CMS Plans Changes to Nephrology Payments

By David White

August 11, 2020

 

Changes ASN has long pushed for will be implemented.

Nephrologists will receive a boost in payments – especially in the rate for reimbursement for home dialysis – made to them by the Centers for Medicare and Medicaid Services (CMS). ASN is proud to have played a significant role by pushing for this change that will begin January 1, 2021.  This move is long overdue and reflects the priority placed on kidney care by the Executive Order on Advancing American Kidney Health of July 2019 and its focus on increasing rates of home dialysis.

The proposed rule includes an overall 6 percent increase in payments for nephrologist-provided services with an approximate 30 percent increase for home dialysis reimbursement.  CMS explained the increase was due to the upward adjustment of relative value units (RVUs) being applied to nephrology billing codes.  ASN is reviewing the proposed rule now, and we will provide the community our analyses of how all aspects of these proposed changes will affect kidney professionals, and provide a comment letter to CMS.

“Finally, after years of advocacy by ASN, Medicare is supporting nephrologists with rates that better reflect our work.  Most importantly, this is a big win for home dialysis, a top  priority for ASN,” Anupam Agarwal, MD, FASN, ASN President.

The home dialysis boost of 30 percent was welcome news, but there was confusion at the time of announcement, because the proposed rule included two different rates of reimbursement for home dialysis.  This left some in the kidney community wondering if there had been a behind the scenes effort to raise the rate even higher than 30 percent.  It also leaves many individuals and groups wondering how the politics of the upcoming mandatory ESRD Treatment Choices (ETC) Model played into the calculations.  ASN is digging into this issue and will be informing members of the final details of the model as soon as possible following its release.

 

 

Category:
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Author:
David White
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Changes ASN has long pushed for will be implemented.

Nephrologists will receive a boost in payments – especially in the rate for reimbursement for home dialysis – made to them by the Centers for Medicare and Medicaid Services (CMS). ASN is proud to have played a significant role by pushing for this change that will begin January 1, 2021.  This move is long overdue and reflects the priority placed on kidney care by the Executive Order on Advancing American Kidney Health of July 2019 and its focus on increasing rates of home dialysis.

The proposed rule includes an overall 6 percent increase in payments for nephrologist-provided services with an approximate 30 percent increase for home dialysis reimbursement.  CMS explained the increase was due to the upward adjustment of relative value units (RVUs) being applied to nephrology billing codes.  ASN is reviewing the proposed rule now, and we will provide the community our analyses of how all aspects of these proposed changes will affect kidney professionals, and provide a comment letter to CMS.

“Finally, after years of advocacy by ASN, Medicare is supporting nephrologists with rates that better reflect our work.  Most importantly, this is a big win for home dialysis, a top  priority for ASN,” Anupam Agarwal, MD, FASN, ASN President.

The home dialysis boost of 30 percent was welcome news, but there was confusion at the time of announcement, because the proposed rule included two different rates of reimbursement for home dialysis.  This left some in the kidney community wondering if there had been a behind the scenes effort to raise the rate even higher than 30 percent.  It also leaves many individuals and groups wondering how the politics of the upcoming mandatory ESRD Treatment Choices (ETC) Model played into the calculations.  ASN is digging into this issue and will be informing members of the final details of the model as soon as possible following its release.

 

 

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Date:
Tuesday, August 11, 2020