Medicare Changing How It Pays For Outpatient Dialysis

How Medicare pays for outpatient dialysis services for Medicare beneficiaries who have end-stage renal disease (ESRD) is changing in January. 

Final regulations published yesterday (August 12, 2010) by the Centers for Medicare & Medicaid Services here will implement a case-mix adjusted bundled prospective payment system (PPS) for Medicare outpatient ESRD facilities beginning January 1, 2011 (ESRD PPS).  The new reimbursement rules implement changes required by the Medicare Improvements for Patients and Providers Act (MIPPA) enacted July 15, 2008. This ESRD PPS also replaces the current basic case-mix adjusted composite payment system and the methodologies for the reimbursement of separately billable outpatient ESRD services. 

Concurrently, CMS also proposed new rules here that would establish a new quality incentive program (QIP) to promote high quality services in dialysis facilities by linking a facility’ s payments to performance standards.  The QIP is the first pay-for-performance program in a Medicare fee-for-service payment system. 

In anticipation of its administration of these new rules, CMS also followed up today (August 13, 2010) by inviting public comment on the Independent Renal Dialysis Facility Cost Report, through which CMS requires providers participating in the Medicare program to identify the specific items of cost and statistics of facility operation that independent renal dialysis facilities are required to report.  See here. 

Read more details here. 

For More Information or Assistance 

The author of this update, attorney Cynthia Marcotte Stamer, has extensive experience advising and assisting health care providers and other health industry clients with licensure, contracting, reimbursement, compliance, public policy, regulatory, staffing, and other operations and risk management matters. Ms. Stamer also regularly publishes and conducts training on these and other compliance, management and operations matters.  You can get more information about her health industry experience here.  If you need assistance with these or other compliance concerns, wish to inquire about arranging for compliance audit or training, or need legal representation on other matters please contact Ms. Stamer at (469) 767-8872 or via e-mail here.  To review the regulations, see here.  For a summary, see here

Other Recent Developments 

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title: 

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