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 Chair: Dialysis Moonshot Revisited: Options for the Elderly

Ajay K. Singh, MBBS, FRCP, MBA Brigham and Women’s Hospital Harvard Medical School In a previous editorial, I made the case for the federal government funding a Dialysis Moonshot initiative, set up similarly to the Obama administration’s Cancer Moonshot that was spearheaded by Vice President Joe Biden. In occasional articles, I intend to cover areas of dialysis care where research ... 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 Chair: Machine Learning Comes to Acute Kidney Injury: Is this the Dawn of a New Age?

Ajay K. Singh, MBBS, FRCP, MBABrigham and Women’s HospitalHarvard Medical School Acute kidney injury (AKI) is a relatively common presentation in hospitalized patients, particularly among critically ill patients where it can be associated a high mortality. Patients who undergo cardiovascular procedures or are treated with chemotherapy, and those with diabetes mellitus and chronic kidney disease who receive intravenous contrast are ... 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 Chair: Time for a Dialysis Moon Shot

Two articles—in February 2019 by Mahesh Krishnan and Kent Thiry1 and by Ron Shinkman in June 20162—both published as New England Journal of Medicine Catalyst essays, coupled with a powerful critique in 2010 by Robin Fields in the Atlantic3, discuss the current state of dialysis care in the United States. Krishnan and Thiry, both senior leaders at DaVita, argue that ... 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 Board: Lessons from My Father

Kenneth A. Liss, DO Editor’s Note: Scroll down for a response from one of the authors referenced in this column. When I was thirteen or fourteen, I took an acquaintance’s side over my brother’s in an argument. Full of righteous indignation, I bragged to my father how I was sure I had the moral high ground and had done the ... Read More »