PD Patient - Medicare Billing

Ns. Beth,
I was recommended to you by another state social worker here in FL. I am a PD patient who was discharged from my nephrologist and subsequently from my clinic. I am having difficulty in being accepted via transfer and/or new patient for reasons unknown to me. In the interim, I am able to obtain equipment and supplies for fulfillment of a prescription from an out of state nephrologist who is licensed here in FL. Doctor can also order blood work and meet with me as required (regulatory/statute). Where do I go to find out the logistics of how I could obtain reimbursement from Medicare for therapy/treatment. In otherwards, is there a process to continue my medical prescription outside of a kidney clinic? I ask this given what ap;pears to be a conflict of interest issue between the clinics and their associated medical directors relationships to other MD’s in their practice/profession.

It upsets me when I hear about patients being discharged from dialysis clinics. Dialysis clinics are required by regulation to attempt to resolve issues that put patients at risk of involuntary discharge. What did the dialysis clinic staff do to attempt to prevent your involuntary discharge? If you believe you were wrongly discharged, you can contact HSAG, the ESRD Network of Florida, and file a complaint/grievance. At the least, you should have been informed about the reason and efforts should have been made with you to work out any issues. They could have tried to identify another physician working at the clinic to see if s/he would assume your care from the physician who no longer wanted to treat you and they could have reached out to other clinics in the area. Here’s a link to their Network’s website for more info:

You can also contact the FL agency that surveys dialysis clinics to assure they’re in compliance with ESRD regulations. They may not have followed the procedure for involuntary discharge and could be investigated for that. The Agency for Healthcare Administration (AHCA) is the agency charged with that. The number to contact AHCA is 888-419-3456.

According to Medicare payment rules, the only way to get dialysis care paid by Medicare is as prescribed by a nephrologist through a dialysis clinic. If you’ve found a nephrologist who is willing to prescribe your PD, my suggestion would be to ask that nephrologist to admit you to the dialysis clinic where s/he treats patients. If you have Original Medicare, it will pay for dialysis in any state no matter where you live. The clinic would likely want to make sure you were trained in a way that is consistent with how they train their patients. You would then have access not only to a nephrologist, but to a home training nurse, a dietitian, and a social worker. The only wrinkle in this would be if you have a Medicare Advantage plan and the doctor and other clinic is not in Network. From 1/1-3/31 there is an opportunity to switch MA plans or to switch to Original Medicare. Before you switch to Original Medicare be sure you can get a Medigap plan to help pay Medicare’s out-of-pocket costs. The SHINE program in FL has people who can advise on options for Medicare coverage.

Hello there! We just opened a clinic in Florida and would be happy to work with you. Please call me at 1.888.Kidney -0. Thank you Josh