Home expands reimbursement for doctors

To combat rising health care costs, Centers for Medicare and Medicaid Services is encouraging home dialysis whenever it is clinically appropriate. Reimbursement now includes earlier Kidney Disease Education, a home training benefit and Day One billing. The Monthly Capitated Payment (MCP) for Peritoneal Dialysis (PD) patient visits gives you more control of your time.

Kidney Disease Education

Physicians can bill for up to six pre-dialysis education sessions for patients with Stage 4 Chronic Kidney Disease.¹ Physicians, nurse practitioners and others can conduct individual or group sessions. Learn more about the Kidney Disease Education benefit.

Home dialysis training benefit

Physicians can bill up to $500 for training, using code 90989, if a patient selects a home therapy.²

Day One billing

If a patient is uninsured, but Medicare-eligible, care teams can begin billing for home dialysis on Day One and the 90-day waiting period is waived.³

Monthly Capitated Payment

MCP between In-center Hemodialysis (HD) and PD differs greatly in the reimbursement of your time.  In-center HD requires four monthly patient visits for maximum reimbursement. While PD only requires one monthly patient visit for maximum reimbursement.⁴ And PD visits typically happen in one-on-one, private meetings where nephrologists have an opportunity to provide higher-quality interactions with their patients. This difference in the amount of time needed to care for patients allows nephrologists to care for more patients in the same amount of time invested.

 

¹ Payment Policies under the Physician Fee Schedule and other Revisions to Part B for CY 2010, 42 CFR Part 410, 411, 414, 415, 485, 498 [CMS-1413-FC]; Center for Medicare and Medicaid Services.
² Medicare Claims Processing Manual, Chapter 8:115; Centers for Medicare and Medicaid Services.
³ Medicare Coverage of Kidney Dialysis and Kidney Transplant Services; CMS Pub No. 10128; Revised May 2008; Center for Medicare and Medicaid Services.
⁴ Proposed CY 2010 Rule Citation: Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for Calendar Year (CY) 2010. Proposed Rule: CMS-1413-P. Released July 2009:1043; Centers for Medicare & Medicaid Services.

Home offers new opportunities

Centers for Medicare and Medicaid Services (CMS) has changed reimbursement to manage Medicare budgets and encourage the resource-sparing advantages of home dialysis therapies. Conditions for Coverage have changed, and the final CMS bundle rule offers facilities a great opportunity to build robust home therapy programs.

"We believe that by providing one balanced payment rate under ESRD PPS for both PD and HD, facilities will have a powerful financial incentive to encourage the use of home PD among dialysis patients where feasible."--CMS¹

New CMS bundle creates a single base rate

The final CMS bundle rule reimburses at a single base rate, regardless of modality, with more case-mix adjusters to help even out reimbursement.¹ Read about the bundle in greater detail.
 

Conditions for Coverage

Patients must be informed of all treatment options, including home therapies, and they must be referred to a facility that offers Peritoneal Dialysis (PD), if requested.²
 

Day One billing

If a patient is uninsured, but Medicare-eligible, care teams can begin billing for home dialysis on Day One, and the 90-day waiting period is waived.³

¹ End-Stage Renal Disease Prospective Payment System, 42 CFR Part 410, 413 and 414, [CMS-1418-P]; Center for Medicare and Medicaid Services.
² Conditions for Coverage for End-Stage Renal Disease Facilities; Final Rule. Federal Register 73, 15 Apr. 2008: 20370-20484; Center for Medicare and Medicaid Services.
³ Medicare Coverage of Kidney Dialysis and Kidney Transplant Services; CMS Pub No. 10128; Revised May 2008; Center for Medicare and Medicaid Services.