Corporate Compliance

Dialysis for transient patient

Compliance Monitor, May 13, 2005

Q: We have a dialysis and acute-care Medicare provider number. Some of the charges on the outpatient hospital bill will not be paid by the FI to which we send the dialysis claims. A staff member asked, "Why don't we send part of the claim to the dialysis FI and the remaining charges to the acute FI?" We of course would NOT file the same charges twice. How should we process dialysis claims for our transient patients who have charges not completely related to the dialysis services?

A: We understand the complexity of the issues this hospital has to face with the billing.

In the case of a patient dialyzing in an outpatient facility, all renal-related problems are treated in that facility and billed under the outpatient dialysis Medicare number assigned. The same would apply to the acute setting.

For all other treatment the patient receives, nonrenal related services should be performed in the outpatient hospital location and billed as such.

In order for services to be paid, they must be performed in the appropriate location of the hospital and billed as such. There could be an outpatient designated area on the same floor that is used for performing other procedures, labs, etc.

This question was answered by Cheryl L. Pezzelle, RN, director of reimbursement systems, Healthcare Design Specialists, Phoenix.

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