Effective Dates: 03/29/2022 - Present
Identification Number:
| EM-22018
|
| Intended Audience: | All RCs/ARCs/ADs/PSCs/OCO/CSTs |
| Originating Office: | DCO OPSOS |
| Title: | Instructions for Handling End Stage Renal Disease (ESRD) Notice and DUMAS Exceptions |
| Type: | EM - Emergency Messages |
| Program: | All Programs |
| Link To Reference: |  |
|
Retention Date: March 23, 2025
A. Purpose
This emergency message provides instructions to technicians when they become aware of an ESRD notice or DUMAS exception that has been routed to any Processing Center (PC) other than PC7.
B. Background
PC7 processes all manual ESRD actions. However, in early 2021, MCS enhancements were made to allow processing of many ESRD claims. The enhancements allowed more ESRD claims to process through Earnings Clearance (EC), requiring PC7 to process less awards. There are times when, due to systems limitations, the award notice cannot be generated automatically, and a notification is sent to AURORA. There are also some instances when an MBR cannot be established, and a DUMAS exception is generated. When these exceptions occur, the action is sent to the PC with jurisdiction of the MBR, which is not always PC7.
C. Procedure for ESRD Notice Exceptions
When a technician from a PC other than PC7 finds a notice exception in AURORA that is associated with an ESRD award, the technician should not attempt to release the notice. Instead,
1. Send an email to ||OCO ODO OSB Medicare with subject “ESRD Notice Exception.”
2. Manually delete the notice from AURORA
D. Procedure for ESRD DUMAS Exceptions
When a technician from a PC other than PC7 finds a DUMAS exception related to an ESRD award, the technician should not attempt to resolve the exception. Instead,
1. Through Paperless, fax the DUMAS exception ACR to PC7 at (877) 385-0643
2. If Paperless action fails, the technician will contact the OSB Medicare Analyst within their PC for review.
a. If necessary, the OSB Medicare Analyst will send an email for the ESRD DUMAS exception to ||OCO ODO OSB Medicare with subject “ESRD DUMAS exception output”
Closing paragraph:
Direct all program-related and technical questions to your Regional Office (RO) support staff or PC Operations Analysis (OA) staff. RO support staff or PC OA staff may refer questions, concerns or problems to their Central Office contacts.
EM-22018 - Instructions for Handling End Stage Renal Disease (ESRD) Notice and DUMAS Exceptions - 03/29/2022