DBidS Reference Guide - CBIC - Home...At this point in the application, you will complete a series...

Reference GuideDBidS

DMEPOS(Durable Medical Equipment, Prosthetics,

Orthotics, and Supplies)

Bidding System

Contents

DBidS Quick Reference Guide DMEPOS Competitive Bidding Program VERSION 1.0 – November 2009

Introduction 1 Form BGetting Started 2 Screen 8: Application Status 28Tips 2 Screen 9: Create Bid 29

Screen 10: Business Organization 30Form A Screen 11: Furnished Items 31

All Business Types (Single Location, Multiple Locations, or Networks) Screen 12: Expansion 32Screen 1: Business Organization Information 4 – 5 Screen 13: Bid Sheet 33Screen 2: Location Specific Information 6 – 7 Screen 14: Manufacturer 34Screen 3: Location Specific Information – Page 2 8 Screen 15: Manufacturer, Model NameScreen 4: Location Specific Information: 9 and Model Number 34

CBA and Product Category Screen 16: Summary 35Screen 17: Bid Certification Statement 36

Multiple Locations Screen 18: Public Address Announcement 37Screen 1: Location Summary 12 Screen 19: Certification 38Screen 2: Additional Locations 13 – 14 Screen 20: Status 39Screen 3: CBAs and Product Categories 15

International KeyboardNetworks & Alt Control Instructions 40Screen 1: Location Summary 17Screen 2: Network Member 18Screen 3: Network Member (continued) 19Screen 4: Additional Locations 20 – 21Screen 5: CBAs and Product Categories 22Screen 6: Network Member (continued) 23

All Business Types (Single Location, Multiple Locations, or Networks)

Screen 5: Application Summary 24Screen 6: Checklist 25Screen 7: Approval 26

DBidS Quick Reference Guide DMEPOS Competitive Bidding Program VERSION 1.0 – November 2009 1

Introduction

The following guide provides step-by-step instructions for entering or modifying a bid using the DBidS application. Before completingthe application and submitting a bid, all bidders should carefully review information such as the Request for Bids (RFB) instructions,bidding charts, financial documentation requirements, and state and local licensure rules on the DMEPOS Competitive BiddingProgram website at http://www.dmecompetitivebid.com/.

For more detailed information regarding entering a bid into DBidS, please refer to the DBidS User Guide available on the DBidSWelcome screen (see screen below).


Getting Started

You must be registered and have received your IACS(Individuals Authorized Access to the CMS Computer Services)system user ID and password by the time registration closes.This will allow you to access DBidS. For more information re-garding registration in IACS, please visit the CompetitiveBidding Program’s website at:

http://www.dmecompetitivebid.com/.

To log into DBidS:

• Go to http://www.dmecompetitivebid.com/

• Click Suppliers

• Select Bidding Process

• Click Enter Bid Submission System (DBidS)

• You will be directed to the IACS login page

• Type your IACS user ID into the User ID field

• Type your IACS password into the Password field(IACS user IDs and passwords are case sensitive)

• Click Login

• Click Enter DBidS

If this is your first time logging into DBidS, the Form A:Business Organization Information screen will appear.If you have previously logged into DBidS and completed thisscreen, the Status screen will appear. If you have more thanone National Supplier Clearinghouse (NSC) number in IACS, theNSC Number Selection screen will appear.

You will find an icon ( ) in the upper right corner of manyof the sections throughout DBidS. Click on this icon foradditional helpful information.

Tips

• After keying information into any page in DBidS, it isalways a good idea to save your entry by clicking Save.Do NOT hit Enter. This will cause the screen to reset andyour information will be lost. Make sure you click theappropriate button (such as Save, Back or Next).

• Error messages may display at the top of the screen in red.

• If you modify any information in Form A or Form B afterthe bid (Form B) is certified, the Authorized Official (AO)or Backup Authorized Official (BAO) will need tore-approve Form A and re-certify Form B.

• If the DBidS application times out, you must completelyclose the browser you are currently in and open a newbrowser to log back into DBidS.

• You may also call the Competitive Bidding CustomerService Center from 9:00 a.m. to 9:00 p.m. ET, Mondaythrough Friday, at 1-877-577-5331 for assistance.

• The screens and sections in DBidS are not numbered.The screens are numbered in this guide to assist youwith using the guide.

• If using special characters, please use the Internationalkeyboard to enter the information (see page 40).

http://www.dmecompetitivebid.com/



Form AIMPORTANT • All suppliers (those with a single location, multiple locations, or networks) complete screens 1 – 4.

• AOs and BAOs must complete the Business Organization Information section ( ) from page 4.• Please note only one user may enter data in Form A at a time.• FormAmust be completed and approved by theAO or BAO before data may be entered on Form B.

* Please note that the screens and sections in DBidS are not numbered. These numbers are to assist you with using this guide only.

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Form A

The Form A: Business Organization Information screenrequests general information about your business.

Screen 1*: Form A – BusinessOrganization Information

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* The screens and sections in DBidS are not numbered. These numbers are to assist you with using thisguide only.

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Business Organization Information – Provide the supplier’s legalbusiness name that is reported to the Internal Revenue Service (IRS) for taxreporting purposes.

Click the drop-down arrow and select one of the following:

• Supplier with single location – Suppliers with only one location and NOTbidding as part of a network.

• Suppliers with multiple locations – Suppliers with more than one locationand NOT bidding as part of a network.

• Network supplier – Small suppliers that are submitting a bid as part of anetwork. A network can have a minimum of two (2) and a maximum of 20 networkmembers (including the primary supplier submitting the bid(s) on behalf of thenetwork). The Network Name box appears when this option is selected.

Specialty Supplier – Only skilled nursing facilities (SNFs) and nursingfacilities (NFs) are eligible to bid as specialty suppliers if they intend toprovide competitively bid items to only their residents. If you choose Yesand identify your business as a specialty supplier, you will only be allowed tobid on enteral nutrition. IfNo is selected and the SNF or NF wins a contract,the SNF or NFmust provide the product category to any Medicare beneficiaryresiding in or visiting the competitive bidding area (CBA). If a SNF or NF isnot selected as a contract supplier, it must use a contract supplier for theCBA to furnish competitively bid items to its residents. This response cannotbe changed once the bidding window closes.

Accreditation –All supplier locationsmust be accredited for the product cat-egory for which the supplier is submitting a bid. As required by 42 CFR §414.414 (c) of the final rule, each supplier location must meet qualitystandards and be accredited in order to be awarded a contract. Thisincludes all product-specific standards. For a list of the Centers for Medicare& Medicaid Services (CMS)-approved organizations and additionalaccreditation information, visit:

http://www.cms.hhs.gov/MedicareProviderSupEnroll/.

If No is selected in the Accreditation section, you will receive thefollowing message: “Are you sure? Each location(s) must be accredited inorder to submit a bid. If you say OK, you may not continue.” If you clickOK,you will be logged out of DBidS.

http://www.cms.hhs.gov/MedicareProviderSupEnroll/


Screen 1*: Form A – BusinessOrganization Information

(continued)

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* The screens and sections in DBidS are not numbered. These numbers are to assistyou with using this guide only.

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Contact Person – Provide a maximum of five (5) persons who should be contacted to answerquestions regarding your bid. The contact person may or may not be an authorized official or keypersonnel. However, this person must have the authority and knowledge to answer questionsabout your organization.

The information will appear in theModify/Delete Contact Person(s) section, and theContactPerson section is cleared to allow entry of additional contact persons. Repeat the sameprocedure to add personnel. You may modify this section to add or delete information. Pleasenote that once deleted, the information is permanently removed from the application.

Authorized Official and Key Personnel – You may list a maximum of five (5) authorizedofficials and key personnel per business organization. The authorized official is the person(s)identified on the CMS-855S enrollment form submitted to the NSC. The authorized official hasthe legal authority to submit a bid on behalf of the company and to enter into a contract withMedicare to provide competitively bid items to Medicare beneficiaries. Key personnel are crucialto the operation of the business organization but are not authorized officials as described above.

The information will appear in the Modify/Delete Authorized Official/Key PersonnelInformation section, and theAuthorized Official and Key Personnel section is clearedto allow entry of additional personnel. Repeat this procedure to add personnel. You may modifythis section to add or delete information. Please note that once deleted, the information ispermanently removed from the application.

Competitive Bidding Area (CBA) and Product Category – Identify all of the CBA(s)and product category(s) for which your organization is submitting a bid. Please note that later inthe application you will be required to identify the CBAs associated with each of your locations. Aminimum of one (1) CBA and one (1) product category must be selected. Failure to do so on thisscreen will result in the CBA and product category not being available for location selection andbid submission later in the application. Please review the list of ZIP codes included ineach CBA prior to completing this section. This list is available on theCompetitive Bidding Program website at http://www.dmecompetitivebid.com/.

Note: Not all ZIP codes included in a county may be in a CBA.

Each CBA will be listed twice with either a mail-order or non mail-order indicator. The productcategory(s) that will appear after the CBA is chosen depends on the CBA selection made. If youselect a CBAwithmail-order indicated, only the diabetic supplies product category will appear.If you select a CBAwith non mail-order indicated, all of the product categories except diabeticsupplies will appear. The support surface product category will only appear for the Miami CBA.

Note: If you previously selectedSpecialty Supplier and then choose a CBAwith the mail-orderindicator, no product categories will appear in the product category section.

Click on the Add CBA/Product Category button after selecting the CBA and product categoryfrom the CBA/product category drop downmenu. This information will appear in theCBA/ProductCategory List section below. You will then be able to select an additional CBA/product categoryfrom the Competitive Bidding Area (CBA) and Product Category section.



Screen 2*: Form A – LocationSpecific Information

The Form A: LocationSpecific Informationscreens request informationfor each location in yourbusiness organization.

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* The screens and sections in DBidS are not numbered. These numbers are to assist you with using this guide only.

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Identifying Information – Please note that the legal businessname as well as the NSC number you previously provided when youregistered in IACS will appear on the screen. You should provideinformation in this section for the location identified by the NSC numberthat is on the screen. Do not provide information for a billing agency,management service organization, or staffing company. Themailingaddress must be the same as the mailing address on file with theNSC and must correspond with the NSC number for this location.The business telephone number should only contain 10 numeric digits.The NSC and National Provider Identifier (NPI) numbers should beentered without dashes, slashes, or spaces (example: 0000000000).

Physical Address – Complete this information if the physicaladdress is different from the mailing address provided in the sectionabove. If it is the same, the box must be checked to populate theaddress. A post office box is not accepted as a physical address. Thephysical address should be the same as the physical address on filewith the NSC and must correspond with the NSC number on thescreen.

Business Information – Provide the Tax Identification Number(TIN) issued by the IRS. Sole proprietors may use their SocialSecurity number. Social Security numbers should be entered withoutdashes.

Provide the total number of years and months this location has beenin business. This may or may not be the same time the business hasbeen billing Medicare. If the number of years is greater than 99,select 99 years and 11 months.

Contract suppliers that wish to have their DBA (doing-business-as)name listed in the Supplier Directory on the Medicare website(http://www.medicare.gov/) must have this information on filewith the NSC. The Supplier Directory is populated with data providedby the NSC, not by DBidS.

http://www.medicare.gov/


Screen 2*: Form A – Location Specific Information(continued)

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icon for business type definitions.

Service Delivery – Check all delivery methods that apply:• Retail• Mail Orders• Home Delivery

Sanctions – If Yes is selected, enter a description of anyprevious or current sanctions (maximum of 1,000 characters).If using special characters, please use International keyboardor Alt Control keys to enter information. (International keyboardand Alt Control instructions may be found on page 40.)

Click on the

Type of Business – Select one response.• Corporation• Sole Proprietorship• Partnership• Non-Profit Organization• Municipality Owned


Screen 3: Form A – Location Specific Information – Page 2

Accreditation

Accreditation Information – After you select your accreditation status, the product category box will appear. Enter the issue and expiration date with thetwo-digit month and four-digit year (example: 02/2009). Not keying the date in this format may result in an error message. The data will then appear in theModify/Delete Accreditation Information section. Click Add Accreditation to clear the Accreditation Information section to allow entry of additionalinformation. Repeat this procedure to add data. You may modify or delete the information in this section. Please note that deleted information is permanently removed from the application.

If you select Not Accredited and click Add Accreditation, the following message will appear: “Are you sure? Each location must be accredited for theproduct category for which you are submitting a bid.” If you say OK, you may not continue. Click Cancel to return to the previous screen. If you click OK, youare agreeing that you are not accredited, and you will be logged out of DBidS.

Please note that if you enter accreditation information into this section and select Not Accredited, you will be logged out of DBidS.

The information entered in this section will be verified with your accreditation organization.


Screen 4: Form A – Location Specific Information:CBA and Product Category

CBA and Product Category

The CBA(s) and product category(s) that appear in the drop down box are based on information previously provided from the Competitive Bidding Area(CBA) and Product Category section (see page 5, Screen 1). Once you choose the CBA from the drop down box, click Select to display the productcategories for this CBA. Review the product categories and click Add CBA. The data will appear in the CBA and Product Category List section. TheCBAand Product Category section is cleared to allow entry for additional information. Repeat this procedure to add CBAs.

Suppliers are not required to maintain a physical location in a CBA to submit a bid for that CBA unless it is required to obtain statelicensure. Suppliers must comply with all program requirements, including the requirement to furnish items to beneficiariesthroughout the CBA, to be awarded a contract. A supplier should not submit a bid unless it currently has the ability to furnish itemsand services throughout the entire CBA. If a supplier intends to use the services of a subcontractor in order to provide servicesthroughout the CBA, it must ensure the subcontractor is accredited, licensed, and only performs services consistent with42 CFR § 424.57(c).


IMPORTANT

At this point in the application, you will complete a series of screens depending on whether yourcompany has a single location, multiple locations or is part of a network.

> If you have a single location, please skip to page 24.

> If you have multiple locations, please complete Screens 1 - 3 on pages 12 - 15. Once thesescreens are completed, skip pages 16 - 23 (these apply to network suppliers only), and continueto page 24 (Screen 5).

> If you have a network, please skip to page 17 and complete Screens 1 - 5. Once these screensare completed, continue to page 24 (Screen 5).

Beginning on page 24 with Screen 5, the application is the same for all types of bidding suppliers.


Multiple Locations


Multiple Locations

Screen 1: Form A – Location Summary

Companies with multiple locations that are solely owned or commonly owned and/or commonly controlled should only submit ONE bid application thatincludes all locations that provide the product category in the CBA. Locations within the CBA as well as those outside the CBA that routinely furnish items tobeneficiaries must be included on the bid application.

Competitive Bidding Program regulations do not allow commonly owned or commonly controlled companies to bid against themselves. Commonly ownedsuppliers are those where one or more of them have an ownership interest totaling at least 5 percent in the other(s). The term “ownership interest” is definedas “the possession of equity in the capital, the stock, or profits of another supplier.” Commonly controlled suppliers are those where one or more of thesupplier’s owners is also an officer, director, or partner of another supplier. Commonly owned or controlled locations that do not provide any of the items within aproduct category either to Medicare or non-Medicare customers should not be included on the bid for that product category. For example, if one location is apharmacy that only provides enteral nutrition products and another location only provides Durable Medical Equipment (DME) items, separate bids using separateForm As must be submitted for the pharmacy location and the DME location.

For more information, please refer to the Common Ownership and Control Fact Sheet on the Competitive Bidding Program website athttp://www.dmecompetitivebid.com/.

Click Add Location to access the Additional Locations screen.



Multiple Locations

Screen 2*: Form A – Additional Locations

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Provide the following information for each locationidentified by its unique NSC number displayed insection

Identifying Information – The infor-mation provided in this section may not befor a billing agency, management serviceorganization or staffing company. Themailing address must be the same asthe mailing address on file with the NSCand must correspond with the NSC numberfor this location. The business telephonenumber should only contain 10 numericdigits. The NSC and NPI numbers shouldbe entered without dashes, slashes, orspaces (example: 0000000000).

Business Information – Provide thetotal number of years and months thislocation has been in business. This may ormay not be the same time the business hasbeen billing Medicare. If the number ofyears is greater than 99, select 99 yearsand 11 months.

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Multiple Locations

Screen 2*: Form A – Additional Locations (continued)

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Accreditation Information –After you select your accreditationstatus, the product category box will appear. Enter the issue andexpiration date with the two-digit month and four-digit year (example:02/2009). Not keying the date in this format may result in an errormessage. The data will then appear in the Modify/DeleteAccreditation Information section. ClickAdd Accreditation.The Accreditation Information section is cleared to allowentry for additional information. Repeat this procedure to add data.You may modify or delete the information in this section. Pleasenote that deleted information is permanently removed from theapplication.

If you select Not Accredited and click Add Accreditation,the following message will appear: “Are you sure? Each locationmust be accredited for the product category for which you are sub-mitting a bid.” If you say OK, you may not continue. Click Cancelto return to the previous screen. If you click OK, you are agreeingthat you are not accredited, and you will be logged out of DBidS.

Please note that if you enter accreditation information into thissection and select Not Accredited, you will be logged out ofDBidS.

The information entered in this section will be verified with youraccreditation organization.

Sanctions – IfYes is selected, enter a description of any previousor current sanctions (maximum of 1,000 characters). If using specialcharacters, please use International keyboard or Alt Control keys toenter information. (International keyboard andAlt Control instructionsmay be found on page 40.)


Multiple Locations

Screen 3: Form A – CBAs and Product Categories

The CBA(s) and product category(s) that willappear in the drop down box are based oninformation previously provided. Once youchoose the CBA from the drop down box,click Select to display the product categoriesfor this CBA. Review the product categoriesand click Add CBA. The data will appear inthe CBA and Product Category Listsection. TheCBA and Product Categorysection is cleared to allow entry of additionalinformation. Repeat this procedure to add CBAs.

Suppliers are not required to main-tain a physical location in a CBA tosubmit a bid for that CBA unless it isrequired to obtain state licensure.Suppliers must comply with allprogram requirements, including therequirement to furnish items tobeneficiaries throughout the CBA, tobe awarded a contract. A suppliershould not submit a bid unless itcurrently has the ability to furnishitems and services throughout theentire CBA. If a supplier intends touse the services of a subcontractorin order to provide services throughoutthe CBA, it must ensure the sub-contractor is accredited, licensed,and only performs services consistentwith 42 CFR § 424.57(c).

After you complete Screens 1 - 3, you will seethe Application Summary screen. (Skipto page 24).

Networks

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Networks

Screen 1: Form A – Location Summary

The primary network member should enter its additional locations if applicable. Do NOT enter other network members’ names or locations on this screen.If no locations for the primary member need to be added, click Next.


Networks

Screen 2: Form A – Network Member

The primary network supplier should enter each network member’s business name in this section. A network can have a minimum of two (2) and a maximumof 20 members, including the primary network member. For more information about networks, please refer to the Request for Bid (RFB) instructions onthe Competitive Bidding Program website at: http://www.dmecompetitivebid.com/.



Networks

Screen 3: Form A – Network Member (continued)

Each member that is added will be displayed in theNetwork Members window. Click Add Location located next to the network member’s name to enterinformation for that member.

Please note that there is no limit to the number of additional locations that can be entered for each network member.


NetworksScreen 4*: Form A – Additional Locations

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Provide the following information for each networkmember:

Identifying Information – The infor-mation provided in this section may not befor a billing agency, management serviceorganization or staffing company. Themailing address must be the same asthe mailing address on file with the NSCand must correspond with the NSC numberfor this location. The business telephonenumber should only contain 10 numericdigits. The NSC and NPI numbers shouldbe entered without dashes, slashes, orspaces (example: 0000000000).

Business Information – Provide thetotal number of years and months thislocation has been in business. This may ormay not be the same time the business hasbeen billing Medicare. If the number ofyears is greater than 99, select 99 yearsand 11 months.

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Networks

Screen 4*: Form A – Additional Locations (continued)

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Accreditation Information –After you select your accreditationstatus, the product category box will appear. Enter the issue andexpiration date with the two-digit month and four-digit year (example:02/2009). Not keying the date in this format may result in an errormessage. The data will then appear in the Modify/DeleteAccreditation Information section. ClickAdd Accreditation.The Accreditation Information section is cleared to allowentry for additional information. Repeat this procedure to add data.You may modify or delete the information in this section. Pleasenote that deleted information is permanently removed from theapplication.

If you select Not Accredited and click Add Accreditation,the following message will appear: “Are you sure? Each locationmust be accredited for the product category for which you are sub-mitting a bid.” If you say OK, you may not continue. Click Cancelto return to the previous screen. If you click OK, you are agreeingthat you are not accredited, and you will be logged out of DBidS.

Please note that if you enter accreditation information into thissection and select Not Accredited, you will be logged out ofDBidS.

The information entered in this section will be verified with youraccreditation organization.

Sanctions – IfYes is selected, enter a description of any previousor current sanctions (maximum of 1,000 characters). If using specialcharacters, please use International keyboard or Alt Control keys toenter information. (International keyboard and Alt Control instruc-tions may be found on page 40.)

Networks


Screen 5: Form A – CBAs and Product Categories

The CBA(s) and product category(s) that will appear inthe drop down box are based on information previouslyprovided. Once you choose the CBA from the dropdown box, clickSelect to display the product categoriesfor this CBA. Review the product categories and clickAdd CBA. The data will appear in theCBA and ProductCategory List section. The CBA and ProductCategory section is cleared to allow entry of additionalinformation. Repeat this procedure to add CBAs.

Suppliers are not required to maintain aphysical location in a CBA to submit a bid forthat CBA unless it is required to obtain statelicensure. Suppliers must comply with allprogram requirements, including the require-ment to furnish items to beneficiariesthroughout the CBA, to be awarded acontract. A supplier should not submit a bidunless it currently has the ability to furnishitems and services throughout the entire CBA.If a supplier intends to use the services of asubcontractor in order to provide servicesthroughout the CBA, it must ensure the sub-contractor is accredited, licensed, and onlyperforms services consistent with 42 CFR §424.57(c).


NetworksScreen 6: Form A – Network Member (continued)

Once the location is added, the location’s NSC number for the network member displays below the member’s name. Please review the information foraccuracy. You may change information by clicking Modify or Delete. Please note that deleted information is permanently removed from the application.

Click Next to continue to the Application Summary screen. (See page 24.)


Screen 5: Form A – Application Summary

You will see a summary of the information provided for each location on this screen. Carefullyreview this summary. You may make modifications by clicking Edit to return to that particularsection of the bid application. If you are satisfied with the information, click Next. AOs andBAOs will see the Checklist screen. EUs will be returned to the Status screen.

To review the summary for additional locations, scroll down to the last section of theApplication Summary screen, labeledAdditional Locations/Network Members/Network Members Additional Locations, and select the NSC number. Next clickGo. The information in the Additional Location Information screen will appear. Tochange any of the information displayed on this screen, click Edit.

Note: Your bidder number is located at the top of this screen. Pleaseremember that your bidder number must be included on every page ofthe required hardcopy documents that you submit. The required hard-copy documents are detailed in the Request for Bids (RFB) Instructions,which can be found on the Competitive Bidding Program website,http://www.dmecompetitivebid.com/, underSuppliers >BiddingProcess.


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Screen 6: Form A – Checklist

Only the AO or BAO can view this screen, and only when all required fields on Form Ahave been completed. This screen provides a checklist of the required hardcopydocuments. Please read this document carefully prior to submitting your hardcopydocuments.

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Screen 7: Form A – Approval

Only an AO or BAO may approve Form A. The user ID is the IACS/DBidS user ID. Form A must be completed and approved by the AO or BAO before Form Bmay be created or accessed.

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Form B


Form BNote: If you are submitting bids for more than one product category/CBA combination, you will need to create or complete a Form B for each product category/CBA.

Multiple users may be in Form B at the same time as long as each user is entering information for a different product category/CBA.

Screen 8: Form A – Application Status

The Application Status screen must display Complete and Approved before you can proceed to Form B. If this is displayed, click Create Form Blocated on the left side of the screen.


Screen 9: Form B – Create Bid

The CBA and product category fields have been populated with information you provided on Form A. Choose the CBA from the drop down list and clickSelect. The product category(s) will then be displayed. Choose the applicable product category for that CBA and then click Create Bid. The informationyou selected will be displayed in the box in the lower part of the screen.


Screen 10*: Form B – Business Organization

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1 Revenue from Product Category – Select thetotal revenue that you collected for this product categoryin this CBA for the past calendar year. If you aresubmitting a bid for multiple locations that servethis CBA, select the total revenue for ALL locations.If you are bidding as a network, select the totalrevenue for this product category in this CBA for allnetwork members.

Select the percentage of total revenue for this productcategory in this CBA that was collected from Medicarefor the past calendar year. Good faith estimates areacceptable.

Customers Served – Enter the total number of allcustomers served in this CBA for this product category,not just the number of Medicare customers served, forthe past calendar year.

Select the percentage of that total number that wereMedicare beneficiaries. Good faith estimates areacceptable.

Geographic Area – Identify the counties in the CBAwhere you currently furnish this product category,not counties where you would furnish this productcategory if awarded a contract.

Indicate the percentage of this area where you currentlyserve Medicare beneficiaries.

Note: CBAs are defined by ZIP codes. It isimportant to note that only portions of somecounties may be included within a CBA. Youmay find a list of ZIP codes included in eachCBA on the Competitive Bidding Programwebsite (http://www.dmecompetitivebid.com/)under Suppliers > About the Program >Competitive Bidding Areas.



Screen 11: Form B – Furnished Items

For each Healthcare Common Procedure Coding System (HCPCS) code, enter the number of units that you provided to all customers in the past calendar year,NOT the number of units you would provide if awarded a contract. Then enter the number of units you provided to Medicare beneficiaries. If you enter a numberinto Units Provided to Medicare Beneficiaries that is larger than the number that was entered into Total Units Provided, an error message willappear. To correct this error, you must increase the number in Total Units Provided first, and then delete the number in Units Provided to MedicareBeneficiaries. Next, delete the increased number you entered in Total Units Provided. Then re-key the correct information in both boxes.

Indicate the percentage increase in Medicare business that your business organization or network would be capable of providing for all HCPCS codes in thatproduct category for this CBA during a projected 12-month period. The percentage increase may exceed 100 percent. For the definition of a unit, please referto the Bidding Information Charts on the Competitive Bidding Program website (http://www.dmecompetitivebid.com/) under Suppliers >Bidding Process.



Screen 12*: Form B – Expansion

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* The screens and sections in DBidS are not numbered. These numbers are to assistyou with using this guide only.

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Expansion Plan – Complete this screen if you plan to expand your business under theDMEPOS Competitive Bidding Program. If using special characters, please use Interna-tional keyboard or Alt Control keys to enter information. (International keyboard and AltControl instructions may be found on page 40.)

If the text box is not large enough to accommodate the information, you may use theAdditional Information field. You may also include additional information with yourother required hardcopy documents. Remember to indicate your bidder number on eachpage of any hardcopy documents.

Add Subcontractors – Identify the legal name and expected function of any entitieswith which you anticipate entering into a subcontracting agreement. Suppliers participatingin the Competitive Bidding Program must comply with the supplier standards set forth in42 CFR § 424.57(c). The supplier standards describe the services a Medicare enrolledDMEPOS supplier may subcontract to another entity. These functions include the purchaseof inventory, the repair of rented equipment, and the delivery and/or instruction on the useof a Medicare-covered item. It is important to note that the supplier is 100% responsible forthe delivery and instruction of Medicare-covered items and for maintaining the properdocumentation, whether it contracts out this service or not. You must submit your signedsubcontractor agreements in hardcopy; the subcontractor agreements are not entered intoDBidS.

If you are awarded a contract, you must notify CMS of any subcontracting relationshipsyou have entered into for purposes of furnishing items and services under the program. Youmust also disclose whether the subcontractor meets accreditation and any state licensurerequirements necessary to furnish these services. Contract suppliers are the party that willbe held responsible for the items and services they provide directly or through the use ofa subcontractor.


Screen 13: Form B – Bid Sheet

You must enter the total estimated capacity and bid price for each HCPCS code or product class.

Product Class is only applicable to the oxygen product category. When bidding on the oxygenproduct class category, you will only submit a single bid price for the payment class or combinationof codes.

The Rental or Purchase column tells you whether to submit your bid price as a rental or asa purchase of a new item. Rental means to enter your bid price for one month’s rental of theitem. Purchase means to enter the bid price as the total purchase of the new item. For theoxygen product category only, you will bid by class based on the rental for one (1) month.

The Product Weight indicates the relative market importance of the item within the productcategory.

To determine the Total Estimated Capacity for each HCPCS code or payment class,calculate the number of units that you currently furnish on a yearly basis and add any additionalnumber of units or capacity you would be capable of providing annually at the start of thecontract period. Do NOT report your estimated capacity for the entire contract period. Thedefinition of a unit for each item in the product category may be found on the CompetitiveBidding Program website, http://www.dmecompetitivebid.com/, under Suppliers >Bidding Process > Bidding Information Charts.

The Bid Price must not exceed the fee schedule amount and must be rational and feasible. Itmust also include the cost of furnishing the item throughout the CBA. If there is a question abouta bid price during bid evaluation, you may be requested to provide supporting documentation, suchas a manufacturer’s invoice, to verify that you can provide the item for the amount indicated onForm B.



Screen 14: Form B – Manufacturer

< Provide the manufacturer, model name, and model number for allproducts you will make available to Medicare beneficiaries in theCBA for each of the identified HCPCS codes. You must provide aminimum of one entry per HCPCS code. If you do not currentlyprovide the item, you should provide information for the item thatyou intend to furnish if awarded a contract.

Screen 15: Form B – Manufacturer, ModelName and Model Number

When you click Add, this screen will appear. Enter the manufacturer, modelname and model number information for the HCPCS code. Click Add

<

Manufacturer, Model Name & Model Number to add the informationto Form B. Once completed, you must click Back to return to the previousscreen so that you may enter manufacturer, model name and model numberinformation for the other HCPCS codes in the product category. Thisinformation will be displayed in the Supplier Directory on the Medicare websiteat http://www.medicare.gov/.

http://www.medicare.gov/


Screen 16: Form B – Summary

The Summary screen displays all of the information entered into Form B. Please scroll down the page toreview each section carefully. If you need to make changes or updates to a section, click Edit for thatsection. This will return you to the selected screen to make any changes. If you are satisfied with theinformation listed on the Summary screen, click Next.


Screen 17: Form B – Bid CertificationStatement

The AO or BAO should read the certification statement carefully. ClickNext to read the penalties for falsifying information. Form B must be certified in order for yourbid to be submitted.

Note: Form B required fields must be completed and the AO or BAO must certify Form B.

The primary supplier for a network must print the certifying statement for each member. Each member must carefully read and sign the statement. The primarysupplier must submit the certifying statements of all members with the network’s hardcopy documents.


Screen 18: Form B – Public AddressAnnouncement

Once you have carefully read this public address announcement, click Next.


Screen 19: Form B – Certification

Form B must be certified by the AO or BAO. The user ID is your IACS/DBidS user ID. If any modifications aremade to Form B after it is certified, the AO or BAO must re-certify Form B. If Form B is not certified, your bidcannot be evaluated, and you will not be considered for a contract.

39DBidS Quick Reference Guide DMEPOS Competitive Bidding Program VERSION 1.0 – November 2009

Screen 20: Form A and Form B – Status

This screen indicates the status of Form A Status is defined as follows:Form A and Form B of your application. • Incomplete – Form A is missing required information.It is the responsibility of the bidding • Pending Approval – Form A has not been approved by the AO or BAO.supplier to submit all required hardcopy • Complete and Approved – Form A is complete and has been approveddocuments to the CBIC. The Docu- by the AO or BAO.mentation Status section indicateswhether a package of documents has Form B Status is defined as follows:been received. It does not indicate • Incomplete – Form B is missing required information.whether the package is complete or the • Pending Certification – Form B has not been certified by the AO ordocuments are accurate or acceptable in BAO. A bid (Form B) that is not in a certified status will not be consideredaccordance with the RFB requirements. for evaluation.

• Complete and Certified – Form B is complete and has been certifiedFor more information on the required by the AO or BAO.hardcopy documents, please reviewthe RFB and financial instructions Documentation Status is defined as follows:found on the Competitive Bidding • Documentation Received – Yes displays if the CBIC has receivedProgram website at: a package; No displays if the CBIC has not received a package.http://www.dmecompetitivebid.com/. • Date Received – Displays the date received.


40DBidS Quick Reference Guide DMEPOS Competitive Bidding Program VERSION 1.0 – November 2009

International Keyboard & Alt Control Instructions

International Keyboard

Click Start in the bottom left of your screen.

Select Settings, then Control Panel.

Double click Regional and Language Options.

A box will appear. Select the Languages tab.

Click Details.

In the Installed services box, click Add and selectUnited States-International under Keyboard Layout/IME.

Click OK.

Click Apply.

Alt Control

Hold down the Alt key while typing the corresponding key combinationsindicated in the box below (use the numeric keypad to enter numbers.)

Character Description Windows Macintosh

¡ inverted exclamation mark 173 opt-1

¿ inverted question mark 168 opt-shift-/

á small a, acute accent 160 opt-E A

Á capital A, acute accent 0193 opt-E shift-A

é small e, acute accent 130 opt-E E

É capital E, acute accent 144 opt-E shift-E

í small i, acute accent 161 opt-E I

Í capital I, acute accent 0205 opt-E shift-I

ñ small n, tilde 164 opt-N N

Ñ capital N, tilde 165 opt-N shift-N

ó small o, acute accent 162 opt-E O

Ó capital O, acute accent 0211 opt-E shift-O

ú small u, acute accent 163 opt-E U

Ú capital U, acute accent 0218 opt-E shift-U

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