On July 11, 2012, CMS published a proposed rule to update the Medicare end-stage renal disease (ESRD) PPS for CY 2013. CMS projects a 2.5% increase in the ESRD PPS base rate in CY 2013, which is derived from an estimated 3.2% market basket update that is partially offset by a -0.7% MFP adjustment under the ACA. After applying a proposed wage index budget-neutrality adjustment factor, the proposed base rate for the ESRD PPS is $240.88 for 2013, and the composite base rate for facilities in the ESRD PPS transition period is $145.49. The rule also would reduce the outlier thresholds (allowing more cases to qualify for outlier payments), maintain the composite rate drug add-on at $20.33, and reduce the wage index floor. CMS estimates that the proposed rule would increase aggregate payments to all dialysis facilities by 3.1% for 2013. CMS also proposes changes to the ESRD Quality Incentive Program (QIP), which adjusts payments to dialysis facilities based on their performance on quality measures. CMS proposes a total of 11 measures (seven clinical measures and four reporting measures) for the 2015 payment determination, solicits comments on topics for future measure development, and proposes requirements regarding notification of QIP performance. As part of the rule, CMS proposes codifying the provisions of section 3201 of the Middle Class Tax Extension and Job Creation Act of 2012 that requires reductions in bad debt reimbursement to all providers, suppliers, and other entities eligible to receive bad debt reimbursement. CMS notes that the bad debt provisions are specifically prescribed by statute and thus are self-implementing (except for certain technical corrections). According to CMS, Medicare will save $10.9 billion over 10 years resulting from the bad debt provisions. Comments will be accepted until August 31, 2012.
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CMS proposes ESRD PPS update, bad debt reimbursement changes
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