End-Stage Renal Disease Facility (ESRD)

On this page, view the below information.

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

Application Tips
PECOS application
  • "Institutional Provider" (e.g., Hospital, Skilled Nursing Facility, Hospice, Home Health Agency)
  • Complete questionnaire to ensure correct applications (CMS-855A and CMS 588-EFT) populate.
CMS-855A
  • Complete all form sections
  • Attach all supporting documentation such as IRS documents
  • List all directors, board members, and contracted or W-2 managing employee
  • Visit the Application Fee webpage to access CMS link to pay application fee
CMS-588 EFT
  • Submit completed CMS-588 EFT and voided check/bank letter. EIN required to be on application in Tax Identification Number (TIN) field

 

  • 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

  • Once Noridian has completed the reviewal of the application, a Recommendation for Approval Letter is sent to the state agency and CMS Survey & Operations Group. Below are the time frames in which Noridian has to review the application
Application Type Processing Time
PECOS On average, it can take 15 calendar days before application is sent to the state and CMS for approval
Paper On average, it can take 30 calendar days before application is sent to the state and CMS for approval

 

  • The state agency and the CMS Survey & Operations Group (SOG) Locations (formerly CMS Regional Offices and hereafter referenced as “SOG Locations.”) work together on the approval process. Once the SOG Locations have all the required information, they will issue the approval letter. This is sent to the provider and to Noridian.
  • After receiving the tie-in Noridian has 21 days to complete the application.

 

Last Updated Mon, 24 May 2021 18:43:26 +0000