BRS supports payment policies for many ESRD services, including:
- List of ESRD facilities, searchable by National Provider Identifier (NPI), 6-character CMS Certification Number (CCN) and facility name
- Pricing by facility or ZIP Code
- Facility type (independent vs. hospital-based) pricing differentiation
- Composite rate adjusted by MSA or CBSA-based wage index, patient characteristics (height, weight, age, co-morbid conditions), and other factors
- 50/50 lab pricing logic for Automated Multi-Channel Chemistry Tests (AMCC)
- Automatic composite rate adjustment for home dialysis and training
- Payment for separately billable drugs and labs
- Payment for certain separately billable vaccines
- Automatic inclusion and exclusion of drug and lab codes in/from the composite rate
- Pricing of Epogen when provided in Value Code 68
- Automatic reductions to Epogen allowed amount when Hematocrit and/or Hemoglobin levels exceed specified thresholds
- “Lesser of” Policy for separately payable clinical lab tests and drugs
- Calculation of ESRD PPS bundled rate, including outliers when applicable
- Lab panel pricing based on ATP rates
- Lab NCDs