Hi Beth,
I am trying to figure out what the advantages and disadvantges of choosing Method I vs. Method II are. Thanks in advance.
Most of the home dialysis patients in the U.S. “choose” Method I vs. Method II.
Method I is where the patient gets all equipment, supplies, and support services through a dialysis clinic that bills Medicare or other insurance for the services. The Method I charge (called the “composite rate”) is the same for in-center and home dialysis patients.
Method II is where the patient contracts with a “supply company” (DME) which provides all the equipment and supplies and bills Medicare or other insurance for them. The DME must have an agreement with a dialysis clinic that trains the paitent/partner for home and provides ongoing support services (RN, MSW, RD). The dialysis clinic charges a separate capped fee for support services to Medicare or other insurance.
In general, the out-of-pocket cost to the patient for the 20% not paid by Medicare is less with Method I than it would be for Method II if the DME is allowed to charge Medicare more than the dialysis clinic is allowed to charge for Method I.
You can read about Medicare coverage in the FAQs and follow links to Medicare manuals if you look for Medicare FAQs on Home Dialysis Central.
In case anyone reads this thread. As of January 1, 2011, there is no longer the option for Method II reimbursement from Medicare. Medicare only reimburses dialysis facilities for home dialysis equipment, supplies, and support from the home training nurse, dietitian, and social worker as well as certain labs and ESRD-related drugs under the ESRD prospective payment system (PPS).