Billing for Traveling Home Dialysis Patients
Ease of travel can be a major benefit for patients who choose PD or do home HD with a portable machine. But, how do you handle billing for a home patient who wants to hit the road—for months at a time?
In my experience, when we had a home patient who was traveling, we made sure the patient had information on clinic(s) where they could get help if they needed it while traveling. Of course, they had their home clinic and doctor's phone number to call if needed. They also carried their medical records with them.
In Section 100.3 of the Medicare Claims Processing Manual, Chapter 8 – Outpatient ESRD Hospital, Independent Facility, and Physician Supplier Claims under Physician's Services Furnished to a Dialysis Patient Away From Home or Usual Facility, it describes how a physician who is not the home patient's usual physician would bill for services.
The Medicare ESRD regulations say a physician should see dialysis patients each month. But, there are times when this doesn't happen. In Section 140.1.1 of the same manual under Payment for Managing Patients on Home Dialysis, it says that an insurance company that pays Medicare's claims can waive the monthly visit requirement if the patient's physician has documented that he/she has "actively and adequately managed" the patient's care. The patient's physician can use a clinical nurse specialist, nurse practitioner, or physician assistant to do face-to-face visits with the patient or the physician can contract with another physician or non-physician providers to do face-to-face visits.
If patients need to have lab tests done while away, the clinic that is billing for the patient's home HD or PD would still need to pay for the labs under the bundle—along with any ESRD-related drugs that are included in the bundle.
Encourage your patients to travel and wish them a good trip. Before they go, be sure to share information about their rights as travelers with life-saving equipment at Home Dialysis Central - Flying with a PD Cycler or NxStage System One.