Reimbursement for Home Dialysis Training: A Primer

Recently, I have received several questions from readers regarding reimbursement for home dialysis training. There have also been several threads in renal industry forums regarding this topic. Home training reimbursement is an area where, over the years, I have learned that there are many interpretations of Medicare’s reimbursement to physicians and dialysis programs for home dialysis training. It is easy to see how there could be confusion regarding reimbursement for home dialysis training as the nephrologist and dialysis program work together to provide dialysis training, but their reimbursements are separate and structured differently. Being able to receive appropriate reimbursement for home dialysis training is important to every dialysis program and nephrologist as it is critical to maximize reimbursement for services rendered to dialysis patients in order to maintain financial viability for your program or practice. To better understand what may be reimbursed, it is beneficial to understand which services are covered.

Medicare Coverage for Home Dialysis Training

Medicare provides coverage for Medicare beneficiaries to receive home dialysis training from a Medicare-certified end-stage renal disease (ESRD) facility that teaches ESRD patients and their caregivers to perform dialysis at home with little to no assistance from the staff at the ESRD facility. Home dialysis training can take place in the dialysis facility or at the patient’s home. According to the Medicare Benefit Policy Manual, the Centers for Medicare & Medicaid Services expects that patients opting to receive home dialysis will be able to complete their training without exceeding the maximum allotted number of home training sessions.

Currently, Medicare covers 25 training sessions for home hemodialysis and 15 training sessions for peritoneal dialysis. There is also coverage for a patient or their caregiver to receive retraining under specific circumstance; instances where reimbursement for retraining is permissible are changes in equipment, dialysis partner, or modality.

Dialysis Program Reimbursement for Home Dialysis Training

Medicare provides reimbursement to a dialysis program via a training and retraining add-on payment. This add-on payment, as its name implies, is added on to the ESRD PPS payment for the date(s) of service for which training was provided and is intended to account for one and a half hours of nursing time. To receive appropriate reimbursement for home dialysis training, the dialysis program would bill Medicare for each date on which training services were rendered. Both the Medicare Benefit Policy Manual and the Medicare Claims Processing Manual are very clear in stating that a dialysis facility should not expect reimbursement above and beyond the 25 maximum home hemodialysis training sessions and the 15 sessions for peritoneal dialysis.

Physician Reimbursement for Home Dialysis Training

Physician reimbursement for home dialysis training is structured differently than training reimbursement for the dialysis program. Where the dialysis facility is intended to be reimbursed for each training session rendered, at the time of this writing, Medicare provides a physician with reimbursement at a flat rate of $500 upon a patient completing their course of home dialysis training. In the event a patient does not complete their home training, Medicare will provide the physician reimbursement at a rate of $20 per training session, regardless of modality.

Just as a dialysis facility may need to provide a patient with retraining sessions due to changes in dialysis equipment or modality, the patient’s physician would be a part of the retraining. The Medicare manual indicates subsequent training sessions may be reimbursed after the initial training course if the retraining is required due to a change in the patient’s treatment machine, modality, setting, or dialysis partner.

Sarah Tolson is the director of operations for Sceptre Management Solutions, Inc., a company specializing in billing for outpatient ESRD facilities, nephrology practices, and vascular access. Your questions are welcome and she can be reached at [email protected], 801.775.8010, or via Sceptre’s website, www.sceptremanagement.com.

Questions?

Do you have questions about billing compliance? Is there an aspect of renal reimbursement you would like more information on? Are you experiencing a dialysis reimbursement dilemma? Questions from the readers of this column help to keep the content relevant and interesting. I would love to address your questions in a future edition of From the Field. Please send your questions to me at [email protected] As always, your information will be kept confidential.