A Nephrology Billing Guide
Under the legally mandated prospective payment system (PPS), health care providers must submit a single payment for bundled outpatient dialysis services related to ESRD, or end stage renal disease. To ensure compliance, national associations and hospitals can develop a nephrology billing guide.-
Medicare and ESRD Facilities
-
A nephrology billing guide must include steps for requesting payment from Centers for Medicare & Medicaid Services (CMS) for routine dialysis treatments on behalf of Medicare beneficiaries. Health care, insurance and national organizations must submit one claim for a bundle of dialysis-related products and services to include supplies, equipment, dialysis administration, drugs, laboratory tests and in-home support. The nephrology billing guide must outline services not included in the PPS.
Rates and Adjustment Factors
-
Nephrology billing guides include policies for calculating and adjusting the base composite payment rate in relation to treatments and frequency of dialysis sessions. The billing guide uses standard criteria such as age, body surface area, body mass index, wage index and drug add-ons as adjustment factors.
Additional Payment
-
According to CMS, an ESRD facility may request additional payment for "separately billable laboratory tests and drugs." Health care facilities and associations that create, develop and implement a nephrology billing guide must include an additional section to comply with the Clinical Diagnostic Laboratory Fee Schedule's requirements for billable lab tests.
-