Nephrologists will receive boosts in payments – especially in the rate for reimbursement for home dialysis – starting on January 1, 2021, according a final rule recently issued by the Centers for Medicare and Medicaid Services (CMS). The increases to nephrologists’ reimbursements were part of a multi-year push by ASN to increase the values incorporated in those reimbursement calculations.
This long overdue rule reflects the current federal policy priority focused on increasing rates of home dialysis. The final rule includes an overall 6 percent increase in payments for nephrologist-provided services with an approximate 30 percent increase for home dialysis reimbursement. The increases were due to the upward adjustment of relative value units (RVUs) being applied to nephrology billing codes. CMS also increased the RVU value of the TCM codes.
“This is a big win for continuity of hospital to dialysis care for our patients. After years of advocacy by ASN, Medicare is supporting nephrologists with rates that better reflect our work and the value of home dialysis, a top priority for ASN,” Anupam Agarwal, MD, FASN, ASN President.
While ASN was pleased to see the increases in home dialysis rates, there is still room for added valuations in order to achieve payment parity with in-center rates. The society will advocate for further increases when Medicare develops proposals for the CY 2022 Medicare Physician Fee Schedule (MPFS).
CMS also accepted another ASN policy priority that will now allow 14 ESRD codes to be billed concurrently with Transitional Care Management (TCM) codes. TCM codes allow for payment for hospital follow up care. This change promotes better follow-up post hospitalization and provides fair reimbursement for nephrologists’ time.
These developments are also seen as complementing the upcoming mandatory ESRD Treatment Choices (ETC) Model also beginning January 21, 2021.
The ASN policy team will continue to keep you informed on these and other developments related to advancing excellence in care of people with kidney diseases.