RE: Recurring Account Scenario

[Guest guest]

We establish a cycle (60 days) account for

pre-transplant testing with a specific patient identifier and the TFC as the

guarantor. That way I can access the accounts and adjust the charges off to the

Cost Report. Our finance people can access the adjusted charges through a

charge master number. The in-patient account is separate and is billed per the appropriate

DRG. Post-transplant accounts are set up with a different cycle number and are

billed to the patient’s insurance.

Barbara Cochrane, MSN, RN

Transplant Financial Coordinator

Mercy Medical Center—Des

Moines, IA

bcochrane@...

From:

TxFinancialCoordinators [mailto:TxFinancialCoordinators ]

On Behalf Of Neff

Sent: Thursday, February 01, 2007

8:58 AM

To:

TxFinancialCoordinators

Subject:

Recurring Account Scenario

Given that Medicare requires you keep outpatient

recurring accounts

open through the month, regardless of whether or not a patient has

been admitted to the hospital, how do you handle this scenario

PT has eval services in clinic on 1/3 - recurring account to

acquisition

PT is admitted and has Transplant on 1/15 - one-time inpatient

account to DRG

PT has post TXPL services in clinic on 1/25 - New recurring

account? One-time account?

Do you even set up recurring accounts for transplant outpatients

undergoing eval?

Thanks

Neff

Financial/Data Coordinator, Transplant

halifax Medical Center

303 N. Clyde Blvd.

Daytona Beach,

Fl 32114

[Guest guest]

We use recurring accounts for both pre (billed to KACC) and post transplant (billed to insurance co) w/different acct#'s & clinc codes. The inpatient service is one-time & billed to insurance.Sherri Sbalbi Financial Counselor Transplant Services Baystate Medical Center 300 Birnie Avenue - Suite 301 Springfield, MA 01107 fax -----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Cochrane, Barbara ESent: Thursday, February 01, 2007 10:07 AMTo: TxFinancialCoordinators Subject: RE: Recurring Account ScenarioWe establish a cycle (60 days) account for pre-transplant testing with a specific patient identifier and the TFC as the guarantor. That way I can access the accounts and adjust the charges off to the Cost Report. Our finance people can access the adjusted charges through a charge master number. The in-patient account is separate and is billed per the appropriate DRG. Post-transplant accounts are set up with a different cycle number and are billed to the patient’s insurance.Barbara Cochrane, MSN, RNTransplant Financial CoordinatorMercy Medical Center—Des Moines, IAbcochranemercydesmoines (DOT) orgFrom: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of NeffSent: Thursday, February 01, 2007 8:58 AMTo: TxFinancialCoordinators Subject: Recurring Account ScenarioGiven that Medicare requires you keep outpatient recurring accounts open through the month, regardless of whether or not a patient has been admitted to the hospital, how do you handle this scenarioPT has eval services in clinic on 1/3 - recurring account to acquisitionPT is admitted and has Transplant on 1/15 - one-time inpatient account to DRGPT has post TXPL services in clinic on 1/25 - New recurring account? One-time account?Do you even set up recurring accounts for transplant outpatients undergoing eval?Thanks NeffFinancial/Data Coordinator, Transplanthalifax Medical Center303 N. Clyde Blvd.Daytona Beach, Fl 32114

[Guest guest]

, could you tell me where in the Medicare regs it states that we are required to keep outpatient accounts open through the month?

Thanks,

n Melton

Seton Heart Specialty Care & Transplant Center

1301 W. 38th Street, Ste 700

Austin, Texas 78705

fax

This transmission and any documents attached to this transmission may contain confidential health or other information that is proprietary, legally privileged, and/or subject to confidentiality requirements by law. This information is intended only for the use of the individual or entity named above. The authorized recipient of this information is prohibited from disclosing this information to any other party unless permitted and/or required to do so by law or regulations and, if the information contains confidential health information, the recipient is required to destroy the information after its stated need has been fulfilled.

If you are not the stated recipient, you are hereby notified that any disclosure, copying, distribution, resending, forwarding or action taken in reliance on the contents of these documents is strictly prohibited. If you have received this information in error, please notify the sender immediately and arrange for the return or destruction of this transmission.

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of NeffSent: Thursday, February 01, 2007 8:58 AMTo: TxFinancialCoordinators Subject: Recurring Account Scenario

Given that Medicare requires you keep outpatient recurring accounts open through the month, regardless of whether or not a patient has been admitted to the hospital, how do you handle this scenarioPT has eval services in clinic on 1/3 - recurring account to acquisitionPT is admitted and has Transplant on 1/15 - one-time inpatient account to DRGPT has post TXPL services in clinic on 1/25 - New recurring account? One-time account?Do you even set up recurring accounts for transplant outpatients undergoing eval?Thanks NeffFinancial/Data Coordinator, Transplanthalifax Medical Center303 N. Clyde Blvd.Daytona Beach, Fl 32114

[Guest guest]

Thanks to all for the feedback. n, I'll have to find that out and get back

to you.

________________________________

From: TxFinancialCoordinators on behalf of Melton, n

Sent: Thu 2/1/2007 10:46 AM

To: TxFinancialCoordinators

Subject: RE: Recurring Account Scenario

, could you tell me where in the Medicare regs it states that we are

required to keep outpatient accounts open through the month?

Thanks,

n Melton

Seton Heart Specialty Care & Transplant Center

1301 W. 38th Street, Ste 700

Austin, Texas 78705

fax

This transmission and any documents attached to this transmission may contain

confidential health or other information that is proprietary, legally

privileged, and/or subject to confidentiality requirements by law. This

information is intended only for the use of the individual or entity named

above. The authorized recipient of this information is prohibited from

disclosing this information to any other party unless permitted and/or required

to do so by law or regulations and, if the information contains confidential

health information, the recipient is required to destroy the information after

its stated need has been fulfilled.

If you are not the stated recipient, you are hereby notified that any

disclosure, copying, distribution, resending, forwarding or action taken in

reliance on the contents of these documents is strictly prohibited. If you have

received this information in error, please notify the sender immediately and

arrange for the return or destruction of this transmission.

________________________________

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of Neff

Sent: Thursday, February 01, 2007 8:58 AM

To: TxFinancialCoordinators

Subject: Recurring Account Scenario

Given that Medicare requires you keep outpatient recurring accounts

open through the month, regardless of whether or not a patient has

been admitted to the hospital, how do you handle this scenario

PT has eval services in clinic on 1/3 - recurring account to

acquisition

PT is admitted and has Transplant on 1/15 - one-time inpatient

account to DRG

PT has post TXPL services in clinic on 1/25 - New recurring

account? One-time account?

Do you even set up recurring accounts for transplant outpatients

undergoing eval?

Thanks

Neff

Financial/Data Coordinator, Transplant

halifax Medical Center

303 N. Clyde Blvd.

Daytona Beach, Fl 32114

[Guest guest]

Good morning

Is anyone out there using KAC and then using the patients insurance to

be billed as primary and the balance put to the cost report????? This is

what our person who does the cost report said can be done.

We have been putting all kidney related pre testing cost on our cost

report and not billing the patients primary insurance for this pre

testing. The exception is global or URN patients. This is a big change

for us wondered if any one else does this or have heard of this

change???

Any in put will be appreciated.

Financial Coordinator

Allegheny General Hospital

mmartin1@...

>>> " Cochrane, Barbara E " 2/1/2007 10:06

am >>>

We establish a cycle (60 days) account for pre-transplant testing with

a

specific patient identifier and the TFC as the guarantor. That way I

can

access the accounts and adjust the charges off to the Cost Report. Our

finance people can access the adjusted charges through a charge master

number. The in-patient account is separate and is billed per the

appropriate DRG. Post-transplant accounts are set up with a different

cycle number and are billed to the patient's insurance.

Barbara Cochrane, MSN, RN

Transplant Financial Coordinator

Mercy Medical Center-Des Moines, IA

bcochrane@...

________________________________

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of

Neff

Sent: Thursday, February 01, 2007 8:58 AM

To: TxFinancialCoordinators

Subject: Recurring Account Scenario

Given that Medicare requires you keep outpatient recurring accounts

open through the month, regardless of whether or not a patient has

been admitted to the hospital, how do you handle this scenario

PT has eval services in clinic on 1/3 - recurring account to

acquisition

PT is admitted and has Transplant on 1/15 - one-time inpatient

account to DRG

PT has post TXPL services in clinic on 1/25 - New recurring

account? One-time account?

Do you even set up recurring accounts for transplant outpatients

undergoing eval?

Thanks

Neff

Financial/Data Coordinator, Transplant

halifax Medical Center

303 N. Clyde Blvd.

Daytona Beach, Fl 32114

**********************************************************************

This email and any files transmitted with it are confidential and

intended solely for the use of the individual or entity to whom they

are addressed. If you have received this email in error please notify

the West Penn Allegheny Health System Help Desk at 412 330-4357.

This footnote also confirms that this email message has been swept by

MIMEsweeper for the presence of computer viruses.

**********************************************************************

[Guest guest]

Bill,

I do know this stuff and for many years we have always billed our

kidney eval charges to OACC, regardless of primary/secondary issues.

However,it seems many centers are starting to bill recipient kidney

evaluations to insurance companies, not just the bundled contract cases,

but all of them. If it is Medicare or Medicaid prime, then those

definitely have to go to the OACC. From the list serv and some of the

conversation, there seems to be quite a variance on how centers are

handling this. It looks like some centers are billing the OACC for

facility kidney eval charges, and profees to the insurance. Some

centers seem to bill facility and profees to insurance, unless it is

medicare/medicaid prime. Times they are changing and it is a mystery to

me how all this will turn out. Our center is also moving in that

direction.

Marcia J. Fisher

Sr. Transplant Financial Coordinator

Michigan Transplant Center

This message is confidential, intended for the named recipient(s). If

you receive this message in error, please notify the sender by email or

at , and delete this email. Thank you.

>>> " Vaughan " 2/5/2007 9:38 AM >>>

Hi Marcia,

Regulations indicate that the transplant center is responsible for all

pro

fees, none are to be billed to the patient or the payer for the

patient,

especially for kidney and pancreas.

CMS has interpreted the regulations in the same manner for heart,

liver,

lung, small bowel, etc. However, we believe that legal counsel needs

to

review the regs in this area for non renal organs other than pancreas.

As you are aware, the physician consult to say yes the patient is a

good

candidate or no they are not do not have the necessary content

(diagnosis or

treatment) to be billable to Medicare and to most payers without a

contract

with that payer. But CMS is saying that they are all to be billed to

the

transplant center and paid at Medicare by the transplant center.

Hope this helps,

Thanks,

Bill

_____

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of Marcia

Fisher

Sent: Monday, February 05, 2007 8:52 AM

To: TxFinancialCoordinators

Subject: RE: Recurring Account Scenario

Hi Bill,

Does this also include pro fees for the evaluation or just the

ancillary charges? Thanks.

Marcia J. Fisher

Sr. Transplant Financial Coordinator

Michigan Transplant Center

This message is confidential, intended for the named recipient(s). If

you receive this message in error, please notify the sender by email

or

at , and delete this email. Thank you.

>>> " Vaughan " <Vaughan@HSC- <mailto:Vaughan%40HSC-CLC.Com>

CLC.Com>

2/2/2007 1:54 PM >>>

HI,

Balance billing is not allowed. Medicare requires a transplant center

to

log all hospital ancillary services utilized to evaluate a patient and

put

them on the cost report. The center can bill group insurance during

the

coordination of benefits period. BUT, if Medicare pays for the

transplant,

the hospital MUST look back and see who " paid " for the evaluation if

it

was

written off and no one was billed, there is no problem. If an " other "

primary payer is billed, the amounts collected for evaluation MUST be

offset

on the Medicare Cost Report. If this is not done, the hospital will

have

been paid twice for the services rendered.

Please be careful with this, while you may bill the payer, you may NOT

bill

the patient for any deductible or co-insurance because the pure

" evaluation "

is NOT medically necessary in Medicare's eyes (that is why it is on

the

cost

report and not billed directly to Medicare).

If you have questions, or if your cost report person has questions,

please

call at .

Hope this helps,

Thanks,

Bill

_____

From: TxFinancialCoordina

<mailto:TxFinancialCoordinators%40yahoogroups.com>

tors

[mailto:TxFinancialCoordina

<mailto:TxFinancialCoordinators%40yahoogroups.com>

tors ] On

Behalf Of

Sent: Friday, February 02, 2007 8:06 AM

To: TxFinancialCoordina

<mailto:TxFinancialCoordinators%40yahoogroups.com>

tors

Subject: RE: Recurring Account Scenario

Good morning

Is anyone out there using KAC and then using the patients insurance to

be billed as primary and the balance put to the cost report????? This

is

what our person who does the cost report said can be done.

We have been putting all kidney related pre testing cost on our cost

report and not billing the patients primary insurance for this pre

testing. The exception is global or URN patients. This is a big change

for us wondered if any one else does this or have heard of this

change???

Any in put will be appreciated.

Financial Coordinator

Allegheny General Hospital

mmartin1wpahs (DOT) <mailto:mmartin1%40wpahs.org> org

>>> " Cochrane, Barbara E " <bcochrane@mercydesm

<mailto:bcochrane%40mercydesmoines.org> oines.org> 2/1/2007 10:06

am >>>

We establish a cycle (60 days) account for pre-transplant testing with

a

specific patient identifier and the TFC as the guarantor. That way I

can

access the accounts and adjust the charges off to the Cost Report. Our

finance people can access the adjusted charges through a charge master

number. The in-patient account is separate and is billed per the

appropriate DRG. Post-transplant accounts are set up with a different

cycle number and are billed to the patient's insurance.

Barbara Cochrane, MSN, RN

Transplant Financial Coordinator

Mercy Medical Center-Des Moines, IA

bcochrane@mercydesm <mailto:bcochrane%40mercydesmoines.org> oines.org

________________________________

From: TxFinancialCoordina

<mailto:TxFinancialCoordinators%40yahoogroups.com>

torsyahoogroups (DOT) <mailto:tors%40yahoogroups.com> com

[mailto:TxFinancialCoordina

<mailto:TxFinancialCoordinators%40yahoogroups.com>

torsyahoogroups (DOT) <mailto:tors%40yahoogroups.com> com] On

Behalf Of

Neff

Sent: Thursday, February 01, 2007 8:58 AM

To: TxFinancialCoordina

<mailto:TxFinancialCoordinators%40yahoogroups.com>

torsyahoogroups (DOT) <mailto:tors%40yahoogroups.com> com

Subject: Recurring Account Scenario

Given that Medicare requires you keep outpatient recurring accounts

open through the month, regardless of whether or not a patient has

been admitted to the hospital, how do you handle this scenario

PT has eval services in clinic on 1/3 - recurring account to

acquisition

PT is admitted and has Transplant on 1/15 - one-time inpatient

account to DRG

PT has post TXPL services in clinic on 1/25 - New recurring

account? One-time account?

Do you even set up recurring accounts for transplant outpatients

undergoing eval?

Thanks

Neff

Financial/Data Coordinator, Transplant

halifax Medical Center

303 N. Clyde Blvd.

Daytona Beach, Fl 32114

**********************************************************************

This email and any files transmitted with it are confidential and

intended solely for the use of the individual or entity to whom they

are addressed. If you have received this email in error please notify

the West Penn Allegheny Health System Help Desk at 412 330-4357.

This footnote also confirms that this email message has been swept by

MIMEsweeper for the presence of computer viruses.

**********************************************************************

**********************************************************

Electronic Mail is not secure, may not be read every day, and should

not be

used for urgent or sensitive issues.

**********************************************************

Electronic Mail is not secure, may not be read every day, and should not be used

for urgent or sensitive issues.

[Guest guest]

Bill,

I do know this stuff and for many years we have always billed our

kidney eval charges to OACC, regardless of primary/secondary issues.

However,it seems many centers are starting to bill recipient kidney

evaluations to insurance companies, not just the bundled contract cases,

but all of them. If it is Medicare or Medicaid prime, then those

definitely have to go to the OACC. From the list serv and some of the

conversation, there seems to be quite a variance on how centers are

handling this. It looks like some centers are billing the OACC for

facility kidney eval charges, and profees to the insurance. Some

centers seem to bill facility and profees to insurance, unless it is

medicare/medicaid prime. Times they are changing and it is a mystery to

me how all this will turn out. Our center is also moving in that

direction.

Marcia J. Fisher

Sr. Transplant Financial Coordinator

Michigan Transplant Center

This message is confidential, intended for the named recipient(s). If

you receive this message in error, please notify the sender by email or

at , and delete this email. Thank you.

>>> " Vaughan " 2/5/2007 9:38 AM >>>

Hi Marcia,

Regulations indicate that the transplant center is responsible for all

pro

fees, none are to be billed to the patient or the payer for the

patient,

especially for kidney and pancreas.

CMS has interpreted the regulations in the same manner for heart,

liver,

lung, small bowel, etc. However, we believe that legal counsel needs

to

review the regs in this area for non renal organs other than pancreas.

As you are aware, the physician consult to say yes the patient is a

good

candidate or no they are not do not have the necessary content

(diagnosis or

treatment) to be billable to Medicare and to most payers without a

contract

with that payer. But CMS is saying that they are all to be billed to

the

transplant center and paid at Medicare by the transplant center.

Hope this helps,

Thanks,

Bill

_____

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of Marcia

Fisher

Sent: Monday, February 05, 2007 8:52 AM

To: TxFinancialCoordinators

Subject: RE: Recurring Account Scenario

Hi Bill,

Does this also include pro fees for the evaluation or just the

ancillary charges? Thanks.

Marcia J. Fisher

Sr. Transplant Financial Coordinator

Michigan Transplant Center

This message is confidential, intended for the named recipient(s). If

you receive this message in error, please notify the sender by email

or

at , and delete this email. Thank you.

>>> " Vaughan " <Vaughan@HSC- <mailto:Vaughan%40HSC-CLC.Com>

CLC.Com>

2/2/2007 1:54 PM >>>

HI,

Balance billing is not allowed. Medicare requires a transplant center

to

log all hospital ancillary services utilized to evaluate a patient and

put

them on the cost report. The center can bill group insurance during

the

coordination of benefits period. BUT, if Medicare pays for the

transplant,

the hospital MUST look back and see who " paid " for the evaluation if

it

was

written off and no one was billed, there is no problem. If an " other "

primary payer is billed, the amounts collected for evaluation MUST be

offset

on the Medicare Cost Report. If this is not done, the hospital will

have

been paid twice for the services rendered.

Please be careful with this, while you may bill the payer, you may NOT

bill

the patient for any deductible or co-insurance because the pure

" evaluation "

is NOT medically necessary in Medicare's eyes (that is why it is on

the

cost

report and not billed directly to Medicare).

If you have questions, or if your cost report person has questions,

please

call at .

Hope this helps,

Thanks,

Bill

_____

From: TxFinancialCoordina

<mailto:TxFinancialCoordinators%40yahoogroups.com>

tors

[mailto:TxFinancialCoordina

<mailto:TxFinancialCoordinators%40yahoogroups.com>

tors ] On

Behalf Of

Sent: Friday, February 02, 2007 8:06 AM

To: TxFinancialCoordina

<mailto:TxFinancialCoordinators%40yahoogroups.com>

tors

Subject: RE: Recurring Account Scenario

Good morning

Is anyone out there using KAC and then using the patients insurance to

be billed as primary and the balance put to the cost report????? This

is

what our person who does the cost report said can be done.

We have been putting all kidney related pre testing cost on our cost

report and not billing the patients primary insurance for this pre

testing. The exception is global or URN patients. This is a big change

for us wondered if any one else does this or have heard of this

change???

Any in put will be appreciated.

Financial Coordinator

Allegheny General Hospital

mmartin1wpahs (DOT) <mailto:mmartin1%40wpahs.org> org

>>> " Cochrane, Barbara E " <bcochrane@mercydesm

<mailto:bcochrane%40mercydesmoines.org> oines.org> 2/1/2007 10:06

am >>>

We establish a cycle (60 days) account for pre-transplant testing with

a

specific patient identifier and the TFC as the guarantor. That way I

can

access the accounts and adjust the charges off to the Cost Report. Our

finance people can access the adjusted charges through a charge master

number. The in-patient account is separate and is billed per the

appropriate DRG. Post-transplant accounts are set up with a different

cycle number and are billed to the patient's insurance.

Barbara Cochrane, MSN, RN

Transplant Financial Coordinator

Mercy Medical Center-Des Moines, IA

bcochrane@mercydesm <mailto:bcochrane%40mercydesmoines.org> oines.org

________________________________

From: TxFinancialCoordina

<mailto:TxFinancialCoordinators%40yahoogroups.com>

torsyahoogroups (DOT) <mailto:tors%40yahoogroups.com> com

[mailto:TxFinancialCoordina

<mailto:TxFinancialCoordinators%40yahoogroups.com>

torsyahoogroups (DOT) <mailto:tors%40yahoogroups.com> com] On

Behalf Of

Neff

Sent: Thursday, February 01, 2007 8:58 AM

To: TxFinancialCoordina

<mailto:TxFinancialCoordinators%40yahoogroups.com>

torsyahoogroups (DOT) <mailto:tors%40yahoogroups.com> com

Subject: Recurring Account Scenario

Given that Medicare requires you keep outpatient recurring accounts

open through the month, regardless of whether or not a patient has

been admitted to the hospital, how do you handle this scenario

PT has eval services in clinic on 1/3 - recurring account to

acquisition

PT is admitted and has Transplant on 1/15 - one-time inpatient

account to DRG

PT has post TXPL services in clinic on 1/25 - New recurring

account? One-time account?

Do you even set up recurring accounts for transplant outpatients

undergoing eval?

Thanks

Neff

Financial/Data Coordinator, Transplant

halifax Medical Center

303 N. Clyde Blvd.

Daytona Beach, Fl 32114

**********************************************************************

This email and any files transmitted with it are confidential and

intended solely for the use of the individual or entity to whom they

are addressed. If you have received this email in error please notify

the West Penn Allegheny Health System Help Desk at 412 330-4357.

This footnote also confirms that this email message has been swept by

MIMEsweeper for the presence of computer viruses.

**********************************************************************

**********************************************************

Electronic Mail is not secure, may not be read every day, and should

not be

used for urgent or sensitive issues.

**********************************************************

Electronic Mail is not secure, may not be read every day, and should not be used

for urgent or sensitive issues.

[Guest guest]

HI Marcia,

All I know is that the regulations have not

changed. The transplant centers could always bill for their services to

insurers other than Medicare and for kidney were not supposed to bill payers

for evaluations. This has not changed. As we have discussed, cost

reporting instructions require that all transplant center services be logged

for inclusion on the cost report.

I don’t know what is going to come of

it either. The OIG will sort it out. I think that the billing

issues will be the next area of Audits. I am afraid that a lot of centers

are going to be embarrassed and that the LA Times will have a ball.

Thanks,

Bill

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Marcia Fisher

Sent: Monday, February 05, 2007

4:36 PM

To: TxFinancialCoordinators

Subject: RE:

Recurring Account Scenario

Bill,

I do know this stuff and for many years we have always billed our

kidney eval charges to OACC, regardless of primary/secondary issues.

However,it seems many centers are starting to bill recipient kidney

evaluations to insurance companies, not just the bundled contract cases,

but all of them. If it is Medicare or Medicaid prime, then those

definitely have to go to the OACC. From the list serv and some of the

conversation, there seems to be quite a variance on how centers are

handling this. It looks like some centers are billing the OACC for

facility kidney eval charges, and profees to the insurance. Some

centers seem to bill facility and profees to insurance, unless it is

medicare/medicaid prime. Times they are changing and it is a mystery to

me how all this will turn out. Our center is also moving in that

direction.

Marcia J. Fisher

Sr. Transplant Financial Coordinator

Michigan

Transplant Center

This message is confidential, intended for the named recipient(s). If

you receive this message in error, please notify the sender by email or

at , and delete this email. Thank you.

>>> " Vaughan " <VaughanHSC-CLC (DOT) Com> 2/5/2007

9:38 AM >>>

Hi Marcia,

Regulations indicate that the transplant center is responsible for all

pro

fees, none are to be billed to the patient or the payer for the

patient,

especially for kidney and pancreas.

CMS has interpreted the regulations in the same manner for heart,

liver,

lung, small bowel, etc. However, we believe that legal counsel needs

to

review the regs in this area for non renal organs other than pancreas.

As you are aware, the physician consult to say yes the patient is a

good

candidate or no they are not do not have the necessary content

(diagnosis or

treatment) to be billable to Medicare and to most payers without a

contract

with that payer. But CMS is saying that they are all to be billed to

the

transplant center and paid at Medicare by the transplant center.

Hope this helps,

Thanks,

Bill

_____

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ]

On Behalf Of Marcia

Fisher

Sent: Monday, February 05, 2007 8:52 AM

To: TxFinancialCoordinators

Subject: RE: Recurring Account Scenario

Hi Bill,

Does this also include pro fees for the evaluation or just the

ancillary charges? Thanks.

Marcia J. Fisher

Sr. Transplant Financial Coordinator

Michigan

Transplant Center

This message is confidential, intended for the named recipient(s). If

you receive this message in error, please notify the sender by email

or

at , and delete this email. Thank you.

>>> " Vaughan " <Vaughan@HSC- <mailto:Vaughan%40HSC-CLC.Com>

CLC.Com>

2/2/2007 1:54 PM >>>

HI,

Balance billing is not allowed. Medicare requires a transplant center

to

log all hospital ancillary services utilized to evaluate a patient and

put

them on the cost report. The center can bill group insurance during

the

coordination of benefits period. BUT, if Medicare pays for the

transplant,

the hospital MUST look back and see who " paid " for the evaluation if

it

was

written off and no one was billed, there is no problem. If an " other "

primary payer is billed, the amounts collected for evaluation MUST be

offset

on the Medicare Cost Report. If this is not done, the hospital will

have

been paid twice for the services rendered.

Please be careful with this, while you may bill the payer, you may NOT

bill

the patient for any deductible or co-insurance because the pure

" evaluation "

is NOT medically necessary in Medicare's eyes (that is why it is on

the

cost

report and not billed directly to Medicare).

If you have questions, or if your cost report person has questions,

please

call at .

Hope this helps,

Thanks,

Bill

_____

From: TxFinancialCoordina

<mailto:TxFinancialCoordinators%40yahoogroups.com>

tors

[mailto:TxFinancialCoordina

<mailto:TxFinancialCoordinators%40yahoogroups.com>

tors ] On

Behalf Of

Sent: Friday, February 02, 2007 8:06 AM

To: TxFinancialCoordina

<mailto:TxFinancialCoordinators%40yahoogroups.com>

tors

Subject: RE: Recurring Account Scenario

Good morning

Is anyone out there using KAC and then using the patients insurance to

be billed as primary and the balance put to the cost report????? This

is

what our person who does the cost report said can be done.

We have been putting all kidney related pre testing cost on our cost

report and not billing the patients primary insurance for this pre

testing. The exception is global or URN patients. This is a big change

for us wondered if any one else does this or have heard of this

change???

Any in put will be appreciated.

Financial Coordinator

Allegheny General Hospital

mmartin1wpahs (DOT) <mailto:mmartin1%40wpahs.org> org

>>> " Cochrane, Barbara E " <bcochrane@mercydesm

<mailto:bcochrane%40mercydesmoines.org> oines.org> 2/1/2007

10:06

am >>>

We establish a cycle (60 days) account for pre-transplant testing with

a

specific patient identifier and the TFC as the guarantor. That way I

can

access the accounts and adjust the charges off to the Cost Report. Our

finance people can access the adjusted charges through a charge master

number. The in-patient account is separate and is billed per the

appropriate DRG. Post-transplant accounts are set up with a different

cycle number and are billed to the patient's insurance.

Barbara Cochrane, MSN, RN

Transplant Financial Coordinator

Mercy Medical Center-Des Moines, IA

bcochrane@mercydesm <mailto:bcochrane%40mercydesmoines.org>

oines.org

________________________________

From: TxFinancialCoordina

<mailto:TxFinancialCoordinators%40yahoogroups.com>

torsyahoogroups (DOT) <mailto:tors%40yahoogroups.com> com

[mailto:TxFinancialCoordina

<mailto:TxFinancialCoordinators%40yahoogroups.com>

torsyahoogroups (DOT) <mailto:tors%40yahoogroups.com> com] On

Behalf Of

Neff

Sent: Thursday, February 01, 2007 8:58 AM

To: TxFinancialCoordina

<mailto:TxFinancialCoordinators%40yahoogroups.com>

torsyahoogroups (DOT) <mailto:tors%40yahoogroups.com> com

Subject: Recurring Account Scenario

Given that Medicare requires you keep outpatient recurring accounts

open through the month, regardless of whether or not a patient has

been admitted to the hospital, how do you handle this scenario

PT has eval services in clinic on 1/3 - recurring account to

acquisition

PT is admitted and has Transplant on 1/15 - one-time inpatient

account to DRG

PT has post TXPL services in clinic on 1/25 - New recurring

account? One-time account?

Do you even set up recurring accounts for transplant outpatients

undergoing eval?

Thanks

Neff

Financial/Data Coordinator, Transplant

halifax Medical Center

303 N. Clyde Blvd.

Daytona Beach,

Fl 32114

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