Need to see to Neph every month while in D?

[ualberta2]

Is there a rule somewhere that you need to see your doctor (neph) at least once a month while you are on dialysis? Dialysis has been going very well for me and my lab numbers are fantastic and my kt/v has been over 3 consistently. Because of this, I have not been seeing my neph every month, but every other month, but for some reason, my dialysis clinic is pestering me and telling me that I need to see him on a monthly basis. The issue I have with this is if the labs numbers are great and the same every month and I have no issues, why is it that I need to see the neph every month? Is this a dialysis requirement? Every time I do see my neph, he saids my lab looks great and 2 minutes after that I am done. Seems like kind of a waste of my $50 co payment.

[tyefly]

I believe it has something to do with the bundle payment  for Medicare.....   I think the clinic needs to have you see a neph once a month  so they can get full payment....  Its not right that you have to pay 50.00 each time ...they should supply it for free.....to you ....   

  There are so many rules... I am not completely sure of all of this  but it from things that I have read...

             Someone here will certainly be able to provide the correct information.....

[Bill Peckham]

There are two things going on.

It is a Medicare rule (Condition for Coverage) that you see your home unit staff every month. This is meant to make sure home patients aren't being neglected but I agree, I think if everything is going well the requirement should be once every three months.

The rules say that you can skip and then your unit staff have chart that they evaluated your reason for missing and it was a sign of health rather than a sign of neglect.

It's a Medicare reimbursement rule for the docs. The docs have a rule tied to reimbursement. You are suppose to see your doc every month but he/she should be able to write a note to convince their Medicare payers (the 10-15 Medicare Administrative Contractors/ Fiscal Intermediaries who actually process bills submitted by nephrologists) that they were providing care by interacting with the unit and you're doing great. This is a new rule so I don't think anyone knows what exactly the FI /MACs are requiring the docs to do.

There was a proposed rule and comment period this summer about this. Here is the proposed rule
http://www.billpeckham.com/from_the_sharp_end_of_the/2010/08/cms-proposes-strict-physician-visit-requirement-for-home-dialyzors.html

here is my comment

http://www.billpeckham.com/from_the_sharp_end_of_the/2010/08/proposed-physician-fee-schedule-for-mcp-physicians.html

I'll have to look for a link to the final announcement but CMS changed their mind and allowed patients to opt out so long as the physician documents it was for positive or unavoidable reasons the physician can still get paid.

[paul.karen]

Before i started dialysis i saw my neph every three months.  As the time drew nearer for me to start dialysis i saw him every month.  Each time there was a $50 copay.
Since starting dialysis i still see my neph once a month but now it is at the dialysis center.  Since i started Dialysis i no longer have to pay a $50 copay.  I assumed it was built into being on dialysis.

Maybe your neph is scamming the system and you?  Maybe not?
But i am sure many doctors like to line there pockets....

[Bill Peckham]

Before i started dialysis i saw my neph every three months.  As the time drew nearer for me to start dialysis i saw him every month.  Each time there was a $50 copay.
Since starting dialysis i still see my neph once a month but now it is at the dialysis center.  Since i started Dialysis i no longer have to pay a $50 copay.  I assumed it was built into being on dialysis.

Maybe your neph is scamming the system and you?  Maybe not?
But i am sure many doctors like to line there pockets....

PK when you started dialysis did you pick up Medicare Part B? That would explain why your private insurance could no longer ask you to pick up their copay. Your private insurance was billing more than Medicare would allow, and you no longer had the copay most likely because you were Medicare secondary.

[paul.karen]

No.
My social worker wanted me to sign up but i didnt want to pay for 30 months for something i wouldn't be using for 30 months.  I have signed the paperwork but told her i didnt want to start any medicare until after the 30 months are up.  Now if medicare is paying the co-pay i use to pay before dialysis i am unaware and have never recv. anything from medicare.
I still have a hard time following the medicare process.  When my insurance is up in 30 months and medicare takes over can i keep my private insurance for perscriptions and other non dialysis related doctor visits.

Truth be told my Social worker is NEW at her job.  She use to be a emergency room nurse but after 25 years wanted a desk job..

[BillSharp]

My nephrologist sees me in-center every WEEK. I thought that was the Medicare requirement.

By the ay, is that a Mayan pyramid in the bg of your photo. Spent 10 days there a long time ago. Both of us really enjoyed it.

[paul.karen]

Yes Bill it is the main pyamid at Chicineya (sp).
Great place.  There is a smaller pyamid inside the one pictured.  But the myans decided they needed an even bigger one so built it around the smaller one.

[thegrammalady]

i'm on incenter nocturnal and my neph comes at least once a month and i can call him any time i need to and he always calls me back if he doesn't answer the phone. when i did regular dialysis i often saw him more than once a month.