September 19, 2024
On July 10, 2024, Centers for Medicare & Medicaid Services (CMS) released the proposed Physician Fee Schedule for public comment. In their own words, these policies were proposed with an eye toward health equity, accessibility, quality, affordability, empowerment, and innovation for all Medicare beneficiaries. That sounds good to us!
The Physician Fee Schedule (PFS)
The Physician Fee Schedule (PFS) is the annual Medicare regulation that determines how Medicare-enrolled physicians and other clinicians are paid in the upcoming calendar year. This year's regulation covers many Medicare Part B (medical insurance) payment policies, affecting people with kidney disease and the professionals who care for them.
The National Kidney Foundation (NKF) focused its response on key policies for our community, including:
- Covering dental services for Medicare beneficiaries with kidney disease
- Covering compounded immunosuppressive drugs
- Telehealth services
- Quality measures
- Care partner training for home dialysis
Today, we'll focus on dental services. Learn more about the new proposed rule or read the comments here.
Email us with questions, concerns, and ideas for how to make Medicare Part B policies work better.
Background on Dental Services in Medicare
Dental care is essential healthcare for people with kidney disease, but there are gaps in coverage, especially for older adults. Until recently, kidney disease beneficiaries could only access an oral or dental examination performed on an inpatient basis before a transplant surgery.
People with kidney disease enrolled in Medicare Advantage plans may or may not cover dental services. You can learn more by calling Medicare's helpline 1-800-MEDICARE (1-800-633-4227).
What's Happened in the Past?
In 2023, CMS clarified a new policy that covers dental services related to other services that Medicare covers. This is great news for people with kidney disease!
Earlier this year, NKF and ASN requested that CMS expand its coverage policies to include diagnostic and therapeutic dental services for beneficiaries receiving dialysis when not accessing dental services exacerbates their kidney disease.
What's Happening Now?
We fully support the proposal and look forward to its implementation. CMS also asked the public to weigh in on other clinical scenarios involving dental services linked to other covered services. Share your thoughts with us! These changes to policy only matter if they work for patients.
Make your voice heard. Become a Voices for Kidney Health advocate today.
Looking Forward
The Physician Fee Schedule may seem long, confusing, and complicated, but it governs how policy change happens. Even minor tweaks to CMS policy can impact the care experience for kidney patients and professionals across the country. Stay tuned for the next major regulatory update, which will come in the form of the proposed 2026 Medicare Advantage and Part D Rate Announcement. We'll read it for you, so you don't have to.
