CMS issues final rule for end-stage renal disease

CMS provided its End-stage Renal Disease Prospective Payment System on Oct. 29 for services on or after Jan. 1, 2022.

Here are four things to know:

1. Base rate updates: Medicare will pay about $8.8 billion to about 7,700 end-stage renal disease facilities for renal dialysis services. The final base rate is $257.90, a $5 increase from the current one.

2. Wage index: For calendar year 2022, CMS will update wage index values using current data from Office of Management and Budget delineations.

3. Update to the outlier policy: CMS is proposing an update to the outlier services fixed-dollar loss amounts for 2022 using 2020 claims data. For pediatric beneficiaries, the fixed-dollar loss amounts will decrease from $44.78 to $26,02. Medicare allowable payment will decrease from $30.88 to $27.15. The fixed-dollar loss amount for adult beneficiaries will decrease from $122.49 to $75.39. The Medicare allowable payment will decrease from $50.92 to $42.75.

4. Transitional add-on payment adjustment: CMS is also approving a transitional add-on payment adjustment for new and innovative equipment and supplies application for a home dialysis machine for 2022.

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