Medicare Competitive Bid Update

Medicare’s Competitive Bid (CB) awards and rates will be announced soon. Össur want to make sure you are as prepared as possible, allowing for the best possible impact on your practice, along with better patient outcomes of those depending on your care.

Many off the shelf brace codes are included in the new Competitive Bid program. Which means, if you are not one of the final contractors awarded a bid, you will not be able to provide the specified off the shelf braces to Medicare beneficiaries.

You will still be able to provide the custom-fit version of the braces, according to state licensure laws as appropriate.

Patient evaluation and individual documentation is critical for successful reimbursement, along with minimizing audit risks.

Documentation should include:

• Medical Necessity of the brace, according to the requirements in the LCD
• What specific modifications were performed to make this a custom fit brace
• Why the modification was clinically required to optimize patient outcome  -  provide more clinical explanation of why the thigh shell needed to be heat molded (“proximal aspect of thigh shell was heat-molded allowing for reverse flare to counteract impingement of soft tissue minimizing pressure points and maximizing distribution of ground reaction forces”).

Review the appropriate LCDS, and learn more about the competitive bidding program.