Frequently Asked Questions

Question: Why team with DCC, Inc. for assistance with your high dollar dialysis claims?

Answer: DCC has successfully applied our dialysis savings services for nearly a decade. Our expertise goes beyond repricing claims. DCC offers multiple services to meet client’s unique needs, including services that actually enhance quality of care while reducing costs. DCC offers end to end program management, from referral intake, through the appeal process. It is our industry knowledge and comprehensive service that sets us apart from the competition. Let us show you how we can give you a competitive edge with your clients who face high dollar dialysis claims.

Question: What is the process for accessing DCC’s Services?

Answer: DCC’s service typically begins with the execution of a Business Associate Agreement that allows us to exchange pertinent patient information with our prospective clients. Once executed, DCC requests the data necessary to affect case review through a one page ‘Referral Form’. We ask that the referral forms are submitted along with 1 month of paid or unpaid claims (when available) and the Plan documents or SPD. Once received our team of industry experts will conduct a hands-on case review and develop cost containment options specific for that particular case. All program options are presented back to our clients for a review and ultimately a decision on how the Plan fiduciaries wish to proceed.

Question: What does DCC, Inc., charge for their services?

Answer: There is no initial charge for DCC’s case review and development of cost containment options. Clients or their plans can contract for DCC services on a percentage of savings basis.

Question: How are DCC’s services affected by Medicare Coverage?

Answer: End-stage renal disease (ESRD) is one of a very few conditions which makes someone younger than 65 eligible for Medicare coverage. Under special ESRD rules Medicare coverage is secondary for a 30 month “coordination period,” beginning from the date Medicare coverage begins. After the end of the coordination period Medicare becomes the primary coverage for ESRD, unless the employee benefits plan provides otherwise. They rarely if ever do.

Question: Can providers “balance bill” plan members who have secondary Medicare coverage?

Answer: No, providers which participate in Medicare are prohibited from balance-billing Medicare beneficiaries for services covered by Medicare.

Question: How does COBRA affect ESRD patients and the Plan?

Answer: If a Plan member has applied for Medicare prior to electing COBRA benefits due to ESRD, the COBRA benefits will be primary for the 30 month (and/or 33 month depending on modality) coordination period unless otherwise noted in the Plan Document. If a Plan member has not applied for Medicare under ESRD and is already a COBRA beneficiary, then the Medicare eligibility is considered a Qualifying Event and the member will no longer be on COBRA if the member applies for Medicare application. There are some Plan Documents that include exceptions to this for ESRD. Be sure to read your Plan Document carefully to determine how the COBRA benefits are detailed for ESRD members.

Question: Do DCC programs obtain provider signoff?

Answer: Some of DCC programs do obtain provider signoff. Single Patient Agreements, HomeHemo and Network programs all obtain provider signoff.

The Payment Based U&R program however does not obtain provider signoff. It is an imposed reimbursement on the provider based on laws provided under ERISA.

Question: How long is the employer group the primary payer for a member’s dialysis treatment?

Answer: The group is the primary payer for the first 33 months of treatment. After that time, Medicare becomes primary for the remainder of the treatment regardless of the patients age.