ESRD PRICERActive Components

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ESRD PRICERActive™ Editor and Reimbursement DLLs

ESRD PRICERActive was developed in response to the implementation of the Medicare End Stage Renal Disease prospective payment system (ESRD PPS). The Medicare Improvements for Patients and Providers Act (MIPPA) replaces the prior ESRD payment methodology known as the ‘basic casemix adjusted composite payment system’ with a bundled ESRD prospective payment system, or the ESRD PPS, for Medicare outpatient ESRD facilities beginning January 1, 2011.

The ESRD PRICERActive Editor DLL identifies comorbidities and outlier services on a claim for payment under the End Stage Renal Disease Prospective Payment System (ESRD PPS) while the ESRD PRICERActive Reimbursement DLL computes the Medicare End Stage Renal Disease (ESRD) payment amount per session according to the revised ESRD payment specifications effective for fiscal year 2011 (FY11) and after.


The ESRD PRICERActive™ Editor and Reimbursement DLLs interface directly with all .Net capable systems (32-bit or 64-bit) and are available as components that provide the ESRD PPS functionality for dates of service from FY11 forward. These products utilize Microsoft SQL Server data components for high-performance in large-scale enterprise and web-based applications.

Features include:

  • Identification of comorbidities and outlier services that affect Medicare ESRD payment
  • Calculates the ESRD PPS payment and composite rate payment, geographically weighted using the wage index of the provider
  • Applies case-mix adjustment factors for:
    • Patient age
    • Body surface area
    • Body mass index
    • Patient comorbidities
    • Onset adjustment
    • Pediatric and training adjustments
  • Calculates the ESRD outlier payment as part of the per-session payment if applicable

Compatible with the leading Windows development environments including:

  • Microsoft Visual Studio (32-bit or 64-bit)
  • Microsoft .Net Framework 4.6.2+
  • Microsoft SQL Server


ESRD PRICERActive™ components are licensed based upon usage.

For a single site installation, like a health plan, hospital, or university, the ESRD PRICERActive™ is licensed for internal use based on the size of the installation.

For a Software Developer including ESRD PRICERActive™ in a software package for distribution to an end user, a distribution agreement is required. Terms: an initial license fee and a per-site fee for ESRD PRICERActive™.

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