Revised Updates For Renal Dialysis Billing

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Revised Updates For Renal Dialysis
Billing
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Revised Updates For Renal Dialysis Billing
Proposed ESRD Payment System The Centers for
Medicare Medicaid Services (CMS) on June 21,
2022, issued a proposed rule that proposes to
update payment rates and policies under the
End-Stage Renal Disease (ESRD) Prospective
Payment System (PPS) for renal dialysis services
furnished to Medicare beneficiaries on or after
January 1, 2023. This rule also proposes an
update to the Acute Kidney Injury (AKI) dialysis
payment rate for renal dialysis services
furnished by ESRD facilities for calendar year
(CY) 2023. In order to explore options regarding
payment under the ESRD PPS, the CY 2023 ESRD PPS
proposed rule includes requests for information
regarding (1) a potential add-on payment
adjustment for certain new renal dialysis drugs
and biological products, and (2) health equity
issues under the ESRD PPS, with a focus on
pediatric dialysis payment. The ESRD PPS provides
a bundled, per-treatment payment to ESRD
facilities that includes all renal dialysis
services furnished for outpatient maintenance
dialysis, including drugs and biological products
(with the exception of oral-only ESRD drugs until
2025). Additionally, the bundled payment includes
all other renal dialysis items and services that
were formerly separately payable under previous
payment methodologies. CMS is expanding
eligibility for the Transitional Add-on Payment
Adjustment for New and Innovative Equipment and
Supplies (TPNIES) to include certain
capital-related assets that are home dialysis
machines when used in the home for a single
patient.
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Revised Updates For Renal Dialysis Billing

• As with other renal dialysis equipment and
  supplies potentially eligible for the TPNIES, CMS
  would evaluate the application to determine
  whether the home dialysis machine represents an
  advance that substantially improves, relative to
  renal dialysis services previously available, the
  diagnosis or treatment of Medicare beneficiaries,
  and meets the other requirements under
  413.236(b).
• CMS is finalizing additional steps the Medicare
  Administrative Contractors (MACs) would follow to
  establish the basis payment of the TPNIES for
  these home dialysis machines. CMS would pay 65
  percent of the MAC-determined pre-adjusted
  reduced by an average per treatment offset amount
  of 9.32 for 2 calendar years. CMS is finalizing
  that after the 2-year TPNIES period ends, the
  home dialysis machines would not become eligible
  outlier services and no change would be made to
  the ESRD PPS base rate.
• Renal Dialysis Services
• Renal dialysis services are all items and
  services used to furnish outpatient maintenance
  dialysis in the ESRD facility or in a patients
  home. Renal dialysis services include but are not
  limited to
• All items and services included under the
  composite rate as of December 31, 2010
• Erythropoiesis stimulating agents (ESAs) and
  their oral or other forms of administration that
  are for the treatment of ESRD
• Injectable drugs and biologicals and their oral
  or other forms of administration that are for the
  treatment of ESRD

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Revised Updates For Renal Dialysis Billing

• Oral or other forms of non-injectable drugs and
  biologicals that are for the treatment of ESRD
• Diagnostic laboratory tests that are for the
  treatment of ESRD
• Home and self-dialysis training and
• All supplies, equipment, and self-dialysis
  support services necessary for the effective
  performance of a patients dialysis furnished in
  the ESRD facility or in a patients home. Support
  services may include
• Visits by trained hospital or dialysis facility
  workers to check on the patients self-dialysis,
  to help in emergencies when needed, and to
  check dialysis equipment and water supply
• Monitoring access and related declotting or
  referring the patient or
• Direct nursing services include registered
  nurses, licensed practical nurses, technicians,
  social workers, and dietitian
• For detailed understanding of billing updates for
  renal dialysis services, you can refer to CMS
  page End Stage Renal Disease (ESRD) Prospective
  Payment System (PPS). Medisys Data Solutions is a
  leading medical billing company providing
  complete billing and coding services for various
  medical billing specialties. Our team of expert
  medical billers and coders are well versed with
  Medicare guidelines and coverages for various
  medical procedures. We can assist you in
  receiving accurate and timely Medicare
  reimbursement for delivered services. To know
  more about our Medicare billing services, contact
  us at info_at_medisysdata.com / 302-261-9187.

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