RSE ESRD PPS Calculator
The RSE ESRD PPS Calculator is designed to show monthly payments and costs. Users can reconcile actual Medicare payments via the calculator to ensure they are being reimbursed appropriately.
Developed by Mark Stephens of Prima Analytics, this valuable business tool provides key reports such as monthly facility revenue, cost and profit analysis, case-mix analysis, and a three-year forecast.
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The ESRD PPS Payment Formula continues to be more and more complex. Changes to the calculator for 2025: In addition to updating all supporting data and payment factors to the most recent year, the following enhancements have been implemented:
- Implementation of the Two-Tiered Low-Volume Payment Adjustment: CMS has implemented a two-tiered approach to the Low Volume adjustment for 2025. On the facility inputs page, users must select which low-volume treatment tier (if any) they are eligible for.
- Implementation of the Rural Adjustment Phase-out: For facilities in counties that were switched from rural to urban status for 2025, CMS will pay a rural adjustment phase-out payment to mitigate the impacts of the loss of the rural adjustment for affected facilities.
- TDAPA payment calculations added for Vadadustat and for Phosphate Binders: This includes the monthly Phosphate Binder "dispensing fee" added to all claims with phosphate binders.
- Korsuva™ (difelikafalin) moved from TDAPA payments to outlier payment calculations: Korsuva is no longer eligible for TDAPA payments in 2025, but it is now included as an eligible outlier cost.
- Addition of AKI Training as a payment modality: Beginning in 2025 CMS will pay for AKI dialysis treatments in the home setting, as well as paying the training add-on for AKI Training treatments. (For AKI non-training treatments, the "AKI" treatment modality now includes both in-center and home treatments.
ACCESS
The ESRD PPS Calculator is accessible only to Renal Healthcare Association members, it is a complementary tool that members receive as a member benefit. If you are an RHA Member visit the Tools & Resources Library on the online member community Voices to download the latest version (Renal Healthcare Association member login is required).
Not a Member? Join today and enjoy all the member benefits including complimentary access to the RSE Bundle PPS Calculator.
Learn more about how to use this tool to benefit their facility by viewing a previously recorded webinar on Education Station.
This tool is updated periodically to reflect the most recent industry data set.