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Elizabeth M. Whitehorn, Director

Provider Notice issued 04/01/11

Renal Dialysis Rates Effective January 1, 2011

To:​ Enrolled Hospitals: Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers; and Renal Dialysis Facilities​
​Date: ​April 1, 2011
​Re: Renal Dialysis Rates Effective January 1, 2011​

This notice supersedes the January 12, 2011, notice to hospitals and renal dialysis facilities, and the individual provider rate letters sent in mid-February to all participating dialysis providers.

The department had outlined a plan to implement a new bundled rate, patterned after the new bundled rate that was effective for the Medicare program January 1, 2011. After additional internal discussion, and discussion with provider groups and other interested parties, HFS administration has determined that implementing the new bundled rate would cause an undue financial hardship to providers. Therefore, for dates of service beginning January 1, 2011, the department will not implement the new rates, but will reimburse at the rates that were in the department's file for each provider as of December 31, 2010. The department will also reinstate add-on payments for Epogen and other specified injectable drugs given in conjunction with dialysis treatment.

Claims that have already been submitted with dates of service January 1, 2011, and after have been placed in hold status by the department. These claims will be released and processed. If Epogen or other injectable drugs and associated charges were not separately identified on the claims, providers must void any affected paid claims and rebill with the drug items for correct payment with the add-ons.

Any new dialysis enrollees will receive the same reimbursement rate that was in effect on December 31, 2010, for providers located in the same geographical area.

Institutional billing requirements will remain the same as those in effect prior to January 1, 2011. Renal dialysis billing instructions are contained in the Handbook for Hospital Services, Appendix H-2c.

The Renal Dialysis Injectable Drug list will be revised to reflect open coverage for Epogen and the other covered 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