Starting Jan. 1, CMS will begin paying separately for dialysis treatments for patients with acute kidney injury who receive care in skilled nursing facilities.

Establishing the new payment code––G0491––for skilled nursing facilities (SNFs) under Medicare Part A comes 1 year after the agency began covering AKI patient care in outpatient dialysis clinics. The policy, sought by dialysis providers for several years, pays the standard bundled payment rate for an outpatient dialysis treatment, but allows providers to bill for other needed lab tests and additional treatments as needed.

Prior to creating the new payment code, SNFs had to absorb the cost of dialysis for patients who developed AKI while in their care under Medicare’s “consolidated billing” rule. Without a separate payment, “if a patient developed AKI and the physician determined that their need for dialysis is not permanent, yet that patient requires post-hospital rehabilitation at a SNF, their dialysis was not excluded from consolidated billing – and therefore, the cost was the responsibility of the SNF,” Ronald Hirsch, MD, FACP, CHCQM, vice president of R1 Physician Advisory Services, wrote in an article in RACMonitor. “In many cases, the SNF refused the referral, stating that the dialysis cost leaves no funds available to pay for the rest of the patient’s care. As a result, hospitals would keep the patient hospitalized until they either were able to go home and receive outpatient dialysis or no longer required dialysis.”

With the new payment code, SNFs can now bill Medicare when sending their patients with AKI to outpatient dialysis clinics for treatment.

Skilled nursing facilities will still be allowed to bill separately for ambulance transportation to and from the dialysis facility; those costs are already outside the consolidated billing requirements. – by Mark E. Neumann

Reference:

www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1725OTN.pdf