News & Announcements

  • Medicare 2011 DME Changes

    Post Date: Tue 1/4/2011

    From: The Trials & Tribulations of Being a Type 1 Diabetic

    In case you are not aware, beginning January 1st, Medicare begins its Competitive Bidding Program. This program will take effect in 9 areas of the country and puts forth new rules about getting durable medical equipment, prosthetics, orthotics and certain supplies (which includes test strips). If you don’t live in one of the 9 areas but travel to one of those areas, you will need to follow the rules in order to get your supplies covered while you are away from home.

    The areas included are North Carolina, South Carolina, Ohio, Kentucky, Indiana, Texas, Missouri, Kansas, Florida, Pennsylvania and California. Now I know that I listed 11 states and said 9 areas – that is government math for you! They have Cincinnati, Oh grouped with areas in Kentucky and Indiana so those three are considered one area, but the Cleveland area is listed as a separate group. It is not necessarily the whole state that will be affected. They have Pittsburgh listed but not Philadelphia. I live a couple hours from Pittsburgh and will not be in the changes for this year. The best thing to do is click on the link below if you are in one of the states I listed and enter your zip code to see if you are part of the 2011 change.

    http://www.medicare.gov/Supplier/static/SupportTab.asp?activeTab=3&language=English&subTab=1&viewtype=

    Medicare has updated some of the requirements for suppliers to participate in the program. From what I understand, most suppliers that you are currently using will be in the new program although some will not be.

    If you are renting durable medical equipment (like oxygen), you should check to make sure that provider is still a Medicare provider. You may be able to continue renting your equipment from that provider if the provider chooses to be grandfathered in. However, the supplier may choose not to be grandfathered in and you will need to change suppliers.

    To see if your supplier is on the new supplier listing, you can check the link below or just go to www.medicare.gov and you will see it at the bottom of the page under “Resource Locator.” Please note that just because your supplier comes up does not mean that they are one of the Medicare suppliers – the Medicare suppliers have a little green “p” next to the supplier name. You can still get stuff from a supplier that is not a preferred supplier, but if they charge $100 and Medicare allows $40, you would be responsible for the $60. With a preferred provider, the supplier has to accept what Medicare pays. You will still be responsible for any co-pays and deductible amounts.

    Here is the supplier directory link:

    http://www.medicare.gov/Supplier/Include/DataSection/Questions/SearchCriteria.asp?version=default&browser=IE%7C7%7CWinXP&language=English&defaultstatus=0&pagelist=Home&CookiesEnabledStatus=True

    There is a big concern about this program is – it is called the competitive bidding program. That means that suppliers put in bids to be able to sell products and the lowest bidders will be able to sell those products. The supplier will get paid a fixed fee for the product, regardless of what brand it is. There has been a lot of discussion over concerns that suppliers will only carry inferior products because they won’t make money on selling better quality products.

    On American Diabetes Wholesale, a box of 50 Aviva test strips is $25.99 per box. A box of Advocate test strips is $15.99 per box. Now if I am a supplier selling test strips and I am going to get paid $25 or even $30 no matter what brand of test strips I send to you, which ones do you think that supplier will send? Many of us have pumps that use certain brand strips and most of those strips are the more expensive ones. The fear is that the suppliers will only offer the cheaper brands and you will not have the option of finding those brands at another supplier.

    I know when I tired the Wavesense Presto, I was very disappointed in it. The Presto was running 20-30 points higher for me. I even tested it at the lab and was 84 per the lab and 110 per the Presto – a little too far off for me. I prefer to hang out in the 70s and 80s and I need a meter that is accurate. Other people love the Presto meter, but it was not accurate for me. This meter conversation came up on TuDiabetes one day and one of the women said that one meter ran high for her, but it read fine for her husband. I do believe that there is something in our makeup that can throw different meters off for us that might work for someone else.

    When my foot wound was first starting to heal, I had to start the process to get orthotics. I was still doing HBO at the time, so the wound center made arrangements with a Pittsburgh supplier to come to the wound center and take care of everything for me. That first pair lasted about a year and when I went to get another pair, I used a local supplier. Less than 3 months after I got them, they started to fall apart. When I showed my doctor, he of course said that they should not be doing that. I went back to the supplier and all they did was glue them and that did not even hold a week. While I was there, some guy came in that had bought some diabetic shoes from them and his shoes were also falling apart. I guess they just carried crappy stuff. I started using a place in Pittsburgh for my orthotics. Orthotics are considered DME and part of the competitive bidding program.

    I understand that Medicare has to cut costs. I also understand that there is a lot of fraud that needs to be taken care of. I am just not sure that how they are going about it is the right way!

    Link: http://kellywpa.wordpress.com/2011/01/04/more-information-on-the-medicare-competitive-bidding-program/

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