decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
Medicare_Carriers_Manual / 4270 / 4270
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Article Overview
This article explains Medicare claim processing procedures for end stage renal disease (ESRD) services. It is relevant to physicians, independent laboratories, beneficiaries, dialysis equipment and supply suppliers, and ESRD facilities, and it outlines the general claim submission pathways used by carriers, DMERCs, and fiscal intermediaries.
Why This Topic Matters
Correct claim routing is essential for ESRD-related billing because different provider and supplier types submit to different Medicare entities. Understanding these submission channels helps readers determine whether the article applies to their billing workflow.
Article Sections
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4270. ESRD Bill Processing Procedures
General Medicare claim submission procedures for ESRD-related services and supplies, including the main parties involved and the responsible claim-processing entities.
What You Will Learn
- How ESRD-related claims are generally routed under Medicare.
- Which provider and supplier categories are addressed in the billing procedure guidance.
- Which Medicare processing entities are referenced for different ESRD claim types.
- The scope of claim submission responsibilities for ESRD services and supplies.
Who Should Read This
- Physicians
- Independent laboratories
- Beneficiaries
- Dialysis equipment and supply suppliers
- ESRD facilities
- Medical billers and coders
- Medicare claims staff
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