CMS pitches End-Stage Renal Disease payment rule: 5 things to know

CMS unveiled its End-Stage Renal Disease Prospective Payment System rule for 2022 on July 1.

Five things to know:

1. Base rate updates. CMS proposed increasing the base rate for end-stage renal disease to $255.55, an increase of $2.42 to the current base rate of $253.13. CMS also proposed lifting the payment rate for renal dialysis services for individuals with acute kidney injury to $255.55.

2. Outlier policy change. CMS is proposing to update the outlier services' fixed-dollar loss amounts for 2022 using 2020 data. For pediatric beneficiaries, the fixed-dollar loss amount would decrease from $44.78 to $30.38, and the Medicare allowable payment amount would decrease from $30.88 to $28.73. The fixed-dollar loss amounts for adult beneficiaries would decrease from $122.49 to $111.18, and the Medicare allowable payment amount would decrease from $50.92 to $47.87.

3. Extension to report quality data. ESRD providers and facilities will have until Sept.1 to report quality performance data from September 2020 to December 2020.

4. Suppress some measures in quality data reporting. CMS is proposing to suppress some quality incentive payment program measures, including the standardized hospitalization ratio measure and standardized readmission ratio clinical measure for scoring and payment adjustment purposes, because of the COVID-19 pandemic. 

5. No payment reductions in the 2022 performance year. CMS is proposing to modify scoring and payment methodologies to ensure that no facility receives a payment reduction in performance year 2022 because of the COVID-19 pandemic. Providers still can see payment increases due to performance.  

Read more about the proposed rule here

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