Rate Increase Analysis for Non-Rural/Non-Bid Suppliers
The COVID-19 stimulus legislation provides significant reimbursement relief for the HME community during this pandemic. One particular measure of relief is being provided to suppliers servicing Medicare beneficiaries in non-rural areas that are not subject to the bidding program. Effective March 6, 2020, the reimbursement rate for items that have been receiving 100% of the competitive bidding adjusted fee schedule will be getting a blended rate of 75% adjusted and 25% unadjusted (2015 fee schedule) rates. According to our estimates, suppliers in non-rural, non-bid areas will see a rate increase of about 30% on average.
Based on our analysis, on average, we anticipate oxygen concentrator (E1390) will see a 36% increase, portable oxygen concentrator (E1392) will see a 10% increase, and gas portable oxygen system (E0431) will see a 21% increase.
AAHomecare analyzed the new rates for the top 25 HCPCS codes for each region. You can find our region-by-region analysis here:
- Far West – CA, OR, NV, WA
- Great Lakes – IL, IN, MI, OH, WI
- Mideast – DE, DC, MD, NJ, NY, PA
- New England – CT, ME, MA, NH, RI, VT
- Plains – IA ,KS, MN, MO, NE, ND, SD
- Rocky Mountains – CO, ID, MT, UT, WY
- Southeast – AL, AR, FL, GA, KY, LA, MS, NC, SC, TN, VA, WV
- Southwest – AZ, NM, OK, TX
As noted above, the new relief rates will retroactively be implemented on March 6, 2020 until the end of the Public Health Emergency. In addition to this relief, all HME services will not be subject the 2% sequestration reduction between May 1-December 31, 2020. However, between March 6-April 30, 2020, suppliers servicing in non-rural, non-CBAs will still have this 2% reduction factored into these payments.