Update: End Stage Renal Disease Claim Adjustments Needed Due to CWF Error in Date of First Dialysis
As of 7/18/2023, CMS has identified that the CWF continues to have some inaccurate dates for the first date of dialysis. We will advise when this issue is corrected.
The CMS identified a coding error occurred in the transmission of data from the EDB to the CWF resulting in a change in the date of first dialysis.
The initial date of first dialysis that is stored in the CWF is used for determining if ESRD claims, bill type 72X paid through the ESRD PPS, should include a payment adjustment for new ESRD beneficiaries. The onset adjustment is applicable when the LIDOS for dialysis on the 72X TOB is within 120 days of the initial date of first dialysis.
Onset Adjustment Issue
The coding error began 5/1/2022 and resulted in some beneficiary records reflecting the ESRD eligibility date in the date of first dialysis field rather than the initial date of first dialysis. In addition, when the date of first dialysis was after the eligibility date, it was defaulting to the first of the month. The error was corrected on 6/12/2023 and all affected beneficiary records in the CWF were corrected on 6/13/2023.
As a result of the coding error, some ESRD claims did not get the onset adjustment applied correctly; therefore, MACs will adjust affected ESRD claims when brought to their attention by the ESRD provider.
ESRD Facility Action
ESRD facilities should submit their requests for adjustments to correct claim payments where the onset adjustment was not applied correctly for dates of service prior to 6/13/2023.
Submit your adjustment requests in spreadsheet format to the applicable FAX number below and include the following information separated by the state
- Provider number
- DCN
- MBI
- Beneficiary name
- From date
- Through date
- Billed amount
Completed spreadsheets should be sent via FAX
- J6 Providers fax to 1-317-841-4584
- JK Providers fax to 1-315-442-4393
Timely Filing
National Government Services will bypass timely filing requirements and apply condition code 15 as necessary to correct payments. NGS will complete adjustment requests within 120 days of a provider's properly submitted adjustment request.
Posted 10/17/2023