11 Oct Medicare Low-Volume Adjustment
It’s that time again.
Time to see if you qualify for the low volume reimbursement from Medicare. CMS implemented the Low Volume Payment Adjustment (LVPA) to compensate dialysis facilities that provided a low volume of dialysis treatments, to offset high costs and ensure access to care. CMS adjusts the base rate for low volume ESRD facilities.
Definition of low-volume facility, outlined in paragraph (b) is an ESRD facility that: (1) Furnished less than 4,000 treatments in each of the 3 years preceding the payment year; and (2) Has not opened, closed, or had a change in ownership in the 3 years preceding the payment year.
To receive the low-volume adjustment, an ESRD facility must include in their attestation provided pursuant to paragraph (e) a statement that the ESRD facility meets the definition of a low-volume facility in paragraph (b).
The number of treatments considered furnished by the ESRD facility shall equal the aggregate number of treatments furnished by the ESRD facility and the number of treatments furnished by other ESRD facilities that are both
- Under common ownership with, and
- 25 miles or less from the ESRD facility in question.
The determination does not apply to an ESRD facility that was in existence and certified for Medicare participation prior January 1, 2011. Common ownership means the same individual, individuals, entity, or entities, directly, or indirectly, own 5 percent or more of each ESRD facility.
To receive the low-volume adjustment, an ESRD facility must provide an attestation statement to their Medicare administrative contractor that the facility has met all the criteria as established above. The low-volume adjustment applies only for dialysis treatments provided to adults (18 years or older). To read more please Click Here.
To receive the low volume adjustment, ESRD providers must submit an attestation signed by the managing director or official of their organization by November 1 preceding the next ESRD prospective payment system (PPS) payment year that includes the following information:
- Provider name
- Medicare provider number (PTAN) and National Provider Identifier (NPI)
- Provider’s physical address (including building/suite/room number, etc.)
- ESRD certification date
- Is your facility a free standing facility or hospital based?
- Has the facility opened, closed, or had a change in ownership in the three years preceding the payment year?
- If there was a change of ownership, did it result in a change of PTAN?
- Is this ESRD part of common ownership?
- If yes, please provide the organization’s name
- Distance between ESRD provider and nearest commonly owned ESRD providers (within five miles or less)
- Treatment counts for other commonly owned ESRD providers that are within five miles or less of each other.
- Provider contact name (please print)
- Provider contact phone number
- Provider contact email address
- Director or official signature
In addition, providers should submit cost report worksheet C (for free standing ESRD providers) and cost report worksheet I-4 (for hospital based ESRD providers) for the three 12 month cost reporting periods immediately preceding the ESRD PPS payment year. For ESRD providers with a December 31 fiscal year end, please provide a projection of the number of treatments for the third eligibility year. Once the current year December 31 cost report is received, treatment numbers will be verified.
If a provider determines that they are no longer qualified to receive the low volume facility adjustment based on the following criteria, they must notify CMS.