From the Field: Cheap Billing Can Be Costly

Rick Collins “We can do your billing for much lower fees than you’re paying now!” While this is a tantalizing phrase for physicians, management, ownership, and accountants, paying for “cheap” billing frequently costs you much more than any savings you realize from the cheaper billing rate. To illustrate this point, following are personal experiences from our company’s 20 years in ... Read More »

From the Chair: Home Dialysis Takes a Big Step

Ajay K. Singh, MBBS, FRCP, MBA Brigham and Women’s Hospital and Harvard Medical School  Boston, Massachusetts From the early days of hemodialysis, many, including the late Dr. Bernard Scribner at the University of Seattle, worked tirelessly to promote home hemodialysis. In the early 1970s, the use of home hemodialysis peaked, with nearly 40% of all patients in the United States ... Read More »

From the Field: New Bill Cuts Facility Certification Delays and Expands Telehealth Options

Rick Collins Ridiculously lengthy delays in getting new dialysis facilities certified might finally be going away. H.R. 3178, sponsored by ten members of the House of Representatives, would allow new facilities to be certified by government-approved agencies other than Medicare. In this age of few agreements between political parties, this bill appears to have great appeal to both parties as ... Read More »

From the Chair: The New Mineral and Bone Disorder Guideline Update: Osteoporosis and Fracture Risk

Ajay K. Singh, MBBS, FRCP, MBA Brigham and Women’s Hospital and Harvard Medical School Boston, Massachusetts Fractures in chronic kidney disease (CKD) patients, particularly those that are elderly, have substantial morbidity and mortality. The Kidney Disease Improving Global Outcomes 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (KDIGO CKD-MBD)1, ... Read More »

From the Field: AKI Billing Update and Insurance Refund Limitations

Rick Collins and Sarah Tolson Recognizing that key differences exist in the reimbursement of services for acute kidney injury (AKI) patients, the Centers for Medicare & Medicaid Services (CMS) issued important clarifications in June that significantly impact physician and outpatient dialysis facility claims. End-stage renal disease (ESRD) Conditions for Coverage, the Low Volume Payment Adjustment, home dialysis, physician services, payment for ... Read More »

From the Chair: Intensive Blood Pressure Treatment in CKD Patients

Ajay K. Singh, MBBS, FRCP, MBA Brigham and Women’s Hospital and Harvard Medical School Boston, Massachusetts The target blood pressure in patients with chronic kidney disease (CKD), both with diabetic and non-diabetic CKD, remains controversial. In early September 2017, a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies conference will convene in Edinburgh, Scotland, to address blood pressure (BP) management in ... Read More »

From the Field: New Medicare Patient ID System

Rick Collins Sarah Tolson Another major change is about to hit healthcare providers in 2018 that has the potential to cause reimbursement delays in Medicare and secondary payer reimbursement. In April 2018, the Centers for Medicare & Medicaid Services (CMS) will begin to replace all current Medicare patient identification numbers with a new numbering system. The current patient identification methodology, ... Read More »

From the Board: Profit Is Not a Four Letter Word

Kenneth A. Liss, DO Hypertension and Nephrology Associates Eatontown, New Jersey I try, perfunctorily, to keep up with journal reading. Some of the publications are fond of placing self-help advice for doctors. Articles about efficiency, making better use of the HER, and how to avoid unnecessary litigation are commonplace. Frankly, some of the advice is timely and helpful, but I ... Read More »

From the Field: AKI Billing and Reimbursement Update

Sarah Tolson While it is exciting that dialysis clinics can now receive reimbursement for treatments provided to acute kidney injury (AKI) patients, there are still a number of unknowns where reimbursement is concerned. The final rule and related change requests indicate that Medicare will pay the base rate adjusted by the wage index. End-stage renal disease (ESRD) dialysis treatments paid ... Read More »

From the Chair: Proton Pump Inhibitors and the Risk of CKD

Ajay K. Singh, MBBS, FRCP, MBA Proton pump inhibitors (PPIs) are one of the commonest classes of prescribed drugs worldwide. Indications include the treatment of acid reflux and peptic ulcer disease. Concerns about over-utilization of PPIs have been raised. However, extensive use continues; in the United States, even excluding over-the-counter sales, there are estimated to be more than 170 million ... Read More »