265-11 ESRD Transmittals
The Medicare Cost Report changes frequently. Health Financial Systems keeps users informed in several different ways; e-mails, live web-ex sessions, news blogs, user meetings and our website. This page gives information about the details of such transmittals.


265-11 Approval Letter
265-11 T-3 from CMS Website

ESRD Transmittal 3

The ESRD, 265-11 system was updated to Transmittal 3 by CMS, in May 2014. Transmittal 3 is effective for cost reporting periods ending on or after March 31, 2014. HFS was approved for Transmittal 3 on June 24, 2014 and the software will be released July 2, 2014.

  • Transmittal 3 changes include:
    • Instructional change on Worksheet A-2, indicating that lines 19 and 20 are not to be completed for purchases on or after January 1, 2012.
    • Instructional change for Worksheet B and B-1, clarifying that negative amounts are excluded when allocating A&G and Other Cost
    • Instructional change to Worksheet E, Part I, line 19 indicating that the sequestration adjustment is not to be computed where negative net reimbursement is reported on line 16.
    • Minor description changes on the following forms:
      • S, Part II
      • S, Part III
      • S-1, line 13.01
      • A-2, lines 19 and 20
      • Worksheet B, Column 1
      • Worksheet B-1, Column 1, 8A, 11A, 13A
      • Worksheet E, Part I, lines 2.01, 2.02, 12, 16
      • Worksheet E-1 note
      • Worksheet F, Column 1 description and lines 48 and 49
      • Worksheet F-1, Column headings and line 4
    • Description changes for edits: 1060, 1005S, 1010S, 1020S, 1000A
    • New Level One edits: 1022S, 1005A, 1000C, 1010C, 1010D, 1010E



ESRD Transmittal 2

The ESRD, 265-11 system was updated to Transmittal 2 by CMS, in June 2013. Transmittal 5 is effective for FY overlapping 4/1/2013, for the Sequestration reduction (i.e. all FYE on or after 4/1/2013 MUST use Transmittal 2). In addition Transmittal 2 includes bad debt changes effective for FY Begin on or after 10/1/2012.

  • HFS was approved for Transmittal 2 on August 5, 2013.
  • Transmittal 2 changes included:
    • Effective for cost reporting periods ending on or after 12/31/2012 ESRD facilities will no longer report statistics relating to Epoetin or Aranesp on Worksheet S-1 lines 14 and 15 respectfully. Instead all erythropoiesis stimulating agent (ESA) statistics will be reported on line 15.01-15.99. Each type of ESA administered should be reported as a separate subscript beginning with line 15.01.
    • Rebates taken on epoetin and aranesp purchased between 1/1/2011 and 12/31/2011 will be reported on Worksheet A-2, lines 19 and 20 respectively. Effective for purchases on or after 1/1/2012 rebates received for each ESA will be reported on Worksheet A-2, line 20.01 and subsequent subscripts of line 20.
    • The instructions to Worksheet D, Column 4.02 and 6.02, were clarified to indicate that these columns should be used to report services rendered on or after 1/1/2014, for cost reporting periods that straddle 1/1/2014.
    • Revised the instructions to Worksheet E, Part I line 7.03 to calculate total deductibles at 20% of net ESRD PPS payments (line 2.03 column 2) if the sum of lines 7-7.02 is less than 20% of line 2.03, column 2)
    • §3101 of the Middle Class Tax Relief and Job Creation Act of 2012, reduced payments for ESRD bad debts ESRD for cost reporting periods beginning during FFY 2013, 88%, for cost reporting periods beginning during FFY 2014, 76%, for cost reporting periods beginning during FFY 2015 and Subsequent, 65%. The bad debt reduction is implemented on Worksheet E, Part I, line 16. In addition, for cost reporting periods beginning on or after 1/1/2013, the ESRD bad debts will no longer be limited to the unrecovered costs for Medicare ESRD services.
    • Sequestration will be computed as days on or after 4/1/2013 divided by total days in the FY, times 2%. Thus, a 6/30/2013 FYE would have about a half percent reduction. Sequestration is implemented on Worksheet E, Part I, line 19.
    • CMS added level one edit 1000D to ensure total treatments on Worksheet D, column 1, line 11 are greater than -0-.
    • CMS added level one edit 1000E to ensure that if Medicare visits were reported on Worksheet D, columns 4-4.02, then Medicare payments on Worksheet E, Part I, line 1 must be greater than -0-.
  • HFS’s current version for the ESRD is 2.1.146.0, posted 8/6/2013.