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VA Technical Reference Model v 21.9

Medicare End Stage Renal Disease (ESRD) Reimbursement
Medicare End Stage Renal Disease (ESRD) Reimbursement Technology

General InformationGeneral Information help

Technologies must be operated and maintained in accordance with Federal and Department security and privacy policies and guidelines. More information on the proper use of the TRM can be found on the TRM Proper Use Tab/Section.

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Description: Medicare End Stage Renal Disease (ESRD) Reimbursement, also known as Medicare Renal Dialysis Facility, allows for pricing hospital-based and independent renal dialysis claims (Bill Type 072X) based on Medicare ESRD regulations effective for `through` dates on or after January 1, 2009. Payment is calculated based on the Medicare ESRD composite rate, and includes payment calculations for separately reimbursed laboratory tests and certain drugs provided during the session that are not included in the composite rate payment. Adjustments to the composite rate are made based on the beneficiary`s age, body surface area (BSA), and body mass index (BMI). The composite rate is also adjusted according to the ESRD provider`s wage index.

This software does not require the use of a database.

Note: This product does not have a dedicated website.
Technology/Standard Usage Requirements: Users must ensure their use of this technology/standard is consistent with VA policies and standards, including, but not limited to, VA Handbooks 6102 and 6500; VA Directives 6004, 6513, and 6517; and National Institute of Standards and Technology (NIST) standards, including Federal Information Processing Standards (FIPS). Users must ensure sensitive data is properly protected in compliance with all VA regulations. Prior to use of this technology, users should check with their supervisor, Information Security Officer (ISO), Facility Chief Information Officer (CIO), or local Office of Information and Technology (OI&T) representative to ensure that all actions are consistent with current VA policies and procedures prior to implementation.
Section 508 Information: This technology has not been assessed by the Section 508 Office. The Implementer of this technology has the responsibility to ensure the version deployed is 508-compliant. Section 508 compliance may be reviewed by the Section 508 Office and appropriate remedial action required if necessary. For additional information or assistance regarding Section 508, please contact the Section 508 Office at Section508@va.gov.
Decision: View Decisions

Decision Source: TRM Mgmt Group
Decision Process: One-VA TRM v20.9
Decision Date: 09/21/2020
Aliases: Medicare Renal Dialysis Facility
Introduced By: TRM Request
Vendor Name: 3M
- The information contained on this page is accurate as of the Decision Date (09/21/2020).