Be prepared for changes in bad debt settlements

Bad debt settlement amounts for dialysis care continue to be limited to those expenses attributable to the former composite payment rate, and exclude the expenses attributable to previously separately billable drugs such as erythropoiesis-stimulating agents, IV iron, and Vitamin D. Since 2011, the cost report form automatically reduces the bad debt amount reported on Schedule E by a percentage of composite rate only costs to total costs entered on schedule B. Therefore, make sure that the bad debt detail submitted includes the entire amounts written off of the patients' account. When in doubt, you can contact individuals at the provider audit departments of the MACs who are assigned to these bad debt recoveries and are knowledgeable about the requirements.