On October 31, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a final rule
that updates payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2020. This rule also updates the acute kidney injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities to individuals with AKI and finalizes changes to the ESRD Quality Incentive Program (QIP).The CMS press release stated that the changes support the development and use of innovative technologies, provide greater access to new treatments in kidney care and modernize program integrity methods to better combat waste, fraud and abuse in the Medicare program. They are also aligned with the goals of President Trump’s two recent Executive Orders on Advancing American Kidney Health and Protecting and Improving Medicare for Our Nation’s Seniors. The rule also establishes methodologies to modernize the pricing of new Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) items and services. This will provide greater transparency for innovators regarding how CMS determines if new items and services are comparable to older items and services for Medicare pricing purposes. The rule also promotes competition and innovation in DMEPOS by setting Medicare payment for new items based on commercial pricing data.
The FACT Sheet issued by CMS summarizes the 2020 ESRD PPS, QIP, and AKI Final Rule. The NRAA will host a Members Only webinar on November 21st to discuss the Final Rule.
NRAA Review Webinar: 2020 ESRD PPS, QIP, and AKI Final Rule Thursday, November 21 11:00 AM - 12:00 PM ET