Renal Dialysis (ESRD Facility) Cost Report — CMS-265-11
By costreporting.aiPublished
The Independent Renal Dialysis Facility cost report is the annual Medicare filing every independent (freestanding) Medicare-certified ESRD facility submits to its MAC on Form CMS-265-11, reconciling the facility's allowable cost of treating Medicare beneficiaries against the ESRD Prospective Payment System (PPS) interim payments received during its fiscal year (42 CFR § 413.20; 42 CFR Part 413 Subpart H). Hospital-based dialysis facilities report their ESRD activity on the parent hospital's CMS-2552-10 instead.
What the CMS-265-11 covers
The CMS-265-11 walks the facility's finances from raw trial balance to Medicare settlement. It captures direct cost by cost center (hemodialysis, peritoneal dialysis, home-training, ESRD drugs, ESRD lab), allocates overhead across patient-care cost centers using step-down apportionment per PRM Pub. 15-1 Chapter 23, and computes cost-per-treatment. Since the ESRD PPS pays a single bundled per-treatment rate, the cost report no longer drives per-treatment payment but still settles bad-debt reimbursement, items outside the PPS bundle, and Medicare credit balances; the treatment counts also feed CMS's annual PPS rate update.
ESRD facility support: pilot status + roadmap
costreporting.ai currently supports HHA (CMS-1728-20) and Hospice (CMS-1984-14) for the November 2026 pilot cohort. We're building the platform deliberately one form at a time — the deterministic engine, audit-trail, and cost-finding methodology must be exactly right for each form's worksheet structure before we add the next. Independent ESRD facility (CMS-265-11) support is on the post-pilot roadmap. Join the waitlist below if you'd like notification when ESRD facility support ships.
The 42 CFR § 413.24 cost-finding standard applies regardless of provider type, so the architectural principle (AI classifies, determinism calculates, every customer-visible number traces to an audit-trail entry) carries forward when ESRD support lands. Whether you use a CPA firm, a billing agency, or an independent consultant for filing today, the documentation standard is the same, and your authorized representative signs the cost report regardless of preparer.
Common questions
What form is the renal dialysis cost report filed on?
Independent (freestanding) Medicare-certified ESRD facilities file Form CMS-265-11. Hospital-based dialysis facilities report their ESRD activity on the parent hospital's CMS-2552-10 rather than filing CMS-265-11 separately.
When is the ESRD facility cost report due?
Five months after the end of the facility's fiscal year, per 42 CFR § 413.24(f)(2). The MAC may grant a limited extension only for good cause beyond the provider's control. The deadline is the same five-month rule that applies to other Medicare cost-report filers.
What does the CMS-265-11 calculate?
The CMS-265-11 captures the facility's trial balance, allocates direct and indirect cost across cost centers (hemodialysis, peritoneal dialysis, home dialysis training, drugs, lab), computes cost-per-treatment, and reconciles allowable cost against the ESRD Prospective Payment System (PPS) payments received during the year under 42 CFR Part 413 Subpart H. Bad-debt reimbursement and the treatment counts that drive the PPS base rate are common preparation focus areas.
How does the ESRD PPS bundle interact with the cost report?
Since 2011 the ESRD PPS pays a single bundled rate per dialysis treatment that includes the dialysis service, ESRD-related drugs, lab tests, and supplies (42 CFR § 413.215 onward). The cost report no longer drives per-treatment payment rates but is still required for: bad-debt reimbursement, settlement of items outside the PPS bundle (e.g., AKI dialysis in some configurations), Medicare credit balance reporting, and program-integrity verification of the data feeding the annual PPS payment update.
Does costreporting.ai support ESRD facility cost reports today?
Not yet. The pilot product currently supports HHA (CMS-1728-20) and Hospice (CMS-1984-14) for the November 2026 cohort. ESRD facility support is on the roadmap for the post-pilot release. If you operate an independent dialysis facility and want to be notified when CMS-265-11 support ships, join the waitlist below.
Sources
- Regulation:42 CFR § 413.20 — Financial data and reports
- Regulation:42 CFR § 413.24 — Adequate cost data and cost finding (filing at § 413.24(f))
- Regulation:42 CFR Part 413 Subpart H — Payment for end-stage renal disease (ESRD) services
- CMS Manual:Provider Reimbursement Manual, Part 2 (Pub. 15-2) — CMS-265-11 ESRD facility cost report instructions