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Home Dialysis

Michael Posted Tue 09th of May, 2017 10:45:53 AM
CMS changed their policy for home dialysis to require the practitioner also has to furnish at least one face-to-face patient visit per month as a condition of payment. How should you bill for this if the one face-to-face patient visit per month was not done? See Pub. 100-04, Medicare Claims Processing, chapter 8, section 140.2.1 for more information
SuperCoder Answered Wed 10th of May, 2017 14:08:00 PM
Hi, our expert team is working on your query. We shall get back with a solution soon. Thank you.
SuperCoder Answered Fri 12th of May, 2017 14:24:57 PM

As you rightly mentioned, as per CMS, there should be at least one face-to-face patient visit per month documented in order to bill for home dialysis. Please share some more information relevant to this case for us to help you with a solution for this. Thank you.

Michael Posted Mon 15th of May, 2017 10:31:54 AM
If a patient receives home dialysis for the entire month but for some reason did not have a face-to-face patient visit how should you bill for this?
SuperCoder Answered Wed 17th of May, 2017 13:27:52 PM

Knowing the case in its entirety, we may be able to gauge whether the physician can bill Medicare for the home dialysis. As per CMS, the MCP physician must provide (with supportive documentation) at least one face-to-face patient visit per month in order to bill home dialysis MCP service. However, Medicare may waive this requirement depending upon the case, for example, when the nephrologist’s notes indicate that the physician actively and adequately managed the care of the home dialysis patient throughout the month. The management of home dialysis patients who remain a home dialysis patient the entire month should be coded using the ESRD-related services for home dialysis patients HCPCS codes.

Please refer to the following link:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c08.pdf

Thank you.

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