RE: Medicare non covered transplant

[Guest guest]

Assistance and confirmation needed

We have a patient who has EGHP which approved liver tx at our center, we are non

approved for livers.

Patient will have medicare eff 10/1/07, I have a few questions.

1. If patient has transplant prior to 10/1/07 when medicare is active, will they

cover immuno's after transplant once EGHP no longer active.

2. If patient has liver transplant after 10/1/07 his medicare will be secondary

to EGHP and pt having liver transplant at non approved center will his immuno's

be covered and procedure's related to liver transplant be covered once pt no

longer has the EGHP

3 If we become a medicare approved liver tx center in 2 years, will the patients

who were transplanted here when we were non certified still not have coverage

for immuno's and tx related issue's

Will appreciate any help with this

Financial Coordinator

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

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]

Assistance and confirmation needed

We have a patient who has EGHP which approved liver tx at our center, we are non

approved for livers.

Patient will have medicare eff 10/1/07, I have a few questions.

1. If patient has transplant prior to 10/1/07 when medicare is active, will they

cover immuno's after transplant once EGHP no longer active.

2. If patient has liver transplant after 10/1/07 his medicare will be secondary

to EGHP and pt having liver transplant at non approved center will his immuno's

be covered and procedure's related to liver transplant be covered once pt no

longer has the EGHP

3 If we become a medicare approved liver tx center in 2 years, will the patients

who were transplanted here when we were non certified still not have coverage

for immuno's and tx related issue's

Will appreciate any help with this

Financial Coordinator

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

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]

Assistance and confirmation needed

We have a patient who has EGHP which approved liver tx at our center, we are non

approved for livers.

Patient will have medicare eff 10/1/07, I have a few questions.

1. If patient has transplant prior to 10/1/07 when medicare is active, will they

cover immuno's after transplant once EGHP no longer active.

2. If patient has liver transplant after 10/1/07 his medicare will be secondary

to EGHP and pt having liver transplant at non approved center will his immuno's

be covered and procedure's related to liver transplant be covered once pt no

longer has the EGHP

3 If we become a medicare approved liver tx center in 2 years, will the patients

who were transplanted here when we were non certified still not have coverage

for immuno's and tx related issue's

Will appreciate any help with this

Financial Coordinator

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

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]

Question #1.

No. The immunos would be billable to the patient’s other Rx plan,

or Part D if they have it (most likely they would NOT have a part D because the

EGHP likely has its own drug plan/vendor). Medicare part B will

never pay for immunos if the transplant takes place before Medicare was even eligible.

Question #2. part

#1: Immunos will not be covered by Medicare even after 10/1/07, because the

transplant was not a “Medicare approved” transplant and never will

be—since your facility is not a Medicare approved for livers. Part

#2: My understanding is that only the actual transplant procedure itself

is not covered at your facility. All other follow up procedures &

care would be covered—unless of course, the patient requires retransplant.

Question #3.

Excellent question! I wish I had an answer to that one… we are

Medicare approved, so I take it for granted & never thought too much about

things like this… I would be in contact with the Center for Medicare

& Medicaid Services about that one!

Good luck!

Meredith Gray

Liver Transplant Financial Coordinator

University of Rochester Strong

Memorial Hospital

601

Elmwood Avenue Box 602

Rochester,

NY 14642

(fax)

(pager)

This message

contains information which may be confidential and privileged. Unless you are

the addressee (or authorized to receive for the addressee), you may not use,

copy or disclose to anyone the message or any information contained in the

message (including attachments). If you have received the message in error,

please advise sender by reply email and delete the message. Thank you!

From:

TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of

Sent: Monday, August 20, 2007 5:09

PM

To: TxFinancialCoordinators

Cc: Dodson

Subject: Re:

Medicare non covered transplant

Assistance and confirmation needed

We have a patient who has EGHP which approved liver tx at our center, we are

non approved for livers.

Patient will have medicare eff 10/1/07, I have a few questions.

1. If patient has transplant prior to 10/1/07 when medicare is active, will

they cover immuno's after transplant once EGHP no longer active.

2. If patient has liver transplant after 10/1/07 his medicare will be secondary

to EGHP and pt having liver transplant at non approved center will his immuno's

be covered and procedure's related to liver transplant be covered once pt no

longer has the EGHP

3 If we become a medicare approved liver tx center in 2 years, will the

patients who were transplanted here when we were non certified still not have

coverage for immuno's and tx related issue's

Will appreciate any help with this

Financial Coordinator

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

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]

The answer to #3 is no. Since the original transplant took place at a non Medicare approved facility it will never cover the immunos down the road. All his follow up visits would always be covered however..

Hogan Transplant Financial Coordinator Lahey Clinic 41 Mall Rd. Burlington, MA 01805 phone fax

Re: Medicare non covered transplant

Assistance and confirmation neededWe have a patient who has EGHP which approved liver tx at our center, we are non approved for livers.Patient will have medicare eff 10/1/07, I have a few questions.1. If patient has transplant prior to 10/1/07 when medicare is active, will they cover immuno's after transplant once EGHP no longer active.2. If patient has liver transplant after 10/1/07 his medicare will be secondary to EGHP and pt having liver transplant at non approved center will his immuno's be covered and procedure's related to liver transplant be covered once pt no longer has the EGHP3 If we become a medicare approved liver tx center in 2 years, will the patients who were transplanted here when we were non certified still not have coverage for immuno's and tx related issue'sWill appreciate any help with this Financial Coordinator**********************************************************************This email and any files transmitted with it are confidential andintended solely for the use of the individual or entity to whom theyare addressed. If you have received this email in error please notifythe West Penn Allegheny Health System Help Desk at 412 330-4357.This footnote also confirms that this email message has been swept byMIMEsweeper for the presence of computer viruses.**********************************************************************

See our web page at http://www.lahey.org for a full directory of Lahey sites, staff, services and career opportunities.

THIS MESSAGE IS INTENDED FOR THE USE OF THE PERSON TO WHOM IT IS ADDRESSED. IT MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records.

[Guest guest]

Thanks for the input any other advise will be appreciated

Transplant Financial Coordinator

>>> " Gray, Meredith M " 8/20/2007 6:00 pm >>>

Question #1. No. The immunos would be billable to the patient's other

Rx plan, or Part D if they have it (most likely they would NOT have a

part D because the EGHP likely has its own drug plan/vendor). Medicare

part B will never pay for immunos if the transplant takes place before

Medicare was even eligible.

Question #2. part #1: Immunos will not be covered by Medicare even

after 10/1/07, because the transplant was not a " Medicare approved "

transplant and never will be-since your facility is not a Medicare

approved for livers. Part #2: My understanding is that only the actual

transplant procedure itself is not covered at your facility. All other

follow up procedures & care would be covered-unless of course, the

patient requires retransplant.

Question #3. Excellent question! I wish I had an answer to that one...

we are Medicare approved, so I take it for granted & never thought too

much about things like this... I would be in contact with the Center for

Medicare & Medicaid Services about that one!

Good luck!

Meredith Gray

Liver Transplant Financial Coordinator

University of Rochester Strong Memorial Hospital

601 Elmwood Avenue Box 602

Rochester, NY 14642

(fax)

(pager)

This message contains information which may be confidential and

privileged. Unless you are the addressee (or authorized to receive for

the addressee), you may not use, copy or disclose to anyone the message

or any information contained in the message (including attachments). If

you have received the message in error, please advise sender by reply

email and delete the message. Thank you!

________________________________

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of

Sent: Monday, August 20, 2007 5:09 PM

To: TxFinancialCoordinators

Cc: Dodson

Subject: Re: Medicare non covered transplant

Assistance and confirmation needed

We have a patient who has EGHP which approved liver tx at our center, we

are non approved for livers.

Patient will have medicare eff 10/1/07, I have a few questions.

1. If patient has transplant prior to 10/1/07 when medicare is active,

will they cover immuno's after transplant once EGHP no longer active.

2. If patient has liver transplant after 10/1/07 his medicare will be

secondary to EGHP and pt having liver transplant at non approved center

will his immuno's be covered and procedure's related to liver transplant

be covered once pt no longer has the EGHP

3 If we become a medicare approved liver tx center in 2 years, will the

patients who were transplanted here when we were non certified still not

have coverage for immuno's and tx related issue's

Will appreciate any help with this

Financial Coordinator

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

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]

,

I dealt with this same issue several years ago here. The liver team moved here from another center and we were not yet approved for liver transplants. The agreement we had was if we transplanted any Medicare patients during this time, our center would be responsible for lifetime immunos. Fortunately we only transplanted 2 Medicare patients during that time and are still covering their immunos. I know a lot of centers would not do that. If your center won't do that, I would make sure the patient understands this is a real issue with his coverage down the road. I would let your team know it is an issue and possibly advise this patient to go to a Medicare approved center for his own benefit if you are talking after his eligibility date of 10/1/07. If he is transplanted before 10/1/07 then this is all a mute point.

Just remember: 1) He has to have Medicare at time of transplant and 2.) Have his transplant in a Medicare approved transplant center in order for him to have immuno coverage.

Hope this helps.

Hogan Transplant Financial Coordinator Lahey Clinic 41 Mall Rd. Burlington, MA 01805 phone fax

Re: Medicare non covered transplantAssistance and confirmation neededWe have a patient who has EGHP which approved liver tx at our center, weare non approved for livers.Patient will have medicare eff 10/1/07, I have a few questions.1. If patient has transplant prior to 10/1/07 when medicare is active,will they cover immuno's after transplant once EGHP no longer active.2. If patient has liver transplant after 10/1/07 his medicare will besecondary to EGHP and pt having liver transplant at non approved centerwill his immuno's be covered and procedure's related to liver transplantbe covered once pt no longer has the EGHP3 If we become a medicare approved liver tx center in 2 years, will thepatients who were transplanted here when we were non certified still nothave coverage for immuno's and tx related issue'sWill appreciate any help with this Financial Coordinator**********************************************************************This email and any files transmitted with it are confidential andintended solely for the use of the individual or entity to whom theyare addressed. If you have received this email in error please notifythe West Penn Allegheny Health System Help Desk at 412 330-4357.This footnote also confirms that this email message has been swept byMIMEsweeper for the presence of computer viruses.**********************************************************************See our web page at http://www.lahey.org for a full directory of Lahey sites, staff, services and career opportunities.

THIS MESSAGE IS INTENDED FOR THE USE OF THE PERSON TO WHOM IT IS ADDRESSED. IT MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records.

[Guest guest]

,

I dealt with this same issue several years ago here. The liver team moved here from another center and we were not yet approved for liver transplants. The agreement we had was if we transplanted any Medicare patients during this time, our center would be responsible for lifetime immunos. Fortunately we only transplanted 2 Medicare patients during that time and are still covering their immunos. I know a lot of centers would not do that. If your center won't do that, I would make sure the patient understands this is a real issue with his coverage down the road. I would let your team know it is an issue and possibly advise this patient to go to a Medicare approved center for his own benefit if you are talking after his eligibility date of 10/1/07. If he is transplanted before 10/1/07 then this is all a mute point.

Just remember: 1) He has to have Medicare at time of transplant and 2.) Have his transplant in a Medicare approved transplant center in order for him to have immuno coverage.

Hope this helps.

Hogan Transplant Financial Coordinator Lahey Clinic 41 Mall Rd. Burlington, MA 01805 phone fax

Re: Medicare non covered transplantAssistance and confirmation neededWe have a patient who has EGHP which approved liver tx at our center, weare non approved for livers.Patient will have medicare eff 10/1/07, I have a few questions.1. If patient has transplant prior to 10/1/07 when medicare is active,will they cover immuno's after transplant once EGHP no longer active.2. If patient has liver transplant after 10/1/07 his medicare will besecondary to EGHP and pt having liver transplant at non approved centerwill his immuno's be covered and procedure's related to liver transplantbe covered once pt no longer has the EGHP3 If we become a medicare approved liver tx center in 2 years, will thepatients who were transplanted here when we were non certified still nothave coverage for immuno's and tx related issue'sWill appreciate any help with this Financial Coordinator**********************************************************************This email and any files transmitted with it are confidential andintended solely for the use of the individual or entity to whom theyare addressed. If you have received this email in error please notifythe West Penn Allegheny Health System Help Desk at 412 330-4357.This footnote also confirms that this email message has been swept byMIMEsweeper for the presence of computer viruses.**********************************************************************See our web page at http://www.lahey.org for a full directory of Lahey sites, staff, services and career opportunities.

THIS MESSAGE IS INTENDED FOR THE USE OF THE PERSON TO WHOM IT IS ADDRESSED. IT MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records.

[Guest guest]

FYI

If there is a Transplant Financial Coordinator from Hershey Medical Center in

our group can you send me your phone number

Thanks

Financial Coordinator

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

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]

On this note, if anyone out there is a TFC from University of Alabama

Birmingham please give me a call. Thanks.

Watts Jr.

Financial Coordinator

Abdominal Transplant Program

Medical University of South Carolina

158 Rutledge Ave Rm 119

ton,SC 29425

(843)792-2874

fax (843)792-8236

pgr (843)792-2123/12304

wattscha@...

>>> M1@... 08/21/07 03:00PM >>>

FYI

If there is a Transplant Financial Coordinator from Hershey Medical Center in

our group can you send me your phone number

Thanks

Financial Coordinator

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

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]

Good morning

I am looking for a form that would inform patient that they are having a non

medicare covered transplant.

If anyone has one and is willing to share this would appreciate.

Thanks

Transplant Financial Coordinator

Allegheny General Hospital

Fax

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

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]

HI ,

Check with your admissions staff, I am

pretty sure that the hospital has a form that they give to patients when they

are going to receive a service at the hospital that is not covered by Medicare.

You should be able to adapt that form.

Hope this helps,

Thanks,

Bill

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of

Sent: Friday, August 31, 2007

10:02 AM

To: TxFinancialCoordinators

Cc: Dodson

Subject: Re:

Medicare non covered transplant

Good morning

I am looking for a form that would inform patient that they are having a non

medicare covered transplant.

If anyone has one and is willing to share this would appreciate.

Thanks

Transplant Financial Coordinator

Allegheny General Hospital

Fax

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

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]

The form is called the ABN - Advance Beneficiary Notice - and it is adaptable to whatever service may not be covered. Very important to fill it out completely. It's my understanding that if the provider doesn't dot all the "i"s and cross all "t"s, the beneficiary has the right to dispute the charges.

on Financial Counselor Legacy Transplant Services Good Samaritan Hospital 1040 NW 22nd Ave Ste 480 Portland OR 97210 toll free fax lmorriso@...

Re: Medicare non covered transplant

Good morning I am looking for a form that would inform patient that they are having a non medicare covered transplant.If anyone has one and is willing to share this would appreciate.Thanks Transplant Financial CoordinatorAllegheny General HospitalFax **********************************************************************This email and any files transmitted with it are confidential andintended solely for the use of the individual or entity to whom theyare addressed. If you have received this email in error please notifythe West Penn Allegheny Health System Help Desk at 412 330-4357.This footnote also confirms that this email message has been swept byMIMEsweeper for the presence of computer viruses.**********************************************************************

IMPORTANT NOTICE: This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature.

[Guest guest]

Here's a link to the form:http://www.cms.hhs.gov/BNI/02_ABNGABNL.asp herri Sbalbi Financial Counselor Division of Transplant Baystate Medical Center 300 Birnie Avenue-Suite 301 Springfield MA 01107 fax Re: Medicare non covered transplantGood morning I am looking for a form that would inform patient that they are having a non medicare covered transplant.If anyone has one and is willing to share this would appreciate.Thanks Transplant Financial CoordinatorAllegheny General HospitalFax **********************************************************************This email and any files transmitted with it are confidential andintended solely for the use of the individual or entity to whom theyare addressed. If you have received this email in error please notifythe West Penn Allegheny Health System Help Desk at 412 330-4357.This footnote also confirms that this email message has been swept byMIMEsweeper for the presence of computer viruses.**********************************************************************IMPORTANT NOTICE: This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature.