actual dialysis biller here

[dialysisbiller]

After reading so many posts, I decided to join the board to offer up help to anyone who may need it. Insurance issues or billing questions, I might be able to help out.

 

[Sluff]

I'm sure you will get plenty of response. Thanks for stepping up. Now get a rope...

[Dan.Larrabee]

You guys and gals do such a great job, I don't even know how much it cost to be on dialysis. Between my insurance and medicare, i don't pay anything out of pocket. What does it cost the average person to be on dialysis monthly?
 

[dialysisbiller]

if you add up the cost of the actual center, including rent/lease, staff and supplies (dont forget the behind the scenes people like me!)

there is ALOT of behind the scenes that most don't understand and that is why there are specialized people that do it. (Hence all the paper pushing that needs to go on at the center level)

I can't give actual dollars because it would depend on the size of the center. I handle a few large centers and a couple of smaller ones.

[Dan.Larrabee]

I am actually on home hemo dialysis. They told me that they bill my insurance the same amount and it did not matter if i was in the center or at home. Its interesting that you bill different per size of center. its as though you get a quantity discount if you are in a center with a large number of patients. If you can explain this, I am sure a few of us would be interested.. If I had any of out of pocket expense, it sounds like I may want to move to the largest, or smallest center as possible. 

[dialysisbiller]

no no, it's no different with the size of the center for billing ... reimbursement(money rec'd from the insurance) is same if you have 5 patients at the center or 105 patients. If you have more patients you have more bills, less patients, less bills. It's a difficult balancing act to say the least, trying not to give up quality care when money is not coming in to support it. Most don't fully understand the business side of it and really do think the medical industry is all about profit, it is and it ISNT. You can't give quality care if you can't afford to hire enough people to staff the center. That's just one look, course then there's the whole insurance circus, and I mean circus.

[Dan.Larrabee]

So how much is billed for the advrage dialysis patient on a monthly basis?

[Bill Peckham]

There was a law suit filed last year that finally put some numbers into the public record
http://www.billpeckham.com/from_the_sharp_end_of_the/2008/01/law-suit-reveal.html

"Blue Cross has received charges from National Renal for dialysis treatments that range from $2,000 to $9,000 per treatment."

That's the revenue side of the equation. For the cost data there was a recently released report from the National Renal Administrators
http://www.billpeckham.com/from_the_sharp_end_of_the/2008/12/dialysis-cost-data-shows-ldos-have-large-purchasing-advantages.html

[Dan.Larrabee]

Thanks Bill!
Boxman started a thread "$19,919.00 man that's a bunch" and it got me curious as to the advrage for each of us. It seamed as though everyone is charged so differently.

Maybe dialysisbiller could shed some light.

[dialysisbiller]

and medicare only reimburses less than that....not a pretty picture

[BigSky]

There was a law suit filed last year that finally put some numbers into the public record
http://www.billpeckham.com/from_the_sharp_end_of_the/2008/01/law-suit-reveal.html

"Blue Cross has received charges from National Renal for dialysis treatments that range from $2,000 to $9,000 per treatment."

That's the revenue side of the equation. For the cost data there was a recently released report from the National Renal Administrators
http://www.billpeckham.com/from_the_sharp_end_of_the/2008/12/dialysis-cost-data-shows-ldos-have-large-purchasing-advantages.html

On the supply side cost.  Is that just the cost of the necessary medical supplies?

Do you know if the other associated costs are figured into the supplies average?  Such as power, water, heat,  building rental, machine maintenance and new purchases of equipment etc. etc.?

[dialysisbiller]

Thanks Bill!
Boxman started a thread "$19,919.00 man that's a bunch" and it got me curious as to the advrage for each of us. It seamed as though everyone is charged so differently.

Maybe dialysisbiller could shed some light.

Standard charge amount for a single dialysis treatment is approx $1,400. (again, this does not reflect the actual amount reimbursed) Medicare allows a fraction of that, on average Medicare will actually allow $140. Commercial private insurance, that depends on the indiviidual policy plan. On rare occasions the reimbursement might be 100% but that's RARE. Some contracted insurance plans are 50% and some are flat inclusive fees of 30-40%. That is for incenter hemo. Home Hemo is usually the same as well as an ultrafiltration treatment.

[Bill Peckham]

There was a law suit filed last year that finally put some numbers into the public record
http://www.billpeckham.com/from_the_sharp_end_of_the/2008/01/law-suit-reveal.html

"Blue Cross has received charges from National Renal for dialysis treatments that range from $2,000 to $9,000 per treatment."

That's the revenue side of the equation. For the cost data there was a recently released report from the National Renal Administrators
http://www.billpeckham.com/from_the_sharp_end_of_the/2008/12/dialysis-cost-data-shows-ldos-have-large-purchasing-advantages.html

On the supply side cost.  Is that just the cost of the necessary medical supplies?

Do you know if the other associated costs are figured into the supplies average?  Such as power, water, heat,  building rental, machine maintenance and new purchases of equipment etc. etc.?

It's a good question. The Avalere report those number are drawn from does not specifically say but I don't see why overhead would be excluded. It could be included in a factor that they use to increase the other categories. For instance they might be multiplying everything by 1.07 to assign overhead but you think they would say that or footnote it in the report. But from what I know the total would be in line with what I expect would be total allowed costs per treatment.

I know that for MedPAC's purposes when they project a negative margin for SDOs they're using allowed costs which would include what you listed but not bad debt or the Medical Director's fee.

[Bill Peckham]

Thanks Bill!
Boxman started a thread "$19,919.00 man that's a bunch" and it got me curious as to the advrage for each of us. It seamed as though everyone is charged so differently.

Maybe dialysisbiller could shed some light.

Standard charge amount for a single dialysis treatment is approx $1,400. (again, this does not reflect the actual amount reimbursed) Medicare allows a fraction of that, on average Medicare will actually allow $140. Commercial private insurance, that depends on the indiviidual policy plan. On rare occasions the reimbursement might be 100% but that's RARE. Some contracted insurance plans are 50% and some are flat inclusive fees of 30-40%. That is for incenter hemo. Home Hemo is usually the same as well as an ultrafiltration treatment.

Here is my breakdown of the standard unit payer mix. DB does this match your experience? Can you tell us what the State Medicaid policies are where you work?

In general terms 50%; 25%; 10%; 10%.
50% Medicare primary/ private insurance secondary
25% Medicare Primary/ Medicaid secondary
10% Medicaid
10% Private insurance

[dialysisbiller]

That is going to depend on the state. It's based on a state level then, some states are absolutely horrible, others not so bad. Billing procedures are hard to keep up with on a state level as they change quarterly. We have a department that specializes in each financial class for keeping up with all the changes. It's a tough job.

The break down is good tho

keep in mind, Medicare has an allowed amount, even if private is secondary, we get no more than what medicare has allowed, Medicare pays 80% of allowed then private or other secondary pays 20% of that allowed, sometimes patients if they only have medicare and no supplimentary policy.

[nursewratchet]

Remember, Medicare reimburses LESS than the treatment costs.  Every treatment loses money.  Medicare IS going up on reimbursement rates, but still won't cover the toral cost of treatment plus meds.  Good to have you here,Biller.  You will be a good help, and You will learn alot, as I have.  Great group to be a part of.

[dialysisbiller]

thanks... glad to meet you too, I am looking forward to getting a chance to spend at a facility to see faces attached to names that I see daily.

I see there are strong opinions here, and enjoy that, to know how people really feel about dialysis as a whole.

You seem like a terrific FA and would some day enjoy a chat with you if you didn't mind.