CMS pitches end-stage renal disease payment rule: 4 things to know 

On June 21, CMS issued a proposed rule to update payment rates and policies under the End-Stage Renal Disease Prospective Payment System for renal dialysis services furnished to Medicare beneficiaries on or after Jan. 1, 2023.

Here are four takeaways from the proposed rule: 

1. Under the proposed rule, Medicare expects to pay $8.2 billion to approximately 7,800 facilities in 2023 for furnishing renal dialysis services. The proposed 2023 base rate is $264.09, an increase of $6.19 to the current base rate.

2. CMS projects that the updates for 2023 would increase the total payments to all ESRD facilities by 3.1 percent compared with 2022. Hospital-based facilities are expected to see total payments increase by 3.7 percent, and freestanding facilities are projected to see a 3.1 percent bump in total payments. 

3. The rule proposes an increase to the wage index floor, a permanent 5 percent cap on decreases to the wage index and a change to the methodology used to calculate the outlier threshold for adult patients. 

4. In the proposed rule, CMS is requesting information regarding health equity issues and a potential add-on payment adjustment for certain renal dialysis drugs and biological products.


The proposed rule can be downloaded from the Federal Register.

 

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