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A series of final rules issued by the Centers for Medicare and Medicaid Services include updates to payment rates and policies based on end-stage renal disease (ESRD). Prospective payment system (PPS) Renal dialysis services provided to Medicare beneficiaries in 2025.
In 2025, CMS is increasing the ESRD PPS base rate to $273.82, which is expected to increase total payments to all ESRD facilities, both freestanding and hospital-based, by approximately 2.7%.
Under the ESRD PPS, Medicare will pay $6.6 billion to approximately 7,700 ESRD facilities. The base rate of $273.82 is an increase of $2.80 from the current CY 2024 base rate of $271.02.
What is the impact?
CMS said it is finalizing a new ESRD PPS-specific wage index that will be used to adjust ESRD PPS payments for geographic differences in regional wages. This method combines data from the Bureau of Labor Statistics' Occupational Employment and Wage Statistics (OEWS) program with independent ESRD facility cost reports to create an index.
CMS says this index will be used to determine geographic payment adjustments in place of the hospital wage index by geographic region used in past years, which is derived from hospital cost reporting data.
The Agency is also expanding the list of ESRD outlier services to include pharmaceutical and biological products that were or would have been included in the composite rate prior to the establishment of the ESRD PPS. CMS stated that this is to better recognize the cost factors for providing renal dialysis services under the PPS.
Also finalized was a proposal to amend the Low Payment Adjustment (LVPA) policy to create a two-tier LVPA, which would allow ESRD facilities that provide fewer than 3,000 procedures per cost reporting year to This will result in an upward adjustment of 28.9%. Basic price. ESRD facilities that provided between 3,000 and 3,999 treatments would receive an 18.3% adjustment.
bigger trends
Additionally, CMS is finalizing a proposal to allow beneficiaries to pay for acute kidney injury (AKI) kidney dialysis services that they receive at home. CMS will allow ESRD facilities to bill Medicare for additional payment adjustments for home dialysis training and self-dialysis training for beneficiaries with AKI.
CMS says this will give beneficiaries with AKI more flexibility in making decisions about their care.
Jeff Lagasse I am the editor of Healthcare Finance News.
Email: [email protected]
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