Corporate Compliance

Note: ESRD PPS final rule released effective for CY 2011

Medicare Insider, August 31, 2010

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Editor’s note: Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc., is the author of this week’s note from the instructor.

CMS recently released the ESRD PPS final rule, which will become effective for services provided on and after January 1, 2011.  Under the new ESRD PPS payment methodology, there will be a single composite PPS rate for all “renal dialysis services,” defined as:

  • Items and services included in the composite rate for renal dialysis services as of December 31, 2010;
  • Erythropoiesis stimulating agents that are furnished to individuals for the treatment of end stage renal disease and for which payment was (before application of the new ESRD PPS) made separately under Parts B or D, and any oral form of such agents;
  • Other drugs and biologicals that are furnished to individuals for the treatment of end stage renal disease and for which payment was (before application of the new  ESRD PPS) made separately under Parts B or D, and any oral equivalent form of such drugs or biologicals; and
  • Diagnostic laboratory tests and other items and services not included in the composite rate on December 31, 2010, that are furnished to individuals for the treatment of end stage renal disease.

Continue reading Judith's note on the MedicareMentor Blog.



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