Time's Up

Based on CMS' proposed rule for DME competitive bidding, it is time for all providers to expand the scope of information that is relevant to their businesses. For companies located outside the first 10 MSAs (whatever they will be), there is no less importance in doing this — and only slightly less urgency — for three reasons:

First, the proposed rule has revealed that some metropolitan statistical areas being considered for 2007 are not really large cities at all. CMS is considering more than population in its ranking and selection of MSAs. Second, CMS proposes to include 100 MSAs in competitive bidding by 2010, and the proposed method of selection could include MSAs that are significantly smaller than those ranked by population alone. Third, most of the information will facilitate better management decisions, regardless of the effects of competitive bidding.

• Medicare Revenue and Services by HCPCS — This data should reside in every billing system, though how it is acquired may vary. The reason it is important is that it indicates the level of exposure a provider has to competitive bidding. It will also indicate opportunities you have to insulate the company from competitive bidding.

  The proposed rule indicates that CMS may not include every HCPCS under competitive bidding and that it is unlikely to include all in 2007. You can use the criteria for item selection from the proposed rule to figure out the likelihood of a product's being on the Request for Bid. Then you can adjust sales efforts to fit your tactics.

  Some billing software has limited query-building capability that will prevent extraction of the desired data, but don't assume the answer is unobtainable. Many applications will allow the billing data to be exported to a text file or to an electronic spreadsheet file. Once the data is in a spreadsheet, it can be searched, analyzed and manipulated in just about any way you desire.

• Activity Costs by HCPCS — In order to submit a bid, you should at least know whether or not the price offered will produce a profit. It is even better to know how much profit the price will yield.