Dialysis ESRD Bundled Payment Reconciler
$3,174.10 in Medicare ESRD prospective payment underpayments recovered across across 3 items.
Home training add-on omitted on 15 eligible training sessions ($95.60 x 15 = $1,434.00 under CMS Rule 2).
Method1Recalculated facility payment rates incorporating case-mix comorbidities and home training add-ons.
2Engineered automated claim adjustment batch file for Medicare administrative contractor resubmission.
| Reference | Description | Underpaid_Reimbursement |
|---|---|---|
| CLM-502 | Home Dialysis Training Add-On Omission | $1,434.00 |
| CLM-504 | High-Cost Treatment Outlier Payment Omission | $1,250.00 |
| CLM-501 | Acute Comorbidity Case-Mix Adjustment Omission | $490.10 |
Outpatient dialysis clinic billing lines, plus CMS End-Stage Renal Disease (ESRD) PPS payment formula
ESRD PPS underpayment schedule and CMS claim adjustment submission file (Resolution Dossier, Findings Schedule)
Run Dialysis ESRD Bundled Payment Reconciler free on the last 12 months of files. If it finds money, the fee is 15 percent of what is actually recovered, nothing on what is not. After that, ongoing monitoring is $1,750 a month. 30% goes to the referring partner.
Read in memory for the session, never stored, never used to train a model.
Not medical, clinical, coding or regulatory advice. A qualified healthcare, coding or regulatory professional must review every result. Letters, notices and legal analysis are drafts, not legal advice. Have a qualified lawyer review them before they are sent or relied on.
Free scan. Pay only on cash recovered.
Run Dialysis ESRD Bundled Payment Reconciler free on the last 12 months of files. If it finds money, the fee is 15 percent of what is actually recovered, nothing on what is not. After that, ongoing monitoring is $1,750 a month.
On a sample file: $3,174.10 in Medicare ESRD prospective payment underpayments recovered across across 3 items.
Why not just use ChatGPT?
Rules that stay current: the rate cards, tariffs, code sets and regulations it checks against are kept up to date for you; a one-off prompt starts from nothing each time. Evidence that stands up: every finding cites the line, the file and the rule, so it holds up with a vendor, a payer or an auditor. The same answer every time: the checks are written rules, not a fresh guess, so this month's result can be compared with last month's. Nobody has to own it: no one inside has to build, test and maintain a home-made tool, and files are not pasted into a public chatbot.
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If you would rather talk it through, write to dev.sathya@baseloom.app; that reaches Dev Sathya, founder.