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Dialysis

Amani Posted Sun 27th of October, 2013 16:14:49 PM

Hi,

Do you know how much the rate for dialysis under Medicare? Do they pay weekly, or per treatment? Thanks

SuperCoder Answered Mon 28th of October, 2013 10:29:11 AM

Kindly provide a broader description of the dialysis treatment provided.

Amani Posted Mon 28th of October, 2013 18:55:01 PM

Hemodialysis rev code 821 and CCPD rev code 851. Thank you

SuperCoder Answered Mon 28th of October, 2013 20:15:51 PM

Please check Page 20-22 of http://www.medicare.gov/Pubs/pdf/10128.pdf

I hope this helps.

Thanks,

Amani Posted Tue 29th of October, 2013 11:07:44 AM

I am looking into facility cost and not physician cost. Thank you

SuperCoder Answered Tue 29th of October, 2013 17:07:41 PM

Basic Case-Mix Adjusted Composite Payment System

The basic case-mix adjusted composite payment system is a comprehensive prospective payment system that covers a bundle of dialysis related items and services routinely required for dialysis treatments to be furnished to Medicare beneficiaries in Medicare-certified ESRD facilities or at their home. For example, those items and services include supplies and equipment used to administer dialysis in the ESRD facility or at a patient's home, drugs, biologicals, laboratory tests, and support services. Payment for all modalities of in-facility dialysis and Method I home dialysis are paid under the basic case-mix adjusted composite payment rate system. Payment for Method II home dialysis is not paid under the basic case-mix adjusted composite payment system and is described in detail below.

The following components are not paid under the basic case-mix adjusted composite payment system:

Method II home patients;
Physician's professional services;
Separately billable laboratory services;
Separately billable drugs;
Blood and blood products; and
Bad debt.
Beneficiaries may either receive maintenance dialysis at a Medicare-certified dialysis facility or at home. Each Medicare home dialysis beneficiary must choose the method by which Medicare pays for his or her dialysis services.

Under Method I, the dialysis facility with which the patient is associated must assume responsibility for providing all home dialysis equipment and supplies, and home support services. For these services, the facility receives the same payment rate as it would receive for an in-facility patient under the basic case-mix adjusted composite payment system. Under this arrangement, the ESRD facility bills the Fiscal Intermediary/Medicare Administrative Contractor (FI/MAC), and the beneficiary is responsible for paying unmet Part B deductible and the 20 percent coinsurance requirement to the ESRD facility.

Under Method II, the beneficiary deals directly with a single Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies supplier to secure the necessary supplies and equipment to dialyze at home. The selected supplier (not a dialysis facility) must take assignment and bill the Durable Medical Equipment Medicare Administrative Contractor. The beneficiary is responsible to his or her supplier for unmet Part B deductible and for the 20 percent Medicare Part B coinsurance requirement.

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ESRDpayment/index.html?redirect=/ESRDPayment/

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