Payment for Managing Patients on Home Dialysis

140.1.1 - Payment for Managing Patients on Home Dialysis (Rev. 2269, Issued: 08-05-11, Effective: 01-01-11, Implementation: 11-07-11) Physicians and practitioners managing ESRD patients who dialyze at home are paid a single monthly rate based on the age of the beneficiary. The MCP physician (or practitioner) must furnish at least one face-to-face patient visit per month for the home dialysis MCP service. Documentation by the MCP physician (or practitioner) should support at least one face-to-face encounter per month with the home dialysis patient. Medicare contractors may waive the requirement for a monthly face-to-face visit for the home dialysis MCP service on a case by case basis, for example, when the nephrologist’s notes indicate that the physician actively and adequately managed the care of the home dialysis patient throughout the month. The management of home dialysis patients who remain a home dialysis patient the entire month should be coded using the ESRD-related services for home dialysis patients HCPCS codes. a. Month defined. For purposes of billing for physician and practitioner ESRD related services, the term ‘month’ means a calendar month. The first month the beneficiary begins dialysis treatments is the date the dialysis treatments begin through the end of the calendar month. Thereafter, the term ‘month’ refers to a calendar month. b. Qualifying Visits under the MCP • General policy. Visits must be furnished face-to-face by a physician, clinical nurse specialist, nurse practitioner, or physician’s assistant. • Visits furnished by another physician or practitioner (who is not the MCP physician or practitioner). The MCP physician or practitioner may use other physicians or qualified nonphysician practitioners to provide the visit(s) during the month. The MCP physician or practitioner does not have to be present when these other physicians or practitioners provide visit(s). The non-MCP physician or practitioner must be a partner, an employee of the same group practice, or an employee of the MCP physician or practitioner. For example, the physician or practitioner furnishing visits under the MCP may be either a W-2 employee or 1099 independent contractor. When another physician is used to furnish some of the visits during the month, the physician who provides the complete assessment, establishes the patient’s plan of care, and provides the ongoing management should bill for the MCP service. If the nonphysician practitioner is the practitioner who performs the complete assessment and establishes the plan of care, then the MCP service should be billed under the PIN of the clinical nurse specialist, nurse practitioner, or physician assistant. • Residents, interns and fellows. Patient visits by residents, interns and fellows enrolled in an approved Medicare graduate medical education (GME) program may be counted towards the MCP visits if the teaching MCP physician is present during the visit.