From the Field: Misinterpreting Dialysis Frequency Rules

Rick Collins Home dialysis programs are taking a big financial hit as several commercial payers are refusing to pay for more than 13 peritoneal dialysis (PD) treatments per month. The payers appear to have misinterpreted a portion of the Medicare Benefit policy manual regarding frequency of dialysis. The information in this article will help home dialysis programs fight this misinterpretation ... Read More »

From the Editor: Should Renal Replacement Therapy Begin Early in ICU Patients with AKI? A Tale of Two Studies

Ajay K. Singh, MD The timing of initiating renal replacement therapy (RRT) among patients with acute kidney injury (AKI) in the intensive care unit (ICU), i.e., among critically ill patients, is controversial. Intuitively, it seems reasonable to think that there should be no downside to initiating therapy early in complex relatively unstable patients, especially since renal-related complications, such as severe ... Read More »

From the Field: New Rules for 2016

Rick Collins New rules related to billing for drug wastage and advanced care planning affect all physicians and outpatient dialysis facilities this year. Drug Wastage In the past, discarded amounts of drugs or biologicals in single-use vials could be billed one of two ways. The first was to bill the amount of the drug used on one claim line and ... Read More »

From the Board: Feel Like a Number

Kenneth A. Liss, DO Hypertension & Nephrology Associates Eatontown New Jersey The iconic Rock and Roll Singer Bob Seger penned the powerful refrain, “I Feel Like a Number,” while referring to man’s eternal sense of inadequacy. At a party the other night, a number  of my colleagues and I were lamenting the same fact, although less poetically. In particular we ... Read More »

From the Editor: At Last, Something to Celebrate about in the Treatment of Diabetic Nephropathy

Ajay K. Singh, MD Diabetic nephropathy is the commonest cause of end stage renal disease in the United States. Long-standing strategies to prevent kidney failure, such as renin-angiotensin blockade, tight blood glucose control, and lowering of blood pressure, are effective but only to a limited degree. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, such as empagliflozin, represent the most exciting new class ... Read More »

From the Field: Revalidate or Risk Losing Your Program

Rick Collins Can you, your practice, or facility afford to lose weeks or possibly months of Medicare reimbursement? If not, pay close attention to the new round of CMS Provider Enrollment Revalidations that will be coming your way. Failing to respond quickly to the new Revalidation Cycle 2 notices will result in the deactivation of your Medicare provider number. Unlike ... Read More »

From the Field: Medicare Capitated Payment Q&A Part Two

Rick Collins In the last issue, we answered questions regarding basic tenets of the Medicare Monthly Capitated Payment (MCP) for nephrologists and their associated practitioners. In this issue we will wrap up our review of the MCP and related regulations by looking at possible exemptions for the face-to-face visit requirement and billing for services provided to an ESRD patient for ... Read More »

From the Editorial Board: Hyperkalemia—The Bane of Our Existence

Kenneth A. Liss, DO Hypertension & Nephrology Associates Eatontown, New Jersey The great existential question that all nephrologists learn early in their career is… “What is the potassium?” For years, medical residents, RNs, and emergency department personnel have heard this frequent inquiry. If the level is acceptable, we can probably go back to sleep and address the problem the next ... Read More »

From the Chair: Treatment of Moderately Severe IgA Nephropathy

Ajay K Singh, MBBS, FRCP, MBA Brigham and Women’s Hospital and Harvard Medical School Boston, Massachusetts D’Amico, in a classic paper published in 19871, labeled IgA nephropathy as the “commonest glomerulonephritis in the world.” This may be true in some parts of the world, such as Southeast Asia, but in North America the prevalence is reported to be about 10%, ... Read More »

From the Field: Medicare Monthly Capitation Payment Q & A (Part One)

Rick Collins Now that we have survived the implementation of ICD-10, our focus for this issue and the next turns to the Medicare Monthly Capitation Payment (MCP). The increase in the use of physician assistants (PAs) and nurse practitioners (NPs), along with the implementation of telehealth are two areas that typically generate many questions related to the MCP. In this ... Read More »