Changes to the End Stage Renal Disease (ESRD) PRICER to Accept the New Outpatient Provider Specific File Supplemental Wage Index Fields, the Network Reduction Calculation and New Value Code for Time on Machine
This article informs you about the changes to the ESRD PRICER software, the new value code
required for reporting minutes of dialysis provided during the billing period. Also, the article
explains the ESRD Network Reduction calculations from the Fiscal Intermediary Shared System
(FISS) into the PRICER and requires MACs to adjust claims for retraining treatments to correct
the network reduction. Make sure your billing staffs are aware of these changes.
Effective January 1, 2011, the Centers for Medicare & Medicaid Services (CMS) implemented
the End Stage Renal Disease (ESRD) Prospective Payment System (PPS) based on the
requirements of Section 1881(b)(14) of the Social Security Act (the Act). The ESRD PPS
provides a single per treatment payment to ESRD facilities that covers all of the resources used
in furnishing an outpatient dialysis treatment.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: September 24, 2020
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.