$19,919.00 man that's a bunch

[st789]

Getting dizzy just seeing those numbers...

[dialysisbiller]

And let's not forget over-billing for EPO, etc.

Zach, I gotta be honest with you, the restrictions in place now for EPO implimented by Medicare, it doesn't exist and hasn't since 2007. Epo reduction is mandatory by CMS based on your HCT calculated over a 3 month time frame, If it's not reduced, Medicare will not pay the full allowed amount and will reduce 25% or 50% of the allowed amount. Time have changed regarding EPO usage within dialysis. And most of our commercial primary payers that were are contracted with have 'all inclusive' contracts meaning, does not matter how much medication you rec've during the treatment, it is still going to be a single treatment contracted rate. Non contracted payers will wind up paying more, but I can guarantee you that majority of your nephs base EPO on CMS guidelines these days because of all the attention it has been getting.

When you say 'over-billing', to me that means 'made up bills', I like my job and intend to keep it so I am always checking up on any 'funny' looking things and to be honest, my centers are very good.... if you believe they give it out too much, it would be 'over dispensing' (just an insight to how it's seen on my end)

Another misleading thing I have seen on a post regarding billing issues, someone posted about companies billing for dead people. Absolutely not true. If a PD patient passes, the family may not notify the center until a few days or weeks, in the meantime, the computer chart creates a daily treatment. It might go out on a claim, but the insurance company will deny due to the date of death. It gets fixed and then goes out correctly. Again, I LIKE my job and intend on keeping it.

[Zach]

When you say 'over-billing', to me that means 'made up bills', I like my job and intend to keep it so I am always checking up on any 'funny' looking things and to be honest, my centers are very good.... if you believe they give it out too much, it would be 'over dispensing' (just an insight to how it's seen on my end)

Perhaps I stand corrected.

But how do you define it when a 4,000 unit vial of medication is dispensed but Medicare is billed for 4,600 units?

[Bill Peckham]

Zach I think the term of the art you're looking for is the "overfill". For example, if the multi-use vials of Epo is labeled as having 10,000mu, when they actually contain 10,500mu.

So they are in fact dispensing the epo they bill for - all 10,500mu were dispensed but they "paid" for 10,000mu.

I don't really see this as an issue unless CMS was to start buying EPO directly on behalf of the units. As it now stands the SDOs and the LDOs are paying different amounts per vial. That data was in the Avarere report the NRAA included in their letter to CMS. The possibility that a provider could administer what is included to accommodate inefficient syringe filling just lowers the dialsyis provider's effective cost by as much as 5%. The prefilled syringes make this all a moot point.

[Zach]

Zach I think the term of the art you're looking for is the "overfill". For example, if the multi-use vials of Epo is labeled as having 10,000mu, when they actually contain 10,500mu.

One can only hope that the patient actually receives every drop of EPO in the vial for which Medicare is billed.
The prefilled syringes do, in fact, make this a moot point--if they were universally used.

What medication, other than EPO, is billed to include overfill?

[Bill Peckham]

Zach I think the term of the art you're looking for is the "overfill". For example, if the multi-use vials of Epo is labeled as having 10,000mu, when they actually contain 10,500mu.

One can only hope that the patient actually receives every drop of EPO in the vial for which Medicare is billed.
The prefilled syringes do, in fact, make this a moot point--if they were universally used.

What medication, other than EPO, is billed to include overfill?

There really isn't a way to know if the syringe contains the prescribed dose, for example 6,400mu or 6,350mu. It's eye balled. To have confidence in what was billed you'd have to circle back and compare the quantity of epo purchased vs. the quantity of epo administered across all payers. I don't know of anyone who's done that.

[Zach]

There really isn't a way to know if the syringe contains the prescribed dose, for example 6,400mu or 6,350mu.

I'm not sure we're talking about just a difference of 50 U or so.

To have confidence in what was billed you'd have to circle back and compare the quantity of epo purchased vs. the quantity of epo administered across all payers. I don't know of anyone who's done that.

Excellent point!
Perhaps MedPAC should do a few audits.

But again, what other medication is billed using overfill as part of the dose? 

[Bill Peckham]

There really isn't a way to know if the syringe contains the prescribed dose, for example 6,400mu or 6,350mu.

I'm not sure we're talking about just a difference of 50 U or so.

To have confidence in what was billed you'd have to circle back and compare the quantity of epo purchased vs. the quantity of epo administered across all payers. I don't know of anyone who's done that.

Excellent point!
Perhaps MedPAC should do a few audits.

But again, what other medication is billed using overfill as part of the dose? 

What other medications are dispensed in multi dose vials?

[dialysisbiller]

let me read up on somethings at work tomorrow and i  might be able to clear up this one when i get back

[nursewratchet]

When you say 'over-billing', to me that means 'made up bills', I like my job and intend to keep it so I am always checking up on any 'funny' looking things and to be honest, my centers are very good.... if you believe they give it out too much, it would be 'over dispensing' (just an insight to how it's seen on my end)

Perhaps I stand corrected.

But how do you define it when a 4,000 unit vial of medication is dispensed but Medicare is billed for 4,600 units?

   Each vial of EPO has an "overfill".  It is stated by EPOGEN, and accepted by Medicare as allowable.  If the dose is for example 1000 units, the vial will actually contain as much as 1300 units.  The "overfill" is entirely profit, and is encouraged by Medicare, the drug companies, and insurance companies.  It is in the vial because it is such an important drug, they don't want it lost to the needle space as it is drawn up, so they put extra in the vial.  You can use the 1000 units out of the vial for you, and use the overfill to start the next dose.  It's basically a give away from Amgen. 

[dialysisbiller]

When you say 'over-billing', to me that means 'made up bills', I like my job and intend to keep it so I am always checking up on any 'funny' looking things and to be honest, my centers are very good.... if you believe they give it out too much, it would be 'over dispensing' (just an insight to how it's seen on my end)

Perhaps I stand corrected.

But how do you define it when a 4,000 unit vial of medication is dispensed but Medicare is billed for 4,600 units?

   Each vial of EPO has an "overfill".  It is stated by EPOGEN, and accepted by Medicare as allowable.  If the dose is for example 1000 units, the vial will actually contain as much as 1300 units.  The "overfill" is entirely profit, and is encouraged by Medicare, the drug companies, and insurance companies.  It is in the vial because it is such an important drug, they don't want it lost to the needle space as it is drawn up, so they put extra in the vial.  You can use the 1000 units out of the vial for you, and use the overfill to start the next dose.  It's basically a give away from Amgen. 

Thank you for explaining it! 

I'm not sure if everyone is aware but CMS regularly selects centers to submit documentation for review to ensure proper billing. I have had a few centers that Medicare decided it was time to review the billing for the center. It is a time consuming process to say the least. All medical records submitted for each patient, there are a few claims reduced by small amounts due to error but in the end after the ADR's are processed, none of my centers were shut down due to inproper billing practices and I don't suspect any of the people who have centers at my office will have any shut down either.








EDITED:Fixed quote tag error-kitkatz,Moderator

[bountyhunter_ga]

Well I just received yesterday a statement from my insurance co. stating the Dialysis center is not a provider for on your insurance the bill was $30,000.00 for the month 0f April.

 I was shocked to say the least. Insurance has paid up to this point.
Why does it coast so much are we paying for every machine and every chair in the building, I know the Nurses working there aren't making much

The center is very clean and the people are great however I guess  corporate America has found its way into every little crack it can find.
Profit makes the system work however this is pure gouging of the insurance co. This is a problem

[kitkatz]

I have a statement for 32, 159.10 of which Medicare only pain 3,345.65.  Who is paying the rest of this? Does my Kaiser insurance max out when I am on Senior Advantage?  I have never gotten a bill for dialysis.  32,000 dollars, who are they kidding?

[Bajanne]

You are worth every penny!

I second that statement 

  That is so kind of you both. Thanks...Boxman

And I third it!!  Great to see you posting again!

[Bajanne]

Dialysis is free over here if you have no insurance.  It used to be totally free, then they said that if you had insurance, they had to pay.  But when I lost my insurance they said that they cannot let me die, so it is free for me.  It used to cost my insurance $500 per session ($1500 per month).  And you get everything - Epogen, no-reuse, sureseals, medication, tests, everything!

[dialysisbiller]

I have a statement for 32, 159.10 of which Medicare only pain 3,345.65.  Who is paying the rest of this? Does my Kaiser insurance max out when I am on Senior Advantage?  I have never gotten a bill for dialysis.  32,000 dollars, who are they kidding?

Medicare has set fees for all medical services- Charges must be the same across the board unless a specific ins co has contracted with a provider then the charged amount may differ. The difference between what Medicare says is 'approved' and what is charged is considered 'contractual adjustment' meaning, it gets tossed aside. (No one pays that) Medicare actually pays 80% of the 'allowed' amount then a secondary insurance (if you have a supplimental policy or are fortunate to have secondary coverage through spouse or employer or can afford it- or even medicaid) will cover the 20%. Otherwise the patient has to pay that 20%. Social workers usually help patients decide if they qualify for a secondary medicaid policy (differs state to state) or help a patient find an affordable Medicare supplimental policy.

I know it's horrible that corporate america stepped into some medical fields, but there is good that does come with it too.... if a center has more commerical primary patients than others, that center can thrive and make improvements to make it a bit better for patients. Centers in poorer areas with more Medicaid and Medicare patients may not be as 'nice' as other centers, but that's where a corporate owned dialysis center may benefit and money can be shifted to make improvments to the centers with less revenue coming in to make it a nicer center. 

It's a give and take kind of thing.

You all are amazing people who do this 3-4 times a week and am humbled at what it takes to endure what you all endure. God bless.

[Bub]

I know!!! I am sure my work insurance company really wishes I would die, or at least get fired.  I know that they cant really believe that I am worth that, and honestly sometimes I have a hard time accepting it too.  But when an insurance company issues a policy they are gambling.  When you gamble, sometimes you win and sometimes you lose. I didn't have kidney failure on purpose you know!

[RichardMEL]

Australian Government spends approx $A85,000 a year on dialysis treatments per patient - obviously this varies based on home hemo, in unit, pd etc but that's the average. Basically everything is provided apart take home meds like binders, calcitrcol etc which is subsidised anyway by the govt PBS system. I consider myself very very lucky to be living under this system and happily pay my tax given that what I pay is not even close to what they spend on me.

($A85,000 = approx $71,100 USD / $77,000 CAD)

[monrein]

That's pretty much the cost here although home hemo is some 29% less according to a 2002 study.  Self-care in a non-hospital setting is also cheaper but not sure by how much.

[dwcrawford]

Remember that medicare and insurance pays only a small portion of what is billed.  Insurance has agreed to take a standard amount for each procedure, etc.

[jpearce]

After reading all the post , I am very thankful to be living in canada. I don't pay for anything. The Nb Government pays for all sessions, home dialysis and all meds prescribed by the neph. The Neph social worker checks with the insurance to see if they cover the meds after the transplant,  if they don't the NB gov't will. I was told when I first started that there would be no money out of my pocket, that it wasn't my fault I got this sick.

[Jie]

The reason that the dialysis cost is so high for the non-medicare patients in the U.S. is that more than 90% patients are with medicare and medicare does not pay enough. The clinic has to "rob" the private insurance to make up the low payment from medicare. My PD costs us$1035/day for the clinic and us$35 for the neph. The lab primarily doing dialysis tests also costs a several times higher than other Labs for the same tests. With the medicines, lab and dialysis, my insurance pays more than US$400,000 a year for my PD dialysis. I really used about 1/3 of that amount, and the rest is robbery for the medicare low payment. I am feeling kinds of guilty for this cost. Since we are self insured, everyone with our insurance will have to pay higher premium for this. Next year when I have the opportunity to switch to pay as you go payment option, I will change payment option to avoid this robbery.

[YLGuy]

Doctors charge             $500.00 - Medicare approves $207.23 - Medicare pays $165.78 - UHC pays $41.45
Daily Home PD charge       58.39 (x30days)                  58.39                          45.61                   11.68
Aranesp Injection           566.00                                566.00                        453.00                 113.00
Total monthly charge will be in the range of $2,583.32 with a yearly cost of approximately $31,000.00.

Having MiSSis on IHD? Priceless!

[YLGuy]

I got a packet of statements today from my insurance they where just related to the dialysis clinic I go to, for the month of November $19,919.00. No Doctor charges no lab charges just dialysis. If you times that by 12 months thats $239,028.00. If you add in two fistula surgeries, gall bladder surgery, all testing to get on the list Doctor visits and monthly labs I would bet it is close to or over $400K. Good Grief...Boxman

BUT WAIT! Act now and they will throw in an uncomfortable chair, sometimes rude staff and a Doctor that barely gives you the time of day! Hurry now, operators are waiting. I am sure you to want kidney failure. 
*Competent staff may cost extra