ground for DME fraud, McTernan says.

“You would think that would be an area they would be interested in restricting access to these products (by offering contracts) to only truly qualified providers,” he said.

AOPA will continue to express its concerns to CMS, but it's also working other angles, like building support for the Medicare O&P Patient Centered Care Act. The act includes a provision that would preserve patient access to OTS orthoses provided by certified and/or licensed orthotists and prosthetists by creating an exemption from the requirement to have a competitive bidding contract, similar to physicians and other health care professionals.?

“It would eliminate that need to compete and be awarded bids, but our language does not expect reimbursement at the full fee-for-service rate,” McTernan said.