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 »

From the Field: JW Modifier: A Big Waste?

Rick Collins Sarah Tolson A new Medicare regulation requires providers to report discarded amounts of separately billable drugs packaged in single dose vials. The waste must be noted in the patient’s medical record and recorded on claims using modifier, JW, “Drug amount discarded/not administered to any patient.” While that sounds simple enough, how many providers are carefully noting in a ... Read More »

From the Board: The Third Rail (Not To Be Confused with the Third Space)

Kenneth A. Liss, DO Hypertension and Nephrology Associates Eatontown, New Jersey Politicians are fond of talking about the third rail of politics. This generally refers to the lack of financial sustainability in Social Security and Medicare. Although many politicians, particularly those that are viewed favorably by their constituents, have talked about the need to reform these programs, even the most ... Read More »

From the Chair: Managing Nonvalvular Atrial Fibrillation in Dialysis Patients: What Should You Do?

Ajay K. Singh, MBBS, FRCP, MBA The Controversies in Nephrology series1-7 in the Clinical Journal of the American Society of Nephrology (CJASN) covered a topic that virtually every nephrologist has had to wrestle with, namely how to manage a dialysis patient who develops nonvalvular atrial fibrillation (NVAF). The articles are outstanding and thoughtful. A stroke from NVAF could have devastating ... Read More »

From the Field: Competing Medicare and Medicaid Regs: You Lose

Sarah Tolson Providers are in a no-win situation when Medicare and Medicaid regulations conflict with one another. A perfect example of this is reflected in the sample question below we received from several billers: Question: Medicaid requires us to report the NDC (National Drug Code) for each vial size we use in dosing a patient. For example, if our physician ... Read More »

From the Field: Hard Lessons about the Business Side of Healthcare

Rick Collins One of the bitter lessons of life is that you can be the very best at what you do and still have an unsuccessful business. Prior to entering healthcare 16 years ago, I sold newspaper advertising and contacted hundreds of small businesses, including healthcare providers, about marketing their products and services. I was frequently amazed at the high ... Read More »