Sarah Tolson

DocwireNews

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&rsquo;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 TrainingMedicare 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&rsquo;s home. According to the Medicare Benefit Policy Manual, the Centers for Medicare &amp; 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 TrainingMedicare 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 TrainingPhysician 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&rsquo;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&rsquo;s treatment machine, modality, setting, or dialysis partner.Sarah Tolson is the director of operations for&nbsp;Sceptre&nbsp;Management Solutions, Inc.,&nbsp;a company specializing in billing for outpatient ESRD facilities, nephrology practices, and vascular access. Your questions are&nbsp;welcome&nbsp;and she&nbsp;can be reached at&nbsp;<a href="mailto:stolson@sceptremanagement.com">stolson@sceptremanagement.com</a>, 801.775.8010, or via&nbsp;Sceptre&rsquo;s&nbsp;website,&nbsp;<a href="http://www.sceptremanagement.com/">www.sceptremanagement.com</a>.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 stolson@sceptremanagement.com. As always, your information will be kept confidential.&nbsp;

Eva Blondeaux, MD

Risk-Reducing Surgery Linked to Survival in Young BRCA Carriers

Genetics & Breast Cancer

Jordana Jampel

Successful HIV Viral Suppression With At-Home Administration

Modernization and the Rising Burden of IBD: New Insights From a Global Study

Gastroenterology

Latest News

Reimbursement for Home Dialysis Training: A Primer

From the Field

Recently, I have received several questions from readers regarding reimbursement for home dialysis training. There have also been several threads in renal industry forums ...

About Us

Editorial Policy

Advertising

Contact Us

eNewsletters

Contribute

Career Center

MashupMD

Blood Cancers Today

Cancer Nursing Today

GU Oncology Now

Urban Health Today

Anemia

Deep Vein Thrombosis

Essential Thrombocythemia

Hemophilia

Immune Thrombocytopenic Purpura

Myelodysplastic Syndromes

Myelofibrosis

Myeloproliferative Neoplasms

Polycythemia Vera

Pulmonary Embolism

Sickle Cell Disease

Thrombocytopenia

Thrombophilia

Thrombosis

Thrombotic Thrombocytopenic Purpura

Venous Thromboembolism

von Willebrand Disease

Heme Today

Acute Kidney Injury

ADPKD

Anemia and Kidney Disease

Chronic Kidney Disease

COVID-19 and Kidney Disease

Diabetes and Hypertension

End-Stage Renal Disease

Gout

Hyperkalemia

IgAN

Kidney Transplantation

Metabolic Acidosis

Nephrology Times

HER2 Breast Cancer

HR Breast Cancer

Triple-Negative Breast Cancer

Breast Cancers Today

Atherosclerotic Disease

Atrial Fibrillation

Heart Failure

Hypertension

Interventional Cardiology

Lipid Management

Practice Tips With Dr. Lichaa

Preventive Cardiology

Stroke

Cardiology

Breast Cancer

Gynecologic Cancer

Head and Neck Cancer

Skin Cancer

Oncology

Sleep

Urology

Diabetes

Ophthalmology

— Demodex Blepharitis

Neurology

Rheumatology

Pulmonology

Infectious Diseases

— HIV

Health and Wellness

Lupus

Future of Medicine

Orthopedics

Pharmacology

Career News

More

Conferences

CardioNerds

The Sleep Source With Dr. Morse

Rheumatology Rounds With Dr. Maheswaranathan

Partners

Expert Interviews

Subscribe