Billing for Home Dialysis Travel and Helping Patients to Plan

Patients may be concerned about how dialysis while traveling is billed. When home patients (PD or home HD) travel, the home clinic pays for home dialysis supplies and bills Medicare and/or other insurance as if the patient is doing his/her dialysis at home. I’ve not heard of supply companies charging more to deliver supplies to a travel location in the U.S. I have heard of patients on PD—or even home HD—who have dialyzed on cruises having supplies delivered to U.S. ports to be loaded on for use on the ship. I’ve also known of patients who traveled outside the continental U.S. who had to pay for shipping supplies.

For those on Medicare, the Medicare Claims Processing Manual, Chapter 8, Section 100.2 describes how the dialysis clinic should bill Medicare for home dialysis patients who are traveling. All dialysis clinics are now paid under “Method I” since Method II was eliminated when the ESRD prospective payment rate took effect.

1. Method I (Composite Rate)

If the patient travels from place to place and never spends a continuous 30 days at a single facility, then all facilities or suppliers which furnish any home dialysis items or services to the patient, must seek payment from the patient’s home town facility. The home town facility bills the program its composite rate for all home dialysis treatments the patient performs.

If the patient spends 30 days or more at a single facility away from his/her home town facility:

• The two facilities may reach an agreement between them as to which facility will bill the program the composite rate. The facility that does not bill the composite rate is paid by the other facility during this period of time. The temporary facility may bill the program directly only for items and services that it furnishes to a patient after a patient has been under its care for 30 days.

If the facility that bills the composite rate is the temporary facility, then it indicates on its claim “temporary patient,” and the name and address of the patient’s home town facility. The A/B MAC (A) receiving this claim must send a copy of the MSN to the A/B MAC (A) servicing the home town facility to assure that the home town facility is not also paid during this time.

If the two facilities cannot reach an agreement as to which one will bill the program, then after the 30-day waiting period, the temporary facility bills its A/B MAC (A); the home town facility does not bill. The procedure outlined for completing and processing the claim must be followed.

Sometimes patients on home HD do dialysis in-center when they travel. The Medicare Benefit Policy Manual, Chapter 11, Section 30.1 describes how the dialysis clinic should bill Medicare for a home dialysis patient who does in-center dialysis while traveling:

B. In-facility Dialysis Sessions Furnished to Home Patients Who Are Traveling

Patients who are normally home dialysis patients may be dialyzed by a Medicare certified ESRD facility on an in-facility basis when traveling away from home. Patients who normally dialyze in an ESRD facility may wish to dialyze temporarily in another facility or as home dialysis patients while they travel or vacation. See Medicare Claims Processing Manual, Chapter 8, “Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims,” §100, for billing services when traveling.

One of the major perks of home dialysis is ease of traveling. Those on home dialysis who plan to travel should notify their dialysis clinic in advance of their travel dates.

• If a home HD patient plans to do in-center dialysis, a minimum of 30-60 days’ notice is needed.
• If the patient plans to do PD or home HD when traveling, notifying the home clinic allows the training nurse to tell the patient who to contact and where to go if he/she has a dialysis-related problem while out of town. The patient or clinic should provide sufficient notice to the company delivering supplies for where to ship supplies, and the patient should ask if there’s a shipping charge.

Patients who travel a lot have found that making a checklist of supplies they use at home helps them to make sure they take or have the right supplies shipped to their travel destination so they do their dialysis safely. If the patient will be:

• Staying at a friend or relative’s house, s/he should alert them when supplies will be arriving and how much to expect.
• Staying at a hotel, s/he should contact the hotel before supplies are scheduled to arrive to ask if there will be a charge for receiving the dialysis supplies and storing them until the check-in date.
• Traveling by plane, it’s important for staff and patients to review the Department of Transportation’s Guidance on the Transport of Portable Dialysis Machines by Travelers with Disabilities. Patients may want to take this guidance with them to avoid issues that can arise.

The Leaving on a Jet Plane blog post is a good resource for patients traveling on PD or home HD. Travel planning can make travel on home dialysis less stressful and more successful.