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Reimbursement
Reimbursement for Chronic Kidney Disease Education (KDE) Services
Beginning in 2010, KDE services are covered by Medicare for eligible patients. Here are some general guidelines:
- Patients are eligible for reimbursement if they are diagnosed with Stage IV chronic kidney disease (CKD). KidneyTIES makes it easy to determine the stage of each of your patients by clearly indicating the stage in the main patient list as well as at the top of each patient's record.
- A total of 6 sessions of KDE services can be billed for in an eligible patient's lifetime, and the sessions can be conducted either individually or in a group setting of 2 to 20 individuals. These 6 sessions form the core structure of KidneyTIES's educational framework, facilitating both individual or group documentation.
- Outcomes assessments must be used to measure beneficiary knowledge about CKD and its treatment, and the results of these assessments must be made available to CMS upon request. KidneyTIES incorporates outcomes assessment documentation for each patient's educational sessions, simplifying the tracking and reporting of this information.
Other resources
MLN Matters newsletter
The Centers for Medicare & Medicaid Services (CMS) produced a Medical News Network (MLN) Matters newsletter (number MM6557) with many of the details related to coverage of kidney disease patient education services.
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM6557.pdf
Job aid
As a companion to the MLN newsletter, the Centers for Medicare & Medicaid Services (CMS) produced a Job Aid (JA6557) to provide important information for providers. This Job Aid includes information about KDE Content Requirements, outcome assessments, and billing instructions.
http://www.cms.gov/Medicare/Medicare-Contracting/ContractorLearningResources/downloads/JA6557.pdf
General FAQ
The Renal Physicians Association (RPA) produced an general "frequently asked questions" (FAQ) document that addresses many of the practical questions that a nephrology practice offering KDE might have.
http://www.renalmd.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4173
Disclaimer
This information was prepared as a service to the public, based on information gathered on or before April 2014. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations.