Agencies
Services
Provider Notice issued 01/12/11
Change in Renal Dialysis Rates Effective
| To;: | Enrolled Hospitals: Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers; and Renal Dialysis Facilities |
| Date: | January 12, 2011 |
| Re: | Change in Renal Dialysis Rates Effective |
The Centers for Medicare and Medicaid Services (CMS) will implement a new bundled payment system effective January 1, 2011, for providers participating in the Medicare End Stage Renal Disease (ESRD) program. The bundled payment base rate will include the actual dialysis treatment, specified injectable drugs including Epogen/Aranesp, and lab services. The final payment may also incorporate patient-specific factors and other add-ons.
The department has historically utilized each dialysis provider’s Medicare composite rate for determining the maximum allowable payment for renal dialysis treatment. Providers have also received add-on payments for certain injectable drugs given in conjunction with the dialysis treatment.
Effective with dates of service on and after January 1, 2011, the department will utilize each provider’s new CMS facility base rate for adjudication of claims, and will no longer calculate add-on payments for injectable drugs, as these are included in the CMS base rate. Providers need to ensure that they are utilizing the correct rate when billing for dialysis services.
Each facility is responsible for providing the department a copy of its CMS rate letter identifying the new CMS base rate. Each facility must also identify its HFS legacy provider number and NPI. This information should be sent to the following address:
Illinois Department of Healthcare and Family Services
Provider Participation Unit
Post Office Box 19114
Springfield, Illinois 62794-9114
Fax: 217-557-8800
Providers should not bill any dates of service on, or after, January 1, 2011, until they have provided the rate letter and received an updated Provider Information Sheet indicating the new base rate. In the event that a provider does bill claims with dates of service on or after January 1st prior to the rate update, those claims will be paid based on the provider’s current rate on file, and it will be the provider’s responsibility to void and rebill those claims. Any time there is a change in rates, it is the provider’s responsibility to notify the department.
The Handbook for Hospital Services will be updated at a later date to identify these changes. The Renal Dialysis Injectable Drug list will also be updated to reflect end dates in coverage for these injectable drugs. Any questions regarding this notice should be directed to your medical assistance consultant in the Bureau of Comprehensive Health Services at 1-877-782-5565.
Theresa A. Eagleson, Administrator
Division of Medical Programs