RE: Donor Billing Question

[Guest guest]

Hi Felicia,

If the recipient has group insurance, the

recipient is probably Medicare Entitled.  If the recipient is Medicare

Entitled, there should be NO billing for donor evaluation services, the

evaluation services are to be “billed” to the transplant center and not any

payer. 

We would recommend that the transplant

center refund the insurance company and place all costs associated with the

donor in the KACC.

Hope this helps,

Thanks,

Bill

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of ELIZONDO, FELICIA

Sent: Tuesday, October 23, 2007

4:16 PM

To: TxFinancialCoordinators

Subject:

Donor Billing Question

I have a

recipient who carries BCBS and no secondary insurance. We have worked up a

donor and BCBS has paid on a portion of the bill and sent back a balance as the

patient portion. What should happen w/ that balance. Is the recipient

responsible for the balance or can it be written off to the cost report?

Thanks,

Felicia

[Guest guest]

HI Felicia,

The Recipient may not be entitled when the workup takes place but may be

entitled or an actual Beneficiary at the time of transplant. Medicare does

NOT consider an evaluation as something that is billable; the transplant is

the care that is rendered. For safety sake, we strongly recommend that all

donors are treated as if Medicare was going to be in either primary or a

secondary payer at the time of transplant. Please remember that less that

5% of ESRD patients nationally will not have Medicare involved in their ESRD

care.

Hope this helps,

Thanks,

Bill

_____

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of ELIZONDO,

FELICIA

Sent: Wednesday, October 24, 2007 8:59 AM

To: TxFinancialCoordinators

Subject: RE: Donor Billing Question

What if the recipient is not Medicare Entitled?

Thanks,

Felicia

Donor Billing Question

I have a recipient who carries BCBS and no secondary insurance. We have

worked up a donor and BCBS has paid on a portion of the bill and sent back a

balance as the patient portion. What should happen w/ that balance. Is the

recipient responsible for the balance or can it be written off to the cost

report?

Thanks,

Felicia

[Guest guest]

HI Felicia,

The Recipient may not be entitled when the workup takes place but may be

entitled or an actual Beneficiary at the time of transplant. Medicare does

NOT consider an evaluation as something that is billable; the transplant is

the care that is rendered. For safety sake, we strongly recommend that all

donors are treated as if Medicare was going to be in either primary or a

secondary payer at the time of transplant. Please remember that less that

5% of ESRD patients nationally will not have Medicare involved in their ESRD

care.

Hope this helps,

Thanks,

Bill

_____

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of ELIZONDO,

FELICIA

Sent: Wednesday, October 24, 2007 8:59 AM

To: TxFinancialCoordinators

Subject: RE: Donor Billing Question

What if the recipient is not Medicare Entitled?

Thanks,

Felicia

Donor Billing Question

I have a recipient who carries BCBS and no secondary insurance. We have

worked up a donor and BCBS has paid on a portion of the bill and sent back a

balance as the patient portion. What should happen w/ that balance. Is the

recipient responsible for the balance or can it be written off to the cost

report?

Thanks,

Felicia

[Guest guest]

HI Felicia,

The Recipient may not be entitled when the workup takes place but may be

entitled or an actual Beneficiary at the time of transplant. Medicare does

NOT consider an evaluation as something that is billable; the transplant is

the care that is rendered. For safety sake, we strongly recommend that all

donors are treated as if Medicare was going to be in either primary or a

secondary payer at the time of transplant. Please remember that less that

5% of ESRD patients nationally will not have Medicare involved in their ESRD

care.

Hope this helps,

Thanks,

Bill

_____

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of ELIZONDO,

FELICIA

Sent: Wednesday, October 24, 2007 8:59 AM

To: TxFinancialCoordinators

Subject: RE: Donor Billing Question

What if the recipient is not Medicare Entitled?

Thanks,

Felicia

Donor Billing Question

I have a recipient who carries BCBS and no secondary insurance. We have

worked up a donor and BCBS has paid on a portion of the bill and sent back a

balance as the patient portion. What should happen w/ that balance. Is the

recipient responsible for the balance or can it be written off to the cost

report?

Thanks,

Felicia