Health Information Management

CMS announces switch to PPS system for ESRD

HIM-HIPAA Insider, September 14, 2010

Want to receive articles like this one in your inbox? Subscribe to HIM-HIPAA Insider!

Effective January 1, 2011, CMS will replace the current basic case-mix adjusted composite payment system to a bundled prospective payment system (PPS) for end stage renal disease (ESRD) patients.

The ESRD PPS will provide one payment to hospitals and renal dialysis facilities to cover all the resources used in providing an outpatient dialysis treatment, including drugs, biologicals, laboratory tests, training, and support services, supplies, and equipment used to administer dialysis in the facility or at a patient’s home.
 
ESRD treatment facilities that use a significantly higher amount of resources will be eligible for outlier payments.
 
The ESRD will have a four-year phase in period, during which facilities will receive a blend of payments from the old case-mix system and the new PPS system.
 
Section 153(b) of the Medicare Improvements for Patients and Providers Act mandated the change. Read more about the specifics of the switch in transmittal 2033 in the Medicare Claims Processing Manual.

Editor’s note: This news article originally appeared in the September 8 issue of JustCoding.com.



Want to receive articles like this one in your inbox? Subscribe to HIM-HIPAA Insider!

Most Popular