Federal Register 2017 ESRD PPS: Updates to Payment Policies and Rates for CY 2019

The Centers for Medicare & Medicaid Services (CMS) has issued the final rule updating payment policies and rates for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and the End-Stage Renal Disease (ESRD) programs. The final rule, titled 'Medicare Program: End-Stage Renal Disease Prospective Payment System; Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury; End-Stage Renal Disease Quality Incentive Program; Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP); and Fee Schedule Amounts,' addresses significant changes to the ESRD Prospective Payment System (PPS) for calendar year (CY) 2019.

One of the key updates is the final CY 2019 ESRD PPS base rate, which has been set at $235.27. This represents an increase of $2.90 from the current base rate of $232.37. The update reflects changes to the payment policies and rates for DMEPOS and ESRD programs aimed at improving patient care and outcomes.

The rule also includes significant updates to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP). The CBP is designed to reduce the costs of DMEPOS items for Medicare beneficiaries while maintaining access to these essential services. The final rule addresses changes to the gap filling methodology used to establish Medicare fee schedules for new Healthcare Common Procedure Coding System (HCPCS) codes.

In addition, the rule includes technical amendments to correct existing regulations related to the CBP for certain DMEPOS items. These updates aim to ensure that patients have continued access to necessary medical equipment and supplies while also promoting cost-effectiveness in the healthcare system.

The final CY 2019 ESRD PPS rule is designed to improve patient care and outcomes by updating payment policies and rates for DMEPOS and ESRD programs. By addressing changes to the gap filling methodology and making technical amendments, CMS aims to ensure that Medicare beneficiaries have continued access to necessary medical equipment and supplies while also promoting cost-effectiveness in the healthcare system.

Overall, the final CY 2019 ESRD PPS rule reflects a commitment to improving patient care and outcomes while also promoting efficiency and effectiveness in the healthcare system. By understanding these updates, healthcare providers can better navigate the changes and ensure that patients receive the highest quality care possible.

Federal register 2017 esrd pps