Medical Billing Forum
Billing => Billing => : jpositos August 28, 2015, 04:51:22 PM
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Hi,
We are new in Dialysis billing and this fell on my lap because the Agency owner is a family friend who asked for my help. We have a client in TX insured with BCBSTX and is out-of-network because BCBSTX has no network for Dialysis. Our client is a HH agency specializing in RN-assisted hemodialysis in patient homes only and provides the RN, DME, supplies and medications needed. BCBSTX requires that the claims be submitted on a UB04 and not on CMS1500. The previous Biller was billing each treatment 3X a week with G0154 and 90937 plus a list of DME(dialysis machine), supplies used (syringe, bicarb, acid, blood tubing, saline) and medications. Another bill goes out once a month for all re-supplies (masks, gloves, blood test strips, carbon filters, antiseptics, etc).
What is the correct way of billing these? Is there a global way of billing each treatment?
Thank you in advance.
Jocelyn
(310)514-8226
PS - I have Alice & Michelle's book on completing the UB04 and is very helpful.
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Glad our book was a help. I wish I had experience in this but I don't. Hoping someone else on the forum will jump in!
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I wish too. There is just not too many resource online that I can find on billing renal dialysis for non-Medicare patients.
Thank you!.
Jocelyn
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Hi Michelle,
My client is a home health agency who provides dialysis in patients home. Based on your book, which code should I use? Are residential homes classified as outpatient or Other? I understand that Field 1 = 3 (home health) but for Field 2, I am torn between 3 (Outpatient) or 4 (Other). If patient is in the Nursing home should I use 6 for residential facility?
Thanks!!
Jocelyn
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The problem is there is no straight answer. One insurance carrier may require one way while another requires totally different. In my opinion, I would use 6 for nursing home and 4 for home.