medicare payment for hospital based chronic/acute dialysis

[Gibbie]

I have a question regarding medicare payments with chronic and acute dialysis runs. We are a hospital based clinic providing outpt as well as inpatient treatments. All acutes are run at the bedside.

I was wondering why we are not able to run the "stable" acutes at our clinic instead of lugging all the equipment to their rooms. Our manager said that billing would be a nightmare and this practice is unheard of. To me it seems like as long as the pt gets the treatment needed, why would medicare/insurance companies care were in the hospital the treatment was done? Any dialysis gurus out there that know the answer?

[Robbilin]

I also work at a hospital based facility. We run the unstable acutes in their ICU rooms, but we do any stable ones in our regular unit. I don't understand the billing nightmare; though I am not a medicare billing guru! We have one acute charge and one chronic inpatient charge that would be billed accordingly.

[fiestynurse]

The hospital gets reimbursed more for the bedside dialysis, it's as simple as that. The hospital makes more money!!

[jnette, ASN, EMT-I]

The hospital gets reimbursed more for the bedside dialysis, it's as simple as that. The hospital makes more money!!

Also... there is the issue of having to discharge the patient first.. each time they leave the hospital to go to the clinic, they must first be officially discharged from the hospital... then readmitted.

[Gibbie]

Thanks for your input robblin. I am trying to gather as much info about this before I go to our regional director. What state are you in?

[Robbilin]

Thanks for your input robblin. I am trying to gather as much info about this before I go to our regional director. What state are you in?

We are a hospital based center in Wisconsin. Our patients don't get discharged first if they are inpatient, to come down to our unit. It is charged under their inpatient hospital number. Our normal outpatient chronics have one number, but if they get admitted they get a new number, then those tx go under the new number. There is one charge for inpatient hemodialysis if the tx is down in the unit, whether they come down in a bed or a wheelchair, or a different charge if we have to take our RO unit to the bedside. Transients, etc, obviously have their own number that everything gets charge to. Hope this helps! R

[Hemo Nurse]

When I worked in an acute/cronic unit based hospital dialysis center.... We had a room and Acute dialysis room within an ICU unit that allowed us to HD our "stable" in-house hemo patients, also in doing this it allowed for us to run more than one "stable" patient at a time. If your #'s are anything like ours was, you need to do more than one patient..... to get out the door before midnight!

[NRSKarenRN, BSN, RN]

Check out info at Renal web:

http://www.renalweb.com/cgi-local/ubb/Ultimate.cgi?action=intro&BypassCookie=true

CMS:ESRD Information Resource

http://www.cms.hhs.gov/providers/esrd.asp

10.5 - Outpatient Hospital Services Which Become Inpatient Hospital

Services

(Rev. 1, 10-01-03)

PRM-1-2702.1.C

When an individual is furnished outpatient hospital services and is thereafter admitted as an inpatient of the same hospital due to renal failure - within 24 hours for non PPS

hospitals and within 72 hours for PPS hospitals - the outpatient hospital services

furnished are treated as inpatient services unless the patient does not have Part A

coverage. Charges are reported on Form CMS-1450. The day on which the patient is

formally admitted as an inpatient is counted as the first inpatient day.

http://www.cms.hhs.gov/manuals/104_claims/clm104c08.pdf

Other payment info available at CMS link