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  1. #21
    Unregistered Guest

    Default Re: STAFF ASSISTED HOME DIALYSIS

    Quote Originally Posted by Anonymous View Post
    We have successfully negotiated benefit exceptions in order to pay for home hemodialysis caregivers. I would be happy to share how to go about this process if you want to email me with information on how to contact you.

    Elton Harding
    PRESIDENT
    DIALYSIS CARE ASSOCIATES
    eharding@dialysiscare.org
    I am very interested in how to negotiate benefit exceptions to pay for staff assisted dialysis. Any information that you are able to provide would be greatly appreciated.

    lclark@dsi-corp.com is my email address.

    Thank you,

  2. #22
    Unregistered Guest

    Default Re: Staff Assisted Home Dialysis

    Can someone please tell me how to get reimbursement for staff assissted home dialysis. I have been trying to find ways to offer this benefit to my patients and have been unsuccessful. I believe that every patient should have the option of doing home dialysis.

  3. #23
    Join Date
    06-25-04
    Location
    Kansas
    Posts
    1,784

    Default Re: Staff Assisted Home Dialysis

    Medicare and most Medicare supplements will not cover staff assisted home dialysis and most patients pay for it out-of-pocket. However, some Medicaid agencies and some long-term care policies may provide this level of home support.

    However, if a patient is receiving SSI or SSDI (Social Security disability income programs) and if that person is able to work, there is a work incentive program called "impairment-related work incentives" (IRWE) that allows disabled people to report the out-of-pocket medical costs, like staff assisted home dialysis (home dialysis is more work-friendly than in-center) that allow them to work to Social Security. Once IRWE items are approved, Social Security won't count that amount of work income when determining if the person's "countable income" is over the "substantial gainful activity level." The SGA in 2013 is $1,040 for sighted people and $1,740 for people who are legally blind. Earnings over the SGA can cause Social Security to stop paying SSI or SSDI. However, if a person's earnings are under the SGA, that person can keep the work income SSI or SSDI checks. Claiming IRWE expenses can allow the dialysis patient who is working in spite of ESRD to have more money to pay their out-of-pocket medical expenses, which may include staff assisted home dialysis.
    Beth Witten MSW ACSW LSCSW
    Medical Education Institute, Inc.

  4. #24
    Unregistered Guest

    Default Re: none

    Quote Originally Posted by Unregistered View Post
    In response to Staff-Assisted Hemodialysis, I know that staff assisted works much better for most patients on Hemodialysis. I don't understand how CMS thinks that a person trained for two - six weeks per year can be safe for the patient. If you read the Regs its seems to be all about the patients well-being. Then a person who does not have near the experience of even a PCT, can push meds and conduct the treatment. Can someone please explain the logic here?
    If patients wish to receive Staff-Assisted Home Hemodialysis, they should be able to choose this type of treatment at home. Medicare does not cover this, but some private insurance carriers may. CMS and State regulators need to reevaluate Staff-Assisted Home Hemodialysis because it is a necessary type of modality that some patients NEED.
    I don't understand what you mean i work staff assist home hemodialysis we only hire RN with 18 months or more experience we have no pcts at all but I live in Texas and our regs is so stricts more than it has to be and that is good wouldn't work in any other state

  5. #25
    Join Date
    06-25-04
    Location
    Kansas
    Posts
    1,784

    Default Re: none

    I haven't seen data showing that staff-assisted hemodialysis works better for patients than having the patient do his/her dialysis and/or using a care partner who is a trained family member or friend. If true, patients doing dialysis in a clinic would have better outcomes than those doing dialysis at home and I have not seen evidence of that. If you have a source for that data, please share it.

    Patients who do their own dialysis or family members or friends who are care partners must prove competency just like staff in a clinic. Even though they may not have prior medical training, home HD patients and their care partners gain similar experience to technicians who provide most of the direct patient care in dialysis clinics throughout the U.S.

    I don't not know the specifics of Texas regulations for home dialysis, but suspect staff who provide dialysis for patients in their homes must meet certain qualifications to do certain aspects of care. However, I don't believe the Texas regulations limit the use of trained family members or friends to assist with or perform all aspects of home dialysis (PD or HD).

    If you believe CMS should change its reimbursement policies to pay for staff-assisted home dialysis, write your legislators and CMS. ESRD care is expensive and on legislators' radar screens and I suspect they are looking for ways to cut reimbursement rather than expand it.
    Beth Witten MSW ACSW LSCSW
    Medical Education Institute, Inc.

  6. #26
    Unregistered Guest

    Default Re: Staff Assisted Home Dialysis

    How do you bill for the Staff Assist at Home. Medicare states that the 99512 must be bill with a revenue code of 821 but then, they don't pay for it and the commercial carriers normally follow suit with Medicare.

  7. #27
    Join Date
    06-25-04
    Location
    Kansas
    Posts
    1,784

    Default Re: Staff Assisted Home Dialysis

    As you stated, Medicare does not cover staff-assisted home dialysis. Check with the specific insurance company to find out what CPT/HCPCS/ICD-9 they want you to use and whether you need to line item bill for this service. A quick Google search found that several insurance companies believe staff-assisted home dialysis to be an effective treatment as long as certain criteria are met. More than one company's site said this:

    "Professional staff-assisted home hemodialysis is medically necessary as an alternative to facility
    based hemodialysis for patients with end-stage renal disease who meet ALL of the following criteria:
    - Patient is stable on dialysis as demonstrated by meeting the criteria of the National Kidney Foundation; AND
    - Patient has good functioning vascular access; AND
    - Patient has medical contraindications to leaving home for hemodialysis; AND
    - Patient or non-professional caregiver is not capable of performing home hemodialysis after hemodialysis training."
    Beth Witten MSW ACSW LSCSW
    Medical Education Institute, Inc.

  8. #28
    Unregistered Guest

    Default Re: Staff Assisted Home Dialysis -URGENT PLEASE REPLY ASAP ASAP ASAP !!

    Hi, I am glad to have found this thread discussion on Staff - Assisted Home Hemodialysis. My Dad lives in Phoenix, Arizona and requires bedside dialysis. I have been searching and not able to find anything.

    If anyone knows of any more information please let me know ASAP. It's Extremely urgent. We are trying to bring my dad home from the hospital and taking to Dialysis clinic is not possible. Unfortunately, I am not in good health condition myself to help my dad. So, need this info soon.

    Thank you!!

  9. #29
    Join Date
    06-25-04
    Location
    Kansas
    Posts
    1,784

    Default Re: Staff Assisted Home Dialysis -URGENT PLEASE REPLY ASAP ASAP ASAP !!

    Check out "staff assisted home dialysis" on the Home Dialysis Central site (www.homedialysis.org). Look under Find a clinic. You can set a distance to travel for training and some clinics train patients/care partners in their home. One thing that's important to know is that Medicare and Medigap plans don't pay for a nurse or technician to provide dialysis in a patient's home. Other insurance may cover this. Because Medicare doesn't cover it, most of the time a family member or friend chooses to be trained to do their loved one's home dialysis. Someone can learn how to do peritoneal dialysis in 1-2 weeks, but hemodialysis training usually takes 3-6 weeks.
    Beth Witten MSW ACSW LSCSW
    Medical Education Institute, Inc.

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