We’ve just published our January 2012 issue of Health Care Commentaries. Articles include:

• Executing on your strategic plan
• New Health Care Development Project - Wilmington, Delaware
• DME Suppliers & Medicare Competitive Bidding Financial Requirements
• Adding a New Physician to Your Practice
• Indiana Sales and Use Tax on Medical, Dental and Optical Supplies and Drugs
• American Academy of Orthopaedic Surgeons 2012 Annual Meeting
• 2012 Farm Tax Strategies Seminars
• Welcome Jason Mangus
• Guard Against Fraud: How to Protect Your Organization

Read more…

A ruling clarifies that sales of medical devices to physicians and hospitals for resale to patients are subject to Indiana sales and use tax, unless the physician or hospital issues the seller a resale certificate. A resale is not exempt even if the sale is only allowed by prescription. Medical devices include durable medical equipment, prosthetic devices, artificial limbs and orthopedic devices. Sales of kits containing medical devices, and the instruments and supplies needed to implant the devices, are not taxable retail transactions if (1) the kits are sold for a single price and (2) the purchase price or selling price of the exempt medical items exceeds 50% of the total purchase price or selling price of the kit. When a sale of a medical kit is not a retail transaction, tangible personal property provided in the medical kits may create use tax liability for the manufacturer or distributor.

The Somerset Health Care Team invites you to our next Health Care Roundtable Webinar. Start your new year off with a successful strategic plan! Join our panel discussion and learn:

Please join us and your fellow health care leaders and industry experts via webinar to discuss these important topics that impact your bottom line. Register Now.

If you are a DME supplier preparing to submit a bid for products covered under the competitive bid program, CMS is strongly urging companies to submit accountant-prepared (compiled) financial statements that meet the requirements set for by the qualifying bid guidelines. In Round 1 of the bidding process, many suppliers were disqualified for submitting non-compliant financials.

For help preparing compliant financial statements to ensure you submit a qualified bid, please contact us.

The Centers for Medicare & Medicaid Services (CMS) has announced the bidding timeline for the Round 2 and national mail-order competitions of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program.  There are several deadlines that are fast approaching so if you are a DME provider to Medicare patients and fall within one of the designated Competitive Bid Medical Service Areas, you will need to get registered and prepare your bids pursuant to the timeline below. 

11/30/2011
The Centers for Medicare & Medicaid Services (CMS) announces bidding timeline, begins bidder education program

12/5/2011
Registration for user IDs and passwords begins

12/22/2011
Authorized Officials are strongly encouraged to register no later than this date

1/12/2012
Backup Authorized Officials are strongly encouraged to register no later than this date

1/30/2012*
CMS opens 60-day bid window for Round 2 and National Mail-Order Competitions

2/9/2012
Registration closes

2/29/2012*
Covered Document Review Date for bidders to submit financial documents

3/30/2012*
60-day bid window closes

Fall 2012*
CMS announces single payment amounts, begins contracting process

Spring 2013*
CMS announces contract suppliers, begins contract supplier education campaign

Spring 2013*
CMS begins supplier, referral agent, and beneficiary education campaign

July 1, 2013*
Implementation of Medicare DMEPOS Competitive Bidding Program Round 2 and National Mail-Order Competition contracts and prices

You may find detailed information about the program here: http://dmecompetitivebid.com/palmetto/cbic.nsf/DocsCat/Home

We can help. We welcome your questions or comments posted here or via email.

The DMEPOS Competitive Bidding Program was mandated by Congress through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). The statute requires that Medicare replace the current fee schedule payment methodology for selected Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) items with a competitive bid process. The intent is to improve the effectiveness of the Medicare methodology for setting DMEPOS payment amounts, which will reduce beneficiary out-of-pocket expenses and save the Medicare program money while ensuring beneficiary access to quality items and services.

Under the program, a competition among suppliers who operate in a particular Competitive Bidding Area (CBA) is conducted. Suppliers are required to submit a bid for selected products. Not all products or items are subject to competitive bidding. Bids are submitted electronically through a web-based application process and required documents are mailed. Bids are evaluated based on the supplier’s eligibility, its financial stability and the bid price. Contracts are awarded to the Medicare suppliers who offer the best price and meet applicable quality and financial standards. Contract suppliers must agree to accept assignment on all claims for bid items and will be paid the bid price amount. The amount is derived from the median of all winning bids for an item.

You may find detailed information about the program here: http://www.cms.gov/DMEPOSCompetitiveBid/.

We welcome your questions and comments posted here or via email.

From Rep. Phil Gingrey (R-Ga.), co-chair of the GOP Doctors Caucus, House Republican leaders currently support 2-year freeze along with 1% increase. The House vote is expected on December 13. We are unsure of Senate support at this time.

The GOP Doctors Caucus recently said negotiations on the Medicare physician payment formula are aiming for a two-year continuation of the current rates instead of a permanent overhaul.

The final outcome and fix is yet to be finalized, but this is current thinking in DC. We will post more news as soon as it is available.

We are posting the message below from CMS just in case you missed a revalidation request. We don’t want any physicians/providers’ billing privileges suspended due to a mail glitch.

In response to provider requests, CMS has posted a listing of providers who have been sent a request to revalidate their Medicare enrollment information. The listing contains the name and national provider identifier (NPI) of each provider sent a letter, as well as the date the letter was sent. To see the listing, click on “Revalidation Phase 1 Listing” in the Downloads section of the Medicare Provider Supplier Enrollment Revalidation Page. NOTE: You must widen each column in the spreadsheet to view the contents. CMS will be updating this list monthly.
 
If you are listed, and have not received the request, please contact your Medicare contractor. Their toll free number may be found at Medicare Fee-For-Service Contact Information.
 
For more information on revalidation of Medicare provider enrollment, see MLN article 1126, Further Details on the Revalidation of Provider Enrollment Information.

 Health care entities are constantly under pressure to manage their costs, which are generally a combination of fixed and variable costs. In an environment where reimbursements from payers continue to decline, the pressures only increase on management to contain and manage overhead costs. For many practices, the battle is difficult as the assumption is made that not much can be done to change the fixed costs, and to a certain extent variable costs, without compromising quality and patient satisfaction.

A quick review of most financial statements shows expenses broken out into various categories. Fixed expenses typically include buildings and most of the operating expenses of the building, with utilities being somewhat “semi-fixed.” These expenses alone can comprise a big chunk of the fixed expenses with the other components of fixed expenses being equipment and furnishings, technology, management salaries and related benefits and third party services—such as legal, accounting, insurance, etc.  Read more…