US · guidance
CMS Pub. 100-04, ch. 8, § 10.3
No-Shows
If a facility sets up in preparation for a dialysis treatment, but the treatment is never
started because the patient never arrives, no payment is made. In this case, no service has
been furnished to a Medicare beneficiary even though staff time and supplies may have
been used. Furthermore, the facility may not bill the patient or the patient’s private
insurance for these services. This is because the program is already paying the cost of
pre-dialysis services through the PPS base rate. In setting that rate, CMS has included
the salaries of facility personnel and the cost of supplies used for furnishing pre-dialysis
services.
Therefore, these costs (e.g., salaries for staff time, overhead, supply costs) are included in
the facility’s costs and reported on its cost report, and they are included in the allowable
costs used to set future reimbursement rates under the End Stage Renal Disease
Prospective Payment System (ESRD PPS) for ESRD facilities. However, these costs
may not be used as the basis for a facility to be reimbursed as Medicare bad debts.
History
(Rev. 10640, Issued:08-06-21, Effective:09-07-21, Implementation:09-07-21)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
f104fc4f184289b01b31db232c9e283f0f3d6cd1e6ff1b4678bee34e6e60d7b4
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