Utilization of REMIS for A/B MAC (B) Claims Adjudication

200 – Utilization of REMIS for A/B MAC (B) Claims Adjudication (Rev. 82, 02-06-04) Renal Management Information System (REMIS) determines the Medicare coverage periods for ESRD patients and serves as the primary mechanism to store and access information in the ESRD Program Management and Medical Information System Database. REMIS is used by CMS and the renal community to monitor the Medicare status, transplant activities, dialysis activities, and Medicare utilization of ESRD patients and their Medicare provider. The following fields are contained in the (Dialysis) auxiliary file: • ESRD Coverage Start Date (The date on which the beneficiary is entitled to Medicare, in some part, because of a diagnosis of End Stage Renal Disease.) • ESRD Coverage Source Code (The source of the information that establishes Medicare-based End-Stage Renal Disease Coverage; A= Part A and Dialysis Training, B= Part A and Dialyzing (No 3 month wait), C= Part A and 3 months after Dialysis, D= Part A and Functioning Transplant, E= Part A and Month of Pre-Transplant Stay, F= Part A and ESRD (Verified Source), Blank= No ESRD Involvement.) • ESRD Coverage Termination Date (The date on which the beneficiary is no longer entitled to Medicare under ESRD Provisions.) • ESRD Coverage Termination Reason (A code that indicates the reason Medicare-based End-Stage Renal Disease Coverage was terminated; codes: A= Month of transplant plus 36 months, B=Last month of chronic dialysis, C= Part A termination, D=Death, E=ESRD ended: other verified source.) • ESRD Dialysis Start Date (A date that indicates when ESRD dialysis started.) • ESRD Dialysis Stop Date (A date that indicates when ESRD dialysis ended.) • ESRD Transplant Start Date (A date that indicates when a kidney transplant operation occurred.) • ESRD Transplant Stop Date (A date that indicates when a kidney transplant failed.) The above data elements are in CWF and stored in the dialysis auxiliary file, which can be used to identify a beneficiary’s ESRD eligibility. This data source will assist carriers in reviewing overpayment determination and accurately processing claims.