Subdomain IV. A.1 Revenue Cycle and Reimbursement ESRD Reimbursement - Practice with ESRD Patient Multipliers (PM) INSTRUCTIONS Create the table as reflected below and label it "Table 1 - Practice with ESRD Patient Multipliers (PM)". Complete Table 1, based on the description of Sam's ESRD services provided March 20 - September 20, 2015. Add the applicable values, ESRD Patient Multipliers and calculate the payment where indicated. Show your work and completed all of the necessary columns, boxes, etc. STEP 1 - ADJUSTED FOR GEOGRAPHIC FACTORS STEP 2 - ADJUST FOR PATIENT & FACILITY CHARACTERISTICS STEP 3 - POLICY ADJUSTMENTS FOR BENEFICIARY ENCOUNTERS THAT QUALITY SCENARIO Sam, a 30-year-old male, began in-center HD on March 20, 2015. His ESRD services were provided from March 20 - September 20, 2015. The wage index for the Dialysis Facility is 0.969 and Base Rate is $239.43. Sam has type II diabetes mellitus and sickle cell anemia and is Medicare ESRD eligible. Because the patient has family caregivers available to assist him, Sam expressed a desire to become a Peritoneal Dialysis (PD) patient. His nephrologist agreed that Sam was a suitable candidate for Continuous Ambulatory Peritoneal Dialysis (CAPD). The onset dialysis adjustment is 1.510. On June 20, 2015, Sam began a series of 12 training treatments at his dialysis facility (one which does not qualify for the low-volume adjustment, but which is certified to provide home dialysis training) to transition to CAPD. These training treatments ended on July 21, 2015. Between July 18 and July 21, Sam had 2 training treatments. Sam successfully began CAPD on July 23, 2015, Sam is 170 cm in height and weighs 78 kg. Sam's BMI equals 26.99. Sam's BSA equals 1.8949 and the BSA Patient Multiplier (PM) is 1.0049. Table 1 - Practice with ESRD Patient Multipliers (PM) STEP 1 - ADJUSTED FOR GEOGRAPHIC FACTORS Adjustment Calculation/Value Use in Payment Determination? Y/N BASE RATE Wage Index Adjusted By Area Wages Non-Labor Related Portion Base Rate adjusted for geographic factors (BRAGF) (Wage Index adjustment for ESRD PPS) Provide formula and Calculate BRAGF (Refer to Figure 7.15 & 7.18 in your textbook) STEP 2 - ADJUST FOR PATIENT & FACILITY CHARACTERISTICS Adjustment Calculation/Value Use in Payment Determination? Y/N Low-volume facility Not a low-volume facility N (LVF) Patient age State age and Age PM value ( refer to: Table 7.18 in your textbook) Body surface area (BSA) PM VALUE BMI (body mass index) Low body mass index BMI New patient (onset of dialysis) Indicate the number of days and date range Onset Dialysis Adjustment (ODA) Specified comorbidities State Comorbidities & PM value (refer to Table 7.19 in your textbook) 2 Fully Adjusted Base Rate (FABR) (Adjusted for Patient & Facility Characteristics) Calculate FABR (Refer to Figure 7.18 in your textbook and formula below) Formula: (BRAGF x BSA x PM x BMI x ODA) (aka PPS FACTORS) STEP 3 - POLICY ADJUSTMENTS FOR BENEFICIARY ENCOUNTERS THAT QUALITY Outlier Payment No Outliers Self-dialysis add-on adjustment FINAL PAYMENT Provide formula and Calculate Final Payment (Refer to Figure 7.18 for the formula in your textbook) 3