Policy and Politics News

With less than three months remaining until the nation switches from ICD-9 to ICD-10 coding for medical diagnoses and inpatient hospital procedures, the Centers for Medicare & Medicaid Services and the American Medical Association are announcing joint efforts to continue to help nephrologists and others physicians get ready for the October 1 deadline. In response to requests from the provider community, CMS is releasing additional guidance that will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD-10 code set.

Restrictions should be lifted for new Medicare patients wanting to enroll in Medicare Advantage plans after being diagnosed with kidney failure, Kidney Care Partners wrote in a recent letter to Congress.

The Centers for Medicare & Medicaid Services published the 2014 Open Payments data about transfers of value by drug and medical device makers to health care providers. The data includes information about 11.4 million financial transactions attributed to over 600,000 physicians and more than 1,100 teaching hospitals, totaling $6.49 billion.

For the 2017 ESRD Quality Incentive Program, the Centers for Medicare & Medicaid Services says tracking influenza vaccination will be in, while adequacy measures will look different.

On Jan. 1 2017, Medicare Part B began including coverage for renal dialysis services furnished by a facility or provider for a Medicare beneficiary with acute kidney injury (AKI).

A proposed $9 cut in the Medicare monthly bundled payment rate for dialysis clinics would be nullified by payment adjustments in other areas and give providers a .02% increase in 2016, according to documents released on June 26.

DaVita HealthCare Partners Inc. said it has received a subpoena from the Office of Inspector General for documents related to patient diagnosis coding and risk adjustment submission and payments to Medicare Advantage plans and organizations. The subpoena covers documents from January 2008 to present, and includes HealthCare Partners and its subsidiary JSA HealthCare Corporation.

Three years ago, the Chief Medical Officers from 13 dialysis providers (listed below) met to share common issues associated with patient outcomes and the patient experience with kidney failure. They shared both successes and areas where improvement was needed. From those initial meetings arose a commitment to share clinical and facility level approaches to procedures, protocols, and policies, even data. Since that time there have been three national meetings attended by the CMOs and their operational teams, plus monthly phone calls to discuss issues. Enormous collaboration has resulted from this collaboration.

The National Kidney Foundation has proposed a new system of bundled Medicare payments to primary care practitioners and nephrologists in an effort to encourage earlier detection and optimal management of chronic kidney disease.

Objectives. The Medicare End-Stage Renal Disease Prospective Payment System (PPS) used data from 2006-08 to set weights for each case-mix adjuster that is part of the bundled payment formula. The details of the population case-mix were not made public, and little is known about consistency of case-mix over time. This study estimated the prevalence of case-mix adjusters during 2006-2008and analyzed changes in case-mix prevalence from 2000-2008.