Medicare Rules Excuses

Hi Beth,

Wondering if you can tell me what Medicare’s rules are for Home-Hemo reimbursement. I think our center may be misleading us regarding flow sheets and kt/v requirements. Is there somewhere I can find Medicare’s specific requirements. The only thing I found was a form that needed to be filled out if a monthly visit with a doctor was missed.

Dialysis Taking Over!

Sorry I didn’t respond to your question sooner. You don’t say what your clinic has told you about flow sheets or Kt/V.

To attempt to answer your question, dialysis regulations that took effect in October 2008 require clinics to collect home dialysis patients’ flow sheets at least every other month. When dialysis facilities bill Medicare they must submit bills that list every date the patient did his/her dialysis. Collecting the flow sheets help to assure that Medicare and other insurance is billed correctly. Another reason why clinics require patients to complete and provide to clinics flow sheets is that the doctor and staff can see patients’ weight gain between treatments, weight loss during dialysis, temperature, blood pressure, respirations, pulse, dialysis-related drugs provided, etc.

Dialysis clinics are supposed to regularly monitor several health factors, to recognize any problems and to address problems promptly. Dialysis adequacy and anemia statu s are two of the health factors that must be monitored regularly. Labs are drawn monthly to do that. In fact, next year dialysis clinics will see their reimbursement cut if already collected data shows they had too many Medicare patients with poor dialysis adequacy and poor anemia. Currently facilities report data for adequacy as URR (urea reduction ratio) but Kt/V is a more precise measure of adequacy and Medicare will be requiring dialysis clinics to report adequacy as Kt/V.

Medicare surveyors who visit dialysis clinics to monitor care provided there have a document called the Measures Assessment Tool that is based on professionally accepted clinical guidelines. On this document, the target for dialysis adequacy is a Kt/V of at least 1.2 for HD done 3x/week or 2.0 for more frequent HD. You can find this document along with other tools that were prepared for surveyors and the kidney community here: