2025-03-25-MLNC

In the CY 2016 ESRD Prospective Payment System (PPS) final rule, CMS updated regulations to incorporate renal dialysis service drugs and biological products with only an oral form into the ESRD PPS bundled payment starting January 1, 2025. Phosphate binders are paid as a renal dialysis service under Medicare Part B effective January 1, 2025. 

As a reminder, phosphate binders aren’t separately payable under Medicare Part D when provided for the treatment of ESRD to a Medicare beneficiary receiving dialysis. When a resident of a nursing home receives dialysis, the regulation requires that the ESRD facility must have a written agreement (PDF) with the nursing home that outlines the responsibility of each entity. The ESRD facility can bill Medicare Part B for renal dialysis services that it furnishes directly or under arrangements, including arrangements it makes with the nursing home. 

See Including Oral-Only Drugs in the ESRD PPS Bundled Payment (PDF) for more information. 

Enrolled skilled nursing facilities should collect data on ownership, managerial, and related party information and submit their revalidation by May 1.  See Become a Medicare Provider or Supplier for more information. 

Last fall, your Medicare Administrative Contractor sent you a revalidation notice. 

Find out when your patient is  eligible for most of these services. (PDF) If you need help, contact your eligibility service provider. 

See Preventive & Screening Services to get information for your patients. 
 

Colorectal Cancer: Screening Saves Lives 

Learn about quarterly updates to the following average sales price and not otherwise classified pricing files: 

See the instruction to your Medicare Administrative Contractor (PDF). 
 

National Correct Coding Initiative: April Update