Initial Method for Physician’s Services to Maintenance Dialysis

130.1 - Initial Method for Physician’s Services to Maintenance Dialysis Patients (Rev. 1, 10-01-03) Under the Initial Method (IM), do not pay for physician’s routine professional dialysis services. Instead, the dialysis facility’s A/B MAC (A) pays the dialysis facility for them as part of the facility’s composite rate. Physician’s professional services that are not routine professional dialysis services are billed to the contractor and paid in the same way as any other Medicare covered physician professional service. 1. For the physician to be paid under the IM, the following requirements must be met: All physicians of the facility must choose the IM with respect to all of the patients treated at the facility and all of the facility’s Method I home dialysis patients. (See §70.1 for a description of Method I). All of the facility’s physicians must file a written statement with their A/B MAC (B) and the facility’s A/B MAC (A) to this effect. For example: The physicians practicing at ________________ dialysis facility are listed below. The signature of each physician indicates the physician’s election to be paid for their routine professional dialysis services under the Initial Method. This election is effective for services furnished beginning with the second month after the month in which this statement is filed with the A/B MAC (B) and the facility’s A/B MAC (A). This written statement must be signed and dated by each physician. 2. The physician may bill the A/B MAC (B) only those physician’s professional services that are not routine professional dialysis services. (See paragraph 3 below). The election of the IM is effective for services furnished beginning with the second calendar month after the month in which all the physicians of a facility elect it. A physician may terminate the election by written notice to the A/B MAC (B) and to the facility’s A/B MAC (A) that the physician thereby terminates the IM. If the A/B MAC (B) and the A/B MAC (A) receive the termination notice on or before November 1, it is effective the following January 1. If the A/B MAC (B) or the A/B MAC (A) receives it after November 1, it is effective January 1 of the second year after the calendar year in which the notice of termination is received. Note that if the IM is terminated by one physician, it is thereby terminated for all physicians at the same facility with respect to the patients treated through that facility. 3. Definitions A. Administrative Services Physician services that are differentiated from routine professional services and other physician services. They include supervision, as described in the definition of “supervision of staff,” are not related directly to the care of an individual patient and are supportive of the facility as a whole and of benefit to patients in general. Examples of administrative services include supervision of staff, staff training, participation in staff conferences and in the management of the facility, and advising staff on the procurement of supplies. B. Dialysis Session The period of time that begins when the patient arrives at the facility and ends when the patient departs from the facility. In the case of home dialysis, the period begins when the patient prepares for dialysis and generally ends when the patient is disconnected from the machine. In this context, a dialysis facility includes only those parts of the building used as a facility. It does not include any areas used as a physician’s private office. C. Medical Direction Routine professional service that entails substantial direct involvement and the physical presence of the physician in the delivery of services directly to the patient. D. Routine Professional Services Physicians’ services furnished during a dialysis session and all services listed under “Types of routine professional services” that: • Are personally furnished by a physician to an individual patient. • Contribute directly to the diagnosis or treatment of an individual patient. • Ordinarily must be performed by a physician. E. Supervision of Staff Administrative services that do not necessarily require the physician to be present at the dialysis session. It is a general activity primarily concerned with monitoring performance of and giving guidance to other health care personnel (such as nurses and dialysis technicians) who deliver services to patients. F. Types of Routine Professional Services Routine professional services include at least the following services when medically appropriate: • Visits to the patient during dialysis, and in conjunction with review of laboratory test results, • Nurses’ notes and any other medical documentation, as a basis for: o Adjustment of the patient’s medication, diet or the dialysis procedure; o Prescription of medical supplies; and o Evaluation of the patient’s psychosocial status and the appropriateness of the modality, o Medical direction of staff in delivering services to a patient during a dialysis session, and o Pre-dialysis and post-dialysis examinations or examinations that could have been furnished on a pre-dialysis or post-dialysis basis.