CMS - ESRD Prospective Payment System (PPS) Final Rule
On July 26th, 2010 CMS released the ESRD Proposed Payment System Final Rule. The following notes highlight a brief summary of the new provisions in the final rule.
• The ESRD base payment rate will be $229.63.
• ESRD-related injectable drugs that were separately payable under Medicare Part B and Part D and their oral equivalents are now included in the bundled rate.
• The inclusion of oral medications with no injectable equivalent has been delayed until after the transition period, stated as January 1, 2014.
• CMS has finalized a list of 53 ESRD-related lab tests to be included in the bundled payment.
• To cover the cost of home dialysis training a monetary add-on of $33.44 per treatment will be added to the bundled rate. This amount will be adjusted by the geographic wage index of the individual ESRD facility.
• CMS has adopted five age groups from the proposed rule as final payment adjusters and will have separate adjusting factors for pediatric patients based on age and treatment modality.
• The final rule excludes adjustors for patient sex and patient race.
• Six more co-morbidities have been selected to be included as case mix adjustments.
• Low-volume facilities, those with 4,000 or less treatments in a three-year period, will have payments adjusted by an 18.9 percent increase.
• A single payment will be made for in-center and home dialysis services through the ESRD facility.
• Medicare billing responsibility for ESRD facilities now includes all dialysis services provided to ESRD patients.
• The final regulation adopts three quality measures that are currently used for dialysis facility care. Failure to meet or exceed performance standards will result in payment reductions of up to 2.0 percent.
1. Anemia Management – patient whose hemoglobin levels were less than 10 g/dL
2. Anemia Management – patients treated with ESAs whose hemoglobin levels were greater than 12 g/dL
3. Hemodialysis Adequacy – percentage of patients at a provider or facility whose urea reduction ratio (URR) is 65 percent or greater
Look for a comprehensive review of the final rule in the near future once we have had time to analyze, in depth, the entire document. Gaia Software will continue to keep our clients and friends abreast of the current industry trends and changes. To review the CMS Bundle Rule pdf document in its entirety CLICK HERE.
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