CMS has proposed switching payment for dialysis services from a fee-for-service basis to a prospective payment. The PPS payment would be for facilities providing dialysis services to Medicare beneficiaries with end-stage renal disease.
CMS proposes to set up a standard bundled payment of $198.64 for all dialysis services related to an ESRD session. This would include services in the current composite rate, along with items like oral drugs that are usually billed separately.
The new bundled rate was developed using 2007 claims data for both separately billable services and the composite rate. The bundled rate was also adjusted to reflect expected 2011 prices, as well as case mix factors like patient age, body size, time on dialysis, and comorbidities that have a major impact on the course of treatment. There'd also be an adjustment for pediatric patients.
To learn more about the pending rule:
- read this HFMA News piece
- read the proposed rule (.pdf)