Prospective Payment System of MIPPA
MIPPA - Pay for Performance Updates
CMS changes in claims reporting for dialysis adequacy, infection and vascular access – new reporting requirements went into effect on July 1, 2010.
These changes are being made as mandated by the Medicare Improvement for Patients & Providers Act (MIPPA).
For additional information, download:
- For additional background, download presentation Dialysis Adequacy, Infection, and Vascular Access Reporting for ESRD [PDF, 197KB]
- The MIPPA-Quality Based Payment Program Billing Info is a PowerPoint slide presenting an overview of the changes. The “Billing Rg7 file” contains complete details as provided by the CMS Manual System.
This final rule implements a case-mix adjusted bundled prospective payment system (PPS) for ESRD Medicare dialysis facilities beginning January 1, 2011, in compliance with requirements under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).
This ESRD PPS replaces the current basic case-mix adjusted composite payment system and the methodologies for the reimbursement of separately billable outpatient ESRD services.
- End-Stage Renal Disease Prospective Payment System {Federal Register/ Vol. 75, No. 15 / Thursday, August 12, 2010 / Rules and Regulations} [PDF, 4.8M]
Timeline:
- September 29th, 2009
NPRM
74 FR 49922 - December 16th, 2009
NPRM Comment Period End - September 2012
Final Action
Effective Date:
These regulations are effective on January 1, 2011,
except for :
- § 413.174(f)(6), which will be effective on January 1, 2014 and
- § 413.232(f) and § 413.239(b), which will be effective November 1, 2010
Additional Documents:
August 2010
July 2010
- End-Stage Renal Disease Prospective Payment System [Final Rule-Filed 07/26/2010] [PDF, 1.3M]
- Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2011
December 2009
- Medicare Program: Changes to the Medicare Claims Appeal Procedures
- The comment period for the proposed rule on the ESRD Prospective Payment System concluded. Read The Renal Network comments on the proposed rule (PDF, 104KB)
November 2009
- The Proposed Rule for Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for 2010 (CMS-1413-P) (PDF, 14.8M). Also see Corrections page (PDF, 47KB)
September 2009
August 2009
July 2009
Background:
In July 2008, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) was approved by Congress and became law.
The proposed rule provides details on the case mix adjusted bundling prospective payment system (PPS) for Medicare outpatient ESRD dialysis facilities, as outlined in the MIPPA legislation approved in July 2008. When finalized, this proposed rule will become the regulations which govern payment for outpatient ESRD treatment.
The PPS will impact the payment for dialysis services beginning January 1, 2011 and beyond.
Overview of Rule:
1. Summary provided by NephrOnline service of Nephrology News & Issues http://www.nephronline.com/features.asp?F_ID=467
2. Overview provided on the CMS Web site:
http://www.cms.hhs.gov/ESRDPayment/
3. For the complete document of the proposed rule Proposed Rule on Bundling of Payments 9/15/2009 [PDF, 547 pages, 1.2M]
4. Open Door Forum End Stage Renal Disease Prospective Payment System (ESRD PPS) Proposed Rule 10/15/2009 [PDF, 41 slides, 308KB]
5. Read The Renal Network comments on the proposed rule. (PDF, 104KB)