36222

FISS Narrative
Revenue codes 821, 880, 881, 831, 841 or 851 are present on an End State Renal Disease (ESRD) claim with condition code 74 for a beneficiary who has not selected Method I.

  1. If an ESRD beneficiary selection form (CMS-382) has not been completed, ask the beneficiary complete the form. Submit the completed form to Palmetto GBA.
  2. If the CMS-382 form has been submitted, verify the type of method that the patient has selected and bill accordingly
  3. Check the condition code(s). Condition code 74 is for home patients only.
  4. Check the revenue code(s) billed

Note: Online users, make corrections and F9 to update the claim.

Explanation and Suggestions:
This reason code indicates that there is a discrepancy between the services being billed and the ESRD Method of Dialysis code stored on the Common Working File (CWF). Ensure that the dialysis revenue code on the claim is correct for the type of dialysis received by the patient.

  • If the revenue code is correct, check the Method of Dialysis cked on CWF by accessing the Beneficiary/CWF screen (menu option #10 on FISS DDE)
  • Go to page two of the CWF data to verify the Method selection in the ESRD CD/DATE field. If the Method on CWF is not correct, correct this by inputting the correct Method selection information from the CMS 382 form for this particular patient.
  • You may enter this form on FISS DDE by choosing #02 from the Main Menu and then choosing #57 (ESRD CMS-382 Form) on the Claims and Attachments Entry Menu
  • Once the Method selection is updated on CWF (two to three days), PF9 (update) to allow the claim to continue processing

Note: Per Change Request (CR) 7064, for claims with dates of service on or after January 1, 2011, payment for home dialysis items and services furnished under Method II is included in the ESRD PPS payment rate, regardless of home treatment modality. Therefore, all home dialysis claims:

  • Must be submitted by a renal dialysis facility
  • Will be processed as Method I claims

CR 7064 instructs DME MACs to stop separate payment to suppliers for Method II home dialysis items and services. All 72x claims from Method II facilities with condition code 74 will be treated as Method I claims as of January 1, 2011. Effective that same date, Medicare will no longer enter Method Selection Forms data into its system.

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Provider Contact Center: 855-696-0705

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