Dialysis patient

Question regarding dialysis and hypertensive kidney disease. Using hypertension and end stage renal disease as a primary diagnosis (MD verified) does this effect the
Renal/Medicare/Dialysis billing connection that we have always avoided in the past? Thanks for any input!

Ann Marie Moe HCS-D 10
Covenant Care at Home
Direct: 209-250-5252
Fax: 209-669-6507

Comments

  • Hi Ann-Marie.
    Under Traditional Medicare Home Health Benefits, End Stage Renal Disease benefits in use cannot utilize Home Health Benefits for any services directly related to services that are already covered under ESRD Program benefits. I refer you to Chapter 7 Medicare Benefits Policy Manual, section 80 - Specific Exclusions From Coverage as Home Health Services, # 80.5 - Services Covered Under the End Stage Renal Disease Program

    80.5 -Services Covered Under the End Stage Renal Disease (ESRD) Program (Rev.208, Issued: 04-22-15, Effective: 01-01-15, Implementation: 05-11-15)
    Renal dialysis services that are covered and paid for under the ESRD PPS,which include any item or service furnished to an ESRD beneficiary that is directly related to that individual's dialysis, are excluded from coverage under the Medicare home health benefit. However, to the extent that other requirements for coverage are met, an item or service that is not directly related to a patient's dialysiswould be covered(e.g.,a skilled nursing visit to furnish wound care for an abandoned shunt site). Within these restrictions, beneficiaries may simultaneously receive items and services under the ESRD PPS through their ESRD facilityat home at the same time as receiving items and services under the home health benefit that are not related to ESRD.


    Nancy Wolverton RN, CCM, HCS-D-10
    Utilization Review Specialist
    Kindred at Home
    Little Rock, Arkansas
    501-508-8526 (o)
    501-690-2027 (c)
    Nancy.Wolverton@kindred.com
  • That given, the HTN/ESRD primary diagnosis might be for monitoring a new HTN med BUT if prescribed by the ESRD MD as related to issues identified at hemodialysis sessions, then that would be crossing the line over into services that will be monitored under the dialysis benefit, by the dialysis nurses and therefore would be duplication of services if HH were to do the same POC focus with the new HTN med.
    But, if the documentation shows it is not related to the dialysis care, then you could use it if appropriate. I would be cautious and be prepared to send additional records to Medicare if requested that will support HH services not related to ESRD Program benefits.

    Nancy Wolverton RN, CCM, HCS-D-10
    Utilization Review Specialist
    Kindred at Home
    Little Rock, Arkansas
    501-508-8526 (o)
    501-690-2027 (c)
    Nancy.Wolverton@kindred.com
  • edited May 2017
    Thank you Nancy for supplying the guidance. I was overthinking the scenario!


    Ann Marie Moe HCS-D 10
    Covenant Care at Home
    Direct: 209-250-5252
    Fax: 209-669-6507
  • edited May 2017
    What I have seen lately is a hypotensive episode in the HTN/ESRD setting but of course it is resolved
    By the time we get them. So we are monitoring the pt's hypertension.


    Ann Marie Moe HCS-D 10
    Covenant Care at Home
    Direct: 209-250-5252
    Fax: 209-669-6507
  • Hypotension is a very frequent occurrence during dialysis sessions and is absolutely related to the procedure of hemodialysis. This is not appropriate for HH POC.

    Nancy Wolverton RN, CCM, HCS-D-10
    Utilization Review Specialist
    Kindred at Home
    Little Rock, Arkansas
    501-508-8526 (o)
    501-690-2027 (c)
    Nancy.Wolverton@kindred.com
Sign In or Register to comment.