Rob Blaser
@robertblaser.bsky.social
Health policy analyst focusing on kidney care delivery issues, competent home cook, DC area sports fan. He/him. #NephSky
The other extender package items (GPCI floor and low volume hospital payments, for example) will be handled similarly. RPA will keep on top of this and keep the nephrology/kidney policy community advised in as real-time a manner as possible. Take care and be kind to others. (2/end).
November 12, 2025 at 2:25 PM
The other extender package items (GPCI floor and low volume hospital payments, for example) will be handled similarly. RPA will keep on top of this and keep the nephrology/kidney policy community advised in as real-time a manner as possible. Take care and be kind to others. (2/end).
More to come, Happy Halloween. (8/end).
November 1, 2025 at 12:30 AM
More to come, Happy Halloween. (8/end).
Recall that this is the first year of the two-conversion factor system mandated by MACRA that gives a higher bonus for qualifying APM participants and a lower increase for non-qualifying Medicare Part B providers. (7)
November 1, 2025 at 12:29 AM
Recall that this is the first year of the two-conversion factor system mandated by MACRA that gives a higher bonus for qualifying APM participants and a lower increase for non-qualifying Medicare Part B providers. (7)
"Similarly, the final CY 2026 nonqualifying APM conversion factor of $33.40 represents a projected increase of $1.05 (+3.26%) from the current conversion factor of $32.35.” (6)
November 1, 2025 at 12:29 AM
"Similarly, the final CY 2026 nonqualifying APM conversion factor of $33.40 represents a projected increase of $1.05 (+3.26%) from the current conversion factor of $32.35.” (6)
Regarding the conversion factor, this too is unchanged from what was proposed; per the CMS press release on the rule, “the final CY 2026 qualifying APM conversion factor of $33.57 represents a projected increase of $1.22 (+3.77%) from the current conversion factor of $32.35. (5)
November 1, 2025 at 12:28 AM
Regarding the conversion factor, this too is unchanged from what was proposed; per the CMS press release on the rule, “the final CY 2026 qualifying APM conversion factor of $33.57 represents a projected increase of $1.22 (+3.77%) from the current conversion factor of $32.35. (5)
Accordingly, changes to the dialysis code family and to E&M codes are as proposed in July, healthy increases for outpatient E&M services/corresponding cuts to I/P E&M codes. One change made to the efficiency adjustment proposal is to exempt new codes from the adjustment. (4)
November 1, 2025 at 12:28 AM
Accordingly, changes to the dialysis code family and to E&M codes are as proposed in July, healthy increases for outpatient E&M services/corresponding cuts to I/P E&M codes. One change made to the efficiency adjustment proposal is to exempt new codes from the adjustment. (4)
Thus, the -9.4% hit for (for example) CPT code 90935 (inpatient dialysis) and the +9.0 increase for 90960 (adult monthly dialysis) are still as proposed. (3)
November 1, 2025 at 12:27 AM
Thus, the -9.4% hit for (for example) CPT code 90935 (inpatient dialysis) and the +9.0 increase for 90960 (adult monthly dialysis) are still as proposed. (3)
So, nephrology is still slated to have a projected impact of +1%, and the inpatient/outpatient dichotomy is in July, as the methodological changes for the work RVUs (via the efficiency adjustment) and the practice expense RVUs (via changes to indirect PEs) are still in place. (2)
November 1, 2025 at 12:27 AM
So, nephrology is still slated to have a projected impact of +1%, and the inpatient/outpatient dichotomy is in July, as the methodological changes for the work RVUs (via the efficiency adjustment) and the practice expense RVUs (via changes to indirect PEs) are still in place. (2)
The MLN post ended up being correct, CMS issued a clarification last night that aligned with the MLN post and thus the vast majority of claims will be paid as scheduled.
October 16, 2025 at 12:48 PM
The MLN post ended up being correct, CMS issued a clarification last night that aligned with the MLN post and thus the vast majority of claims will be paid as scheduled.
Great question. There was much communication (confusion?) yesterday that all payments were paused per a CMS announcement, but the original Medicare Learning Network (MLN) post said it only claims for expiring provisions were being held, like those for telehealth. (1)
October 16, 2025 at 12:46 PM
Great question. There was much communication (confusion?) yesterday that all payments were paused per a CMS announcement, but the original Medicare Learning Network (MLN) post said it only claims for expiring provisions were being held, like those for telehealth. (1)
Very kind Charlotte, thank you. Great seeing you and I hope you had an uneventful trip home.
October 14, 2025 at 11:02 PM
Very kind Charlotte, thank you. Great seeing you and I hope you had an uneventful trip home.
So, given the good chance that a Medicare extenders package happens before say year's end, the flexibilities should be extended then. Stay tuned. (4/end)
September 25, 2025 at 1:50 PM
So, given the good chance that a Medicare extenders package happens before say year's end, the flexibilities should be extended then. Stay tuned. (4/end)
Whether that lasts for days/weeks/months no one knows, but practices should be adjusting their schedules accordingly. The positive news IMO is that everyone on the Hill seems to agree that the telehealth flexibilities should be extended if not made permanent. (3)
September 25, 2025 at 1:49 PM
Whether that lasts for days/weeks/months no one knows, but practices should be adjusting their schedules accordingly. The positive news IMO is that everyone on the Hill seems to agree that the telehealth flexibilities should be extended if not made permanent. (3)
While I was pretty bullish that this would get resolved prior to 9/30 earlier this year, now it looks pretty likely that there will be a lapse in the flexibilities with an almost certain government shutdown. (2)
September 25, 2025 at 1:49 PM
While I was pretty bullish that this would get resolved prior to 9/30 earlier this year, now it looks pretty likely that there will be a lapse in the flexibilities with an almost certain government shutdown. (2)
Charlotte, the chances of it getting resolved by September 30 are slim to nonexistent. My guess is the flexibilities will be extended by years’ end but when that happens, who knows?
September 25, 2025 at 1:28 AM
Charlotte, the chances of it getting resolved by September 30 are slim to nonexistent. My guess is the flexibilities will be extended by years’ end but when that happens, who knows?
Folks, there was a error in my MFS post this A.M., the 'all others' CF increase for 2026 will be about $3.30, not $3.62. The 2nd figure ($3.62) was from the CMS Newsroom press release on the rule, but that's no excuse, I should have double checked the math. Sorry about that.
July 18, 2025 at 8:01 PM
Folks, there was a error in my MFS post this A.M., the 'all others' CF increase for 2026 will be about $3.30, not $3.62. The 2nd figure ($3.62) was from the CMS Newsroom press release on the rule, but that's no excuse, I should have double checked the math. Sorry about that.
Comments on the proposed rule are due on September 12. (12/end).
July 18, 2025 at 2:21 PM
Comments on the proposed rule are due on September 12. (12/end).
creation of a new payment model focused on heart failure and low back pain, a change to the Medicare Diabetes Prevention Program to facilitate greater access to the program, and an effort to reduce Medicare spending on skin substitutes, among others. (11)
July 18, 2025 at 2:21 PM
creation of a new payment model focused on heart failure and low back pain, a change to the Medicare Diabetes Prevention Program to facilitate greater access to the program, and an effort to reduce Medicare spending on skin substitutes, among others. (11)
Those are the foundational changes this year, there are of course numerous other proposals (it's an 1800 page rule), on telehealth (but not about extension of the current flexibilities, Congress has to do that), (10)
July 18, 2025 at 2:20 PM
Those are the foundational changes this year, there are of course numerous other proposals (it's an 1800 page rule), on telehealth (but not about extension of the current flexibilities, Congress has to do that), (10)