CMS to Cut ESRD Bundled Reimbursement up to $880 Million

  • Email
  • Print
  • Printing Articles

    1. Click here to print!
    2. ...or print directly from your browser by choosing File > Print... from the menu or by pressing [Ctrl + P]. Our printer-friendly stylesheet will make sure extraneous website stuff isn't printed.
    3. You're done!

    Close this message.

  • Comments
  • RSS

The Centers for Medicare and Medicaid Services (CMS) will cut the reimbursement rate for end-stage renal disease (ESRD) bundled payments beginning in 2014.

The rebased rate is to reflect the reduced usage of ESRD drugs, specifically Epogen and two other anemia-treating drugs manufactured by Amgen, according to a Washington Post report.

For the past several years the bundled payment system for dialysis treatments has been relatively lucrative for healthcare providers, in part because Medicare’s reimbursement rate was based on the level of usage of anemia drugs of more than five years ago.

Shortly after CMS established the bundled-payment rates for dialysis treatment, the FDA began issuing warnings about potential side-effects of the Amgen pharmaceuticals. Healthcare providers cut back the usage of these drugs on their patients, but according to the Government Accountability Office, Medicare did not reduce the bundled-payment rate commensurately.

Late last year the GAO recommended a dialysis payment rate cut, but CMS could not oblige without approval by Congress. As part of the “fiscal cliff” legislation, Congress included a provision to allow CMS to “make reductions,” the Post reported.

The reduced reimbursement rate will cost providers as much as $880 million per year, according to the Post. The current reimbursement rates can be downloaded here (PDF, registration required):  (You must be logged in to download this file. Don't have an account? Register for free and you'll be returned to this page.)

  • Email
  • Print
  • Printing Articles

    1. Click here to print!
    2. ...or print directly from your browser by choosing File > Print... from the menu or by pressing [Ctrl + P]. Our printer-friendly stylesheet will make sure extraneous website stuff isn't printed.
    3. You're done!

    Close this message.

  • Comments
  • RSS

Posted in Billing and Coding, Denials Management, Medical Receivables, Patient Financial Services .

×
Subscribe to our email newsletters

Continuing the Discussion

We welcome and encourage readers to comment and engage in substantive exchanges over topics on insideARM.com. Users must always follow our Terms of Use. Also know that your comment will be deleted if you: use profanity, engage in any kind of hate speech, post an incoherent or irrelevant thought, make a point of targeting anyone, or do anything else we find unsavory. Your comment will be posted under your current Display Name, shown below. If you'd like to change your Display Name, you must update it on the My Profile page.

Leave a Reply