Dialysis billing

Messages
4
Location
Colorado Springs, CO
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Does anyone know if there is a requirement for a M.D. to see a dialysis patient instead of a N.P. within a certain period with a commercial payer? For example: a N.P. can see the patient for their monthly dialysis visits, but a M.D. must see the patient at least once every 3 months.

Thanks!
 

Jennifer Turner

Networker
Local Chapter Officer
Messages
41
Location
Indianapolis, IN
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0
Hi,

Our practice has yet to run into this issue. We have a mix of both providers (NP's & MD's) but more physicians than we do NP's. Although the NP's do have face to face visits with the pt.'s and would even do the complete assessment visit it is very uncommon in our practice that a physician will go 3 months without seeing a pt. that is on dialysis. The physicians may rotate but I can guarantee that the pt. will see a MD within that time frame. I can say that in the Medicare Claims Processing Manuel, Chapter 8 there are no such rules stating that the pt. has to be seen by a MD within a 3 month period as the physicians and practitioners form a team to provide the monthly continuity of services to the pt.'s.

For a commercial payer I'd suggest you to check their professional reimbursement policy for ESRD/MCP outpatient services which is usually found on their website.
 
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