Answer Summary: Urological supplies (catheters, bags) represent a stable, high-margin, recurring revenue stream that is less volatile than competitive bid items like Oxygen. However, credentialing for urologicals requires specific attention to State Pharmacy Board regulations, as many states classify sterile…
Answer Summary: Negotiating contracts with major commercial payers (UnitedHealthcare, Aetna, Cigna) requires a different strategy than Medicare enrollment. These payers are not obligated to let you in. To succeed in 2026, DME providers must move beyond “filling out the form”…
Answer Summary The 2026 Competitive Bidding Window is officially closed. Now begins the “Great Silence”—a period of 4–5 months where providers wait for Preliminary Bid Evaluations. The most dangerous mistake a DME provider can make in August is to pause…
Answer Summary DME providers must stop treating all payers identically because market data proves cycle times vary significantly, with Blue Cross Blue Shield requiring up to 180 days compared to 155 days for Cigna. Calibrating follow-up thresholds to these specific…
Answer Summary: Clicking “Submit” on Form B is not just an administrative task; it is a Binding Legal Certification. The Authorized Official is attesting under penalty of the False Claims Act that the bid data is accurate, that the supplier…
Answer Summary: In Form B, CMS asks for your “Estimated Capacity”—the number of units you can supply annually. A common error is overestimating this number to appear more attractive to CMS. However, if your capacity bid exceeds your historical claims…
Answer Summary: A major victory for the industry in the 2026 Competitive Bidding Rules is the adoption of the 75th Percentile Methodology for calculating Single Payment Amounts (SPAs). Unlike previous rounds that used the “Median” (50th percentile), this new rule…
Answer Summary The Connexion portal is now open for pricing submissions via Form B. For the 2026 Competitive Bidding round, providers must navigate a new interface that separates “Lead Item” bidding from “Non-Lead” data. This guide walks you through the…
The Scenario: The Passive Wait The Provider Enrollment team at the client organization was diligent. Every week, they logged into various payer portals (Availity, Optum, etc.) to check the status of pending applications. They sent messages through the portal’s internal…
Answer Summary: The most common technical error during the final week of registration is the Surety Bond Mismatch. CMS requires that the “Legal Business Name” (LBN) and “Tax ID” (TIN) on the physical bond document match the PECOS enrollment exactly—down…
