Effective Date: January 1, 2011

Implementation Date: January 3, 2011

The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters article MM7064 to announce the implementation of an end-stage renal disease (ESRD) bundled prospective payment system (PPS). The ESRD PPS is effective for services on or after January 1, 2011; therefore, it is important that providers not submit claims spanning dates of service in 2010 and 2011. However, ESRD facilities may make a one-time election to be excluded from the transition period and have their payment based entirely on the payment amount under the ESRD PPS. Facilities wishing to exercise this option must do so on or before November 1, 2010.

The ESRD PPS will replace the current basic case-mix adjusted composite payment system and the methodologies for the reimbursement of separately billable outpatient ESRD related items and services. The ESRD PPS will provide a single payment to ESRD facilities (i.e., hospital-based providers of services and renal dialysis facilities). The payment will cover all the resources used in providing an outpatient dialysis treatment, which includes the following:

The ESRD PPS provides ESRD facilities a four-year transition period under which they would receive a blend of the current payment methodology and the new ESRD PPS payment. In 2014, the payments will be based 100 percent on the ESRD PPS payment.

Here is the link to the MLN Matters article MM7064 .