From The Field

The Ins and Outs of Partial Month Billing for the MCP

Sarah Tolson The Ins and Outs of Partial Month Billing for the MCP In recent months, I have received many questions with a common theme—billing for a partial month of nephrology services for dialysis patients. In this issue, we will examine these questions and their solutions. The questions keep this column relevant, and I appreciate all of you who read ... Read More »

From the Field: Monthly Capitation Payment Breakdown

By Sarah Tolson In recent months, I’ve received an influx of questions from readers about the Medicare Monthly Capitation Payment (MCP). Many of these questions are related to the increasing utilization of physician assistants (PAs) and nurse practitioners (NPs), in addition to questions about CMS regulation changes at the beginning of the year that allow free-standing dialysis facilities and patient ... Read More »

From the Field: Tips for Successful Appeals

Sarah Tolson The word appeal is frequently considered a dirty word within the walls of Sceptre Management. Generally, by the time a payers’ requirements for appeal submission have been met, the claim in question is past due and the chances for obtaining full reimbursement have decreased. The entire appeal process is labor intensive, and success rates are generally not in ... Read More »

From the Field: Controversy over Commercial Insurance

By Sarah Tolson Earlier this year the California Assembly passed AB 290, a bill with the stated purpose of “preventing dialysis companies from increasing their already excessive corporate profits through a scheme to bankroll patients’ health care premiums,” according to the official website of California Assembly member Jim Wood. The bill, which is now under consideration by the California Senate, ... Read More »

From the Field: Three Tips to Improve Accounts Receivable

In our company, we deal with insurance companies across the nation. Working with a variety of payers gives us a wide range of experience but we also encounter our fair share of challenges in obtaining reimbursement. Here are three simple tips that make collecting from payers a little easier. 1. Know the Rules The best way to cut down on ... Read More »

From the Field: New Frequency of Hemodialysis Local Coverage Determinations

Sarah Tolson Effective March 1, 2019, several Medicare Administrative Contractors (MACs) began processing claims for hemodialysis treatments under new Local Coverage Determinations (LCDs). These LCDs underwent massive revisions after the proposed LCDs released in 2017 would have essentially eliminated reimbursement for more than three treatments per week because they were so strict. Medicare, the largest payer in the United States ... Read More »

From the Field: 40 Years of Lessons from Work and Life

After 19 years at Sceptre Management Solutions, the time has come for me to step aside. My wife and I sold the business last year to our oldest daughter, Jennifer Hicks, who has worked with us since 2001. She has an MBA and is incredibly smart and very talented. I stayed on during the past year to help during the ... Read More »

From the Field: Patient Payments Part 2

Last issue I mentioned that a social worker commented to me that she wishes providers would stop trying to collect from patients. She said providers “make enough money” and wondered why they feel the need to collect from patients who cannot afford their large coinsurances and deductibles. She pointed out that increasing pressure on patients to pay for coinsurances and ... Read More »

Growing Pressure on Renal Patients to Pay Out-of-Pocket

By Rick Collins At a conference I attended recently, a social worker lamented how much grief is placed on dialysis patients due to the large bills they receive from renal providers. She openly wondered why providers feel they need to bill patients since they already are paid “a lot” by Medicare and commercial insurance companies. When I first entered the ... Read More »