End Stage Renal Disease (ESRD) - JE Part A

On this page, view the below information.

• Billing for ESRD
• Application Requirements
• Application Time Frame

Information is found in CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 10, Section 2.1.C and the CMS IOM, Publication 100-07, State Operations Manual, Chapter 2.

• Entities that perform renal services for patients with irreversible and permanent kidney failure
• Types of ESRD facilities
  • Renal Transplantation Center (RTC) - Is a hospital unit approved to furnish - directly- transplantation and other medical and surgical specialty services required for the care of ESRD transplant patients, including inpatient dialysis furnished directly or under arrangement. Must be a member of the Organ Procurement and Transplantation Network (OPTN).
  • Renal Dialysis Center (RDC) - Is a hospital unit approved to furnish the full spectrum of diagnostic, therapeutic, and rehabilitative services required for the care of ESRD dialysis patients (including inpatient dialysis furnished directly or under arrangement and outpatient dialysis).
    • The RDC need not furnish transplantation services
    • An RTC can also be an RDC
    • Must be hospital-owned and operated, and the hospital must be enrolled in Medicare
  • A separate, independent dialysis unit located in a Medicare-approved hospital cannot be approved as an RTC or RDC
  • Renal Dialysis Facility (RDF) - Is a unit approved to furnish dialysis services directly to ESRD patients as an outpatient provider of dialysis services. A hospital-based RDF "satellite' is one that is hospital-owned and administered but is not located on the hospital premises - a hospital can have multiple RDF satellites.
  • Self-Dialysis Unit (SDU) - is a unit of an approved RTC, RDC or RDF that provides self-dialysis services
  • Special Purpose Renal Dialysis Facility (SPRDF) - is an entity that perform ESRD services on a short-term basis in special situations for patients who cannot otherwise receive treatment in the geographical area. SPRDFs can be approved to serve vacation areas and in emergency situations.

Billing for ESRD

• For more information regarding billing, go to the billing portion of the website.

Application Requirements

• Each type of ESRD facility must enroll as an ESRD facility via the Form CMS-855A. Since the Form CMS-855A does not distinguish between the different types of ESRD facilities, the following principles apply
  • If an enrolled Renal Transplantation Center (RTC) also wants to become a Renal Dialysis Center (RDC), the provider must submit a new, complete Form CMS-855A for the RDC. For enrollment purposes, the RTC and the RDC will be treated as two separate ESRD facilities
  • If an enrolled ESRD wants to change to another type of ESRD, the provider need not submit an 855A change of information (if this is the only change to the provider's enrollment data)
• ESRD entities/facilities cannot be mobile

Application Time Frame

Note:

1. Once Noridian has completed the reviewal of the application, a Recommendation for Approval Letter is sent to the State Agency and CMS. There is no set timeframe for their review.
2. Additional days after State and CMS approval Noridian will have additional days to finalize enrollment records.