Reimbursement for daily dialysis

Who is paying the costs for daily dialysis programs?

Re-imbursement rate is the same as doing 3x a week…for profit clinics are less likely to offer daily dialysis but the non-profits are the clinics that put patients first…

The re-imbursement rate may change as soon as the data for daily home is completed…

I’ve heard that some clinics have gotten commercial insurance companies to pay for daily dialysis by providing documentation of studies showing the benefits. Medicare typically limits reimbursement for hemodialysis to three times per week unless the patient has congestive heart failure or fluid overload and the doctor justifies there is a medical need for more treatments. I have heard that some Medicare intermediaries (the insurance companies that contract to pay Medicare claims) have paid for more treatments if the clinic provides studies showing the benefits.

If you would like to do daily dialysis, your dialysis clinic should talk with its Medicare intermediary or your commercial insurer about what documentation is needed to get coverage for daily dialysis for you.

Other than recommendation by a nephrologist, are there any other criteria patients must meet in order for a Medicare intermediiary to consider paying for daily dialysis txs. :?:

Other than fluid overload and/or congestive heart failure justifying extra HD treatments, I’ve not heard of patient criteria that Medicare intermediaries use when allowing Medicare payment for extra treatments. I believe when it’s allowed, it’s on a case-by-case basis and depends on the doctor’s justification. I suspect approval for payment for daily dialysis happens rarely. I don’t know which intermediaries pay for daily treatments. This would be interesting to know, but what I’ve heard from those that have gotten payment is fear that if you draw attention to it, those intermediaries will stop paying so no one wants to “rock the boat.”

There is legislation before Congress right now (HR 1004) that would allow Medicare to pay for daily HD treatments. You can read about this law and write your elected officials from the Home Dialysis Central Legislative Action Center. Unless this law is passed this year or reintroduced and passed in the next session of Congress, Medicare will wait until the National Institute of Medicine study of daily compared with 3 times weekly HD is done in 2008 or later before deciding to pay for daily (nightly) HD treatments. Ask your friends, family, others who have kidney disease and staff to write letters supporting this legislation this year (easy to do through the Legislative Action Center). Even if it doesn’t pass this year, you can help to build support for it next session. Don’t get discouraged. Remember Rome wasn’t built in a day and legislation often takes years to get enacted. Being persistent pays off.

I asked about the cost of daily dialysis and was told the center that sponsors it absorbs the cost. at about 20-25 patients it levels off but in the meantime they work at a loss.
2-3 years ago Sen. John Kerry sponsored a daily dialysis bill which has been forgotten, apparently. at the time I encouraged anyone on dialysis, interested or not, to write reps. unfortunately this was right around the time of the anthrax episode so who knows where those letters are.
don’t know what good trying to revive that bill now would do.

Hi y’all,

The bill that Spiderwoman references will need to be introduced again at the next session of Congress–but you can write to your representatives to ask them to co-sponsor it right from Home Dialysis Central! Either go to “Legislative Action Center” and click the link, or just go right to:

The Kerry bill on dialysis dialysis was a different number because it was introduced in the last session of Congress. The bill this sesson is H.R. 1004. When it’s introduced next session, it will have a different number again.

It’s very simple to use the Legislative Action Center to send a letter to your elected official. In fact, there is already a sample letter that you can easily change to include why this bill and Medicare coverage for daily dialysis is important to you. I’d definitely personalize the letter to reflect your “story.” Some things you might include:
– If you’re not on daily dialysis, why you think daily dialysis would help you and why you’re not on it (i.e. no clinic in your area).
– If you’re already on daily dialysis compare to before so far as how you feel, the activities you do (if you work be sure to mention this), etc.

Remember, this is just a preview of what we’ll need to do again in 2005. With budget deficits and concerns about Medicare funds, it will be an uphill fight, but it’s one that we must take on!

When looking at your listing of 75 units who offer nocturnal dialysis, the majority seem to be FMC so I am guessing this is 3x week nocturnal which Medicare pays. But in looking at the 39 listings for daily dialysis, there are few offerings by FMC or the major corporations. Wonder how many patients get into these programs with private insurance vs the units eating the costs?

FMC’s nocturnal program is an every other night program or 7 treatments in two weeks. Patients run around 8 hours while they sleep and are monitored at an offsite location using the Internet.

Other than providers like Dialysis Clinic Inc., Northwest Kidney Centers, and Satellite Dialysis, we don’t know which clinics are for-profit or non-profit. We have heard that if a clinic has a few patients with commercial insurance it allows that clinic to offer more innovative treatments to all interested patients.

Some clinics have not billed commercial payers more than 3 days a week believing that commercial payers base their decisions on what Medicare does. Other clinics bill Medicare and commercial payers for every treatment and take what they can get.

I don’t know if dialysis clinics limit who is accepted into daily or nocturnal programs based on whether they have Medicare or commercial insurance. However, I do know that Lynchburg Nephrology, one of the first US clinics to offer nocturnal dialysis, offered NHHD to any patient who was interested no matter what their health or payer status was and they’ve had excellent outcomes.

During our calls clinic staff told us that they’re offering daily dialysis (or nocturnal dialysis) for a variety of reasons:
– Patients requested the modality.
– They’re piloting these programs.
– They believe improved outcomes will lead to overall cost savings.
– Based on the research, it’s the right thing to do.

Just read a news article on akys which stated that txs are covered by most insurances. Can we get a statement form AKSYS rep as to whether this means commercial or Medicare?

Medicare pays for 3 hemodialysis treatments a week. This translates to 13 treatments in 30-day months and 14 treatments in 31-day months. Commercial insurers may pay for more treatments than what Medicare allows.

Here’s a tip I’ve heard. When trying to find out if your insurance will pay for home hemodialysis, see if your policy says it will cover dialysis or hemodiaysis. If this is not in your policy and you must call, ask if your insurance covers hemodialysis. Don’t ask whether it pays for home hemodialysis. If hemodialysis is covered, it should be covered whether it’s done at home or in a clinic.

Clinics usually bill Medicare once a month for all the treatments in the month. Medicare pays dialysis providers a set amount for each hemodialysis treatment whether it is performed at home or in a clinic. Medicare’s composite rate per treatment is around $130 per hemodialysis treatment not counting medications. The composite rate that has been set for years is going up slightly in 2005.

I’ve heard that dialysis providers may charge commercial insurance $500-$800 per hemodialysis treatment not counting medications. Although many clinics bill monthly for 3 times a week dialysis, some bill weekly for daily treatments. Some commercial insurance companies have contracts with dialysis providers that limit how much they pay per treatment. Others have not set a “reasonable” charge and pay a percentage of the bill. How much you have to pay depends on what your policy says and what your insurance company agrees is “reasonable.” Having Medicare may limit what you have to pay out-of-pocket.