Does the implementation of the Outpatient Prospective Payment System (OPPS) affect hospital-based ESRD facilities?

Yes. Effective for claims with dates of service on or after August 1, 2000, hospital-based ESRD facilities, that are not already doing so, should submit ESRD dialysis and those items and services directly related to the dialysis (e.g. , drugs, supplies) on a separate claim from non-related ESRD dialysis services. Items and services not related to the dialysis must be billed by the hospital using the hospital bill type.

This requirement is necessary to properly pay the non-related ESRD services under OPPS. Reference: CMS Pub. 100-04, Chapter 4, Section 200.2 In certain medical situations in which the ESRD patient cannot obtain their regularly scheduled dialysis treatment in a certified ESRD facility, the OPPS rule for 2003 allows payment for non-routine dialysis treatment in the outpatient department of a hospital that does not have a designation as a certified ESRD.

This treatment has the following limiting circumstances: dialysis performed following or in connection with a dialysis ... more.

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