End Stage Renal Disease (ESRD) Low Volume Facility Adjustment

The Medicare Improvements for Patients and Providers Act (MIPPA); Section 153(b) requires the Centers for Medicare & Medicaid services (CMS) to implement an End Stage Renal Disease (ESRD) bundled prospective payment system (PPS) effective January 1, 2011.

Change Request (CR) 7064 issued January 14, 2011 outlines the new ESRD PPS system as well as a new adjustment applicable to the ESRD PPS payment rate.

Low Volume Facility Adjustment: Providers will receive an adjustment to their PPS rate when the facility furnished less than 4,000 treatments in each of the three years preceding the payment year and has not opened, closed, or received a new provider number due to a change in ownership during the 3 years preceding the payment year. The provider must notify their Medicare Contractor if they believe they are eligible for the low volume adjustment. A complete request would include a cover letter from the provider and support to show that less than 4,000 treatments were provided in each of the 3 years preceding the payment year. This package should be submitted to Kristi Rohrich, WPS Cost Report Audit Supervisor. Contractors will then validate the eligibility and update the provider specific file so that the provider will begin receiving the adjusted payment.

The official instruction, CR 7064, issued to FIs and/or A/B MACs regarding this change may be viewed at http://www.cms.gov/Transmittals/downloads/R2134CP.pdfAdobe Portable Document Format on the CMS website.

Page Last Updated: Thursday, 15-Dec-2011 14:48:02 CST