Newsletter

DialysisPPO Fall 2015 Industry Update
Welcome to our Fall 2015 Industry Update newsletter! Twice yearly, our goal will be to share key industry, regulatory, and cost containment issues of relevance to self-funded plan sponsors, TPAs, brokers, and stop loss professionals dealing with the high cost of End-Stage Renal Disease (“ESRD”) and dialysis. We hope that you will find great value in its educational content, and that it supports you in developing risk management and cost containment strategies for you and your clients.

Legal

Boise Dialysis vs. Nieto
What Plans can expect if they pay as “reasonable and customary”. Note: similar name, but different cost containment vendor in this case who pursued a much different strategy than we employ.

OIG Issues Favorable Advisory Opinion Regarding the Reimbursement of Medicare Part B Premiums for ESRD Members
In an important ruling for self-funded health plans seeking to control the high cost of kidney dialysis for members suffering from End-Stage Renal Disease, the Department of Health and Human Services Office of Inspector General (“OIG”) recently issued an Advisory Opinion that the reimbursement of Part B premiums for group health plan members would not constitute grounds for the imposition of civil monetary penalties, nor would the OIG impose administrative sanctions.

NRA vs. BC of Georgia
Favorable payer-side ruling regarding key Medicare Secondary Payer Act issues.

Medicare Secondary Payer Act
One of the key statutes that has bearing on the value our program can bring to health Plans.

Medicare

Enrolling in Medicare
CMS guide to the Medicare enrollment process, including ESRD-related enrollment.

Medicare Coverage of Dialysis and Transplant Services
CMS guide to the services available to ESRD patients.

Medicare: Who Pays First
CMS guide to the coordination of benefits between health Plans and Medicare.

 

General Dialysis Links

RenalWeb
The "daily newspaper" for the dialysis industry and community, providing useful information, new products, services, and educational resources.

United States Renal Data System
National data system that collects, analyzes, and distributes information about ESRD in the United States.

Dialysis From the Sharp End of the Needle
Blog tracking industry news and trends, in advocacy, reimbursement, politics and the provision of dialysis.

We Recommend

Med-Vision
20/20 Healthcare Vision. Med-Vision partners with health Plans to implement a data-driven, outcomes-focused program that identifies and captures actionable information to improve quality, increase productivity and lower cost.

The Phia Group
Specializes in controlling health care costs by retrieving collectible claim dollars using subrogation and other recovery tools.

Best Doctors
Best Doctors brings the clinical knowledge of experts to the problems of people with serious medical conditions and injuries.