decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
Answer_Book / Dialysis_Services / Take_advantage_of_new_billing_opportunities_for_ESRD_patients_in_2005
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Article Overview
This premium article reviews CMS billing guidance for ESRD services and how 2005 policy changes affect payment when patients are transient, change physicians, miss a full month of care, or receive services in settings such as hospital observation or skilled nursing facilities. It is intended for dialysis billers, coders, and revenue cycle staff who need to understand the general categories of ESRD monthly and daily payment guidance and the settings that may count toward monthly visit totals. The article also notes related CMS cautionary guidance and a transmittal reference.
Why This Topic Matters
ESRD billing can depend on where care is furnished, whether a full monthly assessment occurs, and whether the patient’s circumstances are unusual. Understanding the scope of the CMS update helps billing staff recognize when the article’s guidance may affect claim submission and monthly payment reporting.
What You Will Learn
- How CMS updated ESRD billing guidance for certain unusual patient circumstances
- Which care settings may count toward monthly visit totals
- How hospital observation and skilled nursing facility encounters are discussed in ESRD billing context
- What general CMS cautions are noted about using daily ESRD payment codes in the same month
Who Should Read This
- Dialysis billers
- Medical coders
- Revenue cycle staff
- ESRD clinic administrators
- Nephrology practice staff
Codes Discussed
Code Ranges Discussed
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