Centers for Medicare & Medicaid Services (CMS) issued a Medical Learning Network (MLN) Matters article #MM12188 on Implementation of Changes in the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Payment for Dialysis Furnished for Acute Kidney Injury (AKI) in ESRD Facilities for Calendar Year (CY) 2021. The MLN Matters article is for ESRD facilities that bill Medicare Administrative Contractors (MACs) for services they provide to Medicare patients. The article tells about the Calendar Year (CY) 2021 rate updates and policies for the ESRD PPS and implements payment for renal dialysis services furnished to Medicare patients with Acute Kidney Injury (AKI) in ESRD facilities. Learn about rate and policy updates, and make sure billing staff are aware of these changes.
Category: Acute Kidney Injury (AKI)
Changes in the ESRD PPS and Payment for Dialysis Furnished for AKI in ESRD Facilities for CY 2021
CMS issued a new MLN Matters Article MM12011 on Implementation of Changes in the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Payment for Dialysis Furnished for Acute Kidney Injury (AKI) in ESRD Facilities for Calendar Year (CY) 2021 (PDF). Learn about rate and policy updates.
CMS/NKF Webinar on CKD Risk Reduction
CMS and NKF will present a May 22, 2019 webinar on on Population Health Strategies for Kidney Disease Risk Reduction, at noon PST. Nephrologists, dialysis facility medical directors and renal care providers are invited and encouraged to attend. The NKF CKD Change Package will be introduced, systematic strategies for improving identification and management of CKD will be described, and a population health strategy for registry function, QI, and patient engagement for people living with CKD will be presented. Register for the webinar at https://meetings-cms.webex.com/meetings-cms/onstage/g.php?MTID=e06e8b0a5642756b1b7a7e0998d0eeeb8. Find the NKF CKD Change Package at https://www.kidney.org/sites/default/files/02-11-8036_JBI_CKD_ChangePackV17.pdf.
CY2019 PPS/AKI MLN Matters
CMS has published an MLN Matters bulletin on Implementation of Changes in the ESRD PPS and Payment for Dialysis Furnished for AKI in ESRD Facilities for CY2019. Find it at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM11021.pdf.
CY2019 Changes and Updates to the ESRD QIP & ESRD PPS
On November 1, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2019. This rule also updates the acute kidney injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities to individuals with AKI, and finalizes changes to the ESRD Quality Incentive Program (QIP). Find the summary at https://www.cms.gov/newsroom/fact-sheets/cy19-esrddme-nprm-cms-1691-f-and-dmepos-competitive-bidding-program-temporary-gap-period
NHSN Dialysis Event Surveillance Instructions for Acute Kidney Injury (AKI) Patients
Beginning January 1, 2018, dialysis facilities should include acute kidney injury (AKI) patients in National Healthcare Safety Network (NHSN) Dialysis Event Surveillance. Reporting AKI patient data to a new, separate NHSN location will enable CDC to exclude AKI patient data from NHSN Bloodstream Infection (BSI) information shared with CMS for purposes of the ESRD Quality Incentive Program (QIP).
The “Acute Kidney Injury (AKI) Location” should be used to report Dialysis Events, and denominator data for patients who have acute kidney injury and do not have an end-stage renal disease (ESRD) diagnosis at the time of the Event, or at time of denominator data collection.
The “Acute Kidney Injury Location” was released as part of the NHSN version 8.8 update on December 2, 2017. Please click here for instructions on using the “Acute Kidney Injury Location”.
Of those included in the NHSN Dialysis Event Surveillance population, the following criteria should be used to identify patients who have acute kidney injury:
1. No diagnosis of “End Stage Renal Disease” or “ESRD” in the patient medical record, or through the ESRD Medical Evidence Form (Form CMS-2728-U3).
AND
2. Physician-diagnosis of “Acute Kidney Injury: or “AKI” listed in the patient medical record (e.g., nephrologist consult or referral form).
AND
3. The event date, or date of denominator data collection, is not more than 6 months after the date the patient initiated outpatient hemodialysis.
For questions, please contact the NHSN helpdesk: nhsn@cdc.gov with “dialysis” in the subject line.