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