From the Field

From the Field: KNOCKED SENSIPARLESS

Rick Collins Chief Operating Officer Sceptre Management Solutions, Inc.   KNOCKED SENSIPARLESS Patients and providers using Sensipar® (cinacalcet) and Parsabiv™ (etelcalcetide) are experiencing significantly increased financial liability due to inconsistent coverage of the drugs by payers and the dramatic increase in the coinsurance amount assigned by Medicare Part B. The biggest causes of potential lost reimbursement for providers are Medicare ... Read More »

From the Field: Losing Money by “Saving” Money

By Rick Collins and Sarah Tolson It is a saying I have never forgotten. “For a company to make a profit, you can cut costs or bring in more money. I prefer to bring in more money.” These words were spoken by the owner of a small company that was struggling to make ends meet. Over the years, I have ... Read More »

From the Field: Reimbursement for Parsabiv™ and Sensipar®

Sarah Tolson For the first time since the inception of the End-Stage Renal Disease (ESRD) Prospective Payment System, two drugs qualify for payment outside of the dialysis base rate. The renal community is buzzing with questions about reimbursement, purchasing, clinical protocol, and supply chain logistics for Parsabiv™ (etelcalcetide) and Sensipar® (cinacalet). I’ve been speaking with clients to discuss their plans ... Read More »

From the Field: More Frequent Dialysis Appears Dead for Now

I still remember the excitement expressed by our company’s first client that purchased new, smaller home dialysis machines nearly 20 years ago. While the machines were expensive and would require patients to receive more frequent treatments, the patients’ quality of life would improve significantly, according to the company’s sales representative. Instead of being tied to a standard hemodialysis machine for ... Read More »

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 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 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 »