It is important to understand the challenges Medicare Advantage plans present for ESRD care. Sarah Tolson reviews the key financial implications of the CMS proposed rule for the ESRD Prospective Payment System. It is essential for nephrology practices and dialysis centers to have backup methods for processing claims. Medicare Advantage plans are posing significant operational and financial hurdles for dialysis programs. The choice of a billing solution, often made under the guise of cost savings, requires a thoughtful approach. The new base rate for CY 2024 is set at $271.02, which is a 2% increase from CY 2023. When collections waver, a facility’s financial health teeters. Advocacy for improved reimbursement is crucial to ensuring continued access to care. Telemedicine has emerged as a game-changer in nephrology. Building a resilient practice