Federal regulatory and code compliance: The dialysis providers' challenge

    Authors

    A. Liberman

    Comments

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    Abbreviated Journal Title

    Dial. Transplant.

    Keywords

    Engineering, Biomedical; Transplantation; Urology & Nephrology

    Abstract

    With the attention of federal and state oversight authorities firmly affixed on alleged fraudulent activities in the healthcare industry, two practices employed by dialysis service organizations may soon be called into question: the purchase of Medicare supplements (''Medi-gap'' policies), and the payment of Medicare Part B premiums on behalf of patients who are unable to afford such coverages or are financially unreliable. While the rationale may be defensible from the standpoint of a clinician or administrator; the reasoning is questionable and poses a significant risk to those organizations attempting to justify these practices. using the insurance industry's concept of indemnification as a guide, this article seeks to outline a reimbursement mechanism whereby providers of dialysis therapy can be ''made whole'' for the services they provide to financially troubled recipients while, at the same time, maintaining a profit/loss-neutral result for those services. Resource-based relative value scales (RBRVS) can be utilized to document both the propriety and accuracy of third-party billings. In addition, RBRVS exerts control over the cost of outpatient services traditionally seen by governmental and private third-party payers as overpriced. The use of RBRVS affords a credible measure of compliance with current public policy, which has embraced the RBRVS mechanism as a balanced and accurate measure of the cost structure of outpatient provider organizations. In turn, a provider purchasing either a Medi-gap policy or Medicare Part B coverage on behalf of an indigent patient can then be reasonably assured of recovering the cost of services to those who, through fiscal inability and/or financial irresponsibility, are unable to secure the necessary coverages to supplement the reimbursements of Medicare or Medicaid as the primary payer(s).

    Journal Title

    Dialysis & Transplantation

    Volume

    26

    Issue/Number

    10

    Publication Date

    1-1-1997

    Document Type

    Article

    Language

    English

    First Page

    656

    WOS Identifier

    WOS:A1997XY45900010

    ISSN

    0090-2934

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