2014 marked the first year that all End-Stage Renal Disease (ESRD) facilities were paid under the End-Stage Renal Disease Prospective Payment System (ESRD PPS). This payment system reflects an attempt by CMS to both improve patient care and control costs. The base payment model combines payments for the composite rate and separately billable renal dialysis items and services.
ESRD providers are also participating in the End-Stage Renal Disease Quality Incentive Program (ESRD QIP). Adjustments are made to the Medicare reimbursements based on how the provider performs in the 11 quality measures for CY2014. This data effects payments for CY2016 and the maximum payment reduction is 2 percent.
CMS publishes an informative ESRD PPS fact sheet ICN 905143 that can be found at www.cms.gov.
Adults with diabetes, high blood pressure, or both have a higher risk of developing chronic kidney disease than those without these diseases.
High Blood Pressure Facts:
It is estimated 1 of 3 U.S. adults – or 67 million people – have high blood pressure.
Only about half (47%) of these people have their high blood pressure under control.
It is estimated 9.3% of the population – or 29.1 million people – have diabetes.
Only about 72.2% have been diagnosed which leaves nearly 8.1 million people untreated.
Chronic Kidney Disease (CKD) and End-Stage Renal Disease (ESRD) Facts:
Approximately 1 of 3 adults with diabetes and 1 of 5 adults with high blood pressure have chronic kidney disease.
It is estimated 10% of the adult population may suffer from CKD, this equates to more than 20 million people.
In 2011, over 100,000 patients in the United States started treatment for ESRD.
Diabetes and hypertension are the leading causes of ESRD. In 2011, diabetes or hypertension was listed as the primary cause for 7 of 10 new cases of ESRD in the United States.
With the Affordable Care Act (ACA) CMS has developed an extensive panel of preventive
services many of which help to combat both high blood pressure and diabetes.
Iridium Suite Practice Management Software can provide your medical practice with all the tools you need to collect the proper reimbursement for not just preventive services, but all those that you provide. Contact us for a free demo today!
Annual Wellness Visit, Including Personalized Prevention Plan Services
G0438 – Initial visit
G0439 – Subsequent visit
Cardiovascular Screening Blood Tests
80061 – Lipid panel, this panel must include the following:
82465 – Cholesterol, serum, total
83718 – Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol)
84478 – Triglycerides
82947 – Glucose; quantitative, blood (except reagent strip)
82950 – Glucose; postglucose dose (includes glucose)
82951 – Glucose; tolerance test (GTT), 3 specimens (includes glucose)
Diabetes Self-Management Training
G0108 – DSMT, individual, per 30 minutes
G0109 – DSMT, group (2 or more), per 30 minutes
Initial Preventive Physical Exam ("Welcome to Medicare" Physical Exam)
G0402 – IPPE
G0403 – EKG for IPPE
G0404 – EKG tracing for IPPE
G0405 – EKG interpret & report for IPPE
Intensive Behavioral Therapy for Cardiovascular Disease
G0446 – Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes
Intensive Behavioral Therapy for Obesity
G0447 – Face-to-face behavioral counseling for obesity, 15 minutes
Medical Nutrition Therapy (for Medicare beneficiaries with diabetes or renal disease)
97802 – MNT; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes
97803 – MNT; re-assessment and intervention, individual, face-to-face with the patient each 15 minutes
97804 – MNT; group (2 or more individual(s)), each 30 minutes
G0270 – MNT reassessment and subsequent intervention(s) for change in diagnosis, individual, each 15 minutes
G0271 – MNT reassessment and subsequent intervention(s) for change in diagnosis, group (2 or more), each 30 minutes
Tobacco-Use Cessation Counseling Services
G0436 – Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than3 minutes, up to 10 minutes
G0437 – Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes
With HBP and diabetes both having such an influence on the development of CKD, it is crucial that Medicare beneficiaries take full advantage of the Medicare covered benefits that can prevent and control these two conditions.
For a complete guide of Medicare covered preventive services, look up ICN 006559 at www.cms.gov.