RE: COB for D/E Medicare and GHP

[Guest guest]

According to the brand new copy of the Fiscal Intermediary Standard System Terminology (FISS) Training Manual, courtesy of the new Part A Intermediary we have as of this week, the code definitions are:

0-Normal entitlement

1-Disability

2-ESRD

3-Has, or had ESRD, but current DIB

4-Old age but has or had ESRD

8-Has or had ESRD & is covered under Part A premium

9-Covered under Part A Premium

J. Aguiar

Beth Israel Deaconess, Boston

-----Original Message-----From: Woodward, L Sent: Thursday, May 06, 2004 11:38 AMTo: TxFinancialCoordinatorsYahoogroupsSubject: COB for D/E Medicare and GHP

Ok... I hope everyone has had their coffee or coke. If a patient is coded as a 3 in Medicare (has/had ESRD and currently disabled) is currently off dialysis (last treatment in March) and has GHP through their spouse. Who is primary? I was under the impression that when they are listed as a 3 (dually entitled) that ESRD takes precedence so the Medicare would be primary, but I am not sure since he is currently off dialysis. Help!!!!

L. Woodward, BS, TFC

Renal Transplant Financial Coordinator

University Hospital of Arkansas

FAX

[Guest guest]

The way I was made to understand, and yesterday when I happen to be verifying a patient with Medicare, if the treatment is kidney related the ESRD rule comes in effect, if treatment is for anything other than kidney related the group insurance would be primary, that is of course if the 30 months has past. Is the patient not on dialysis due to transplant?

Kreci Transplant Financial Coordinator Southwest Regional Florida Medical Center Fort Myers, FL

-----Original Message-----From: Woodward, L Sent: Thursday, May 06, 2004 11:38 AMTo: TxFinancialCoordinatorsYahoogroupsSubject: COB for D/E Medicare and GHP

Ok... I hope everyone has had their coffee or coke. If a patient is coded as a 3 in Medicare (has/had ESRD and currently disabled) is currently off dialysis (last treatment in March) and has GHP through their spouse. Who is primary? I was under the impression that when they are listed as a 3 (dually entitled) that ESRD takes precedence so the Medicare would be primary, but I am not sure since he is currently off dialysis. Help!!!!

L. Woodward, BS, TFC

Renal Transplant Financial Coordinator

University Hospital of Arkansas

FAX

[Guest guest]

If the patient has Medicare based on esr and has met the 30 month coordination of benefits rule, Medicare is primary for everything whether it is related to his kidneys or his brain. His group was prime for 30 months but after that period Medicare is prime for everything.

Also, Medicare will not pay for HMO copays as these are the patient's responsibility while Medicare is the secondary payer. Bev

>>> .Kreci@... 05/07/04 08:30AM >>>

The way I was made to understand, and yesterday when I happen to be verifying a patient with Medicare, if the treatment is kidney related the ESRD rule comes in effect, if treatment is for anything other than kidney related the group insurance would be primary, that is of course if the 30 months has past. Is the patient not on dialysis due to transplant?

Kreci Transplant Financial Coordinator Southwest Regional Florida Medical Center Fort Myers, FL

-----Original Message-----From: Woodward, L Sent: Thursday, May 06, 2004 11:38 AMTo: TxFinancialCoordinatorsYahoogroupsSubject: COB for D/E Medicare and GHP

Ok... I hope everyone has had their coffee or coke. If a patient is coded as a 3 in Medicare (has/had ESRD and currently disabled) is currently off dialysis (last treatment in March) and has GHP through their spouse. Who is primary? I was under the impression that when they are listed as a 3 (dually entitled) that ESRD takes precedence so the Medicare would be primary, but I am not sure since he is currently off dialysis. Help!!!!

L. Woodward, BS, TFC

Renal Transplant Financial Coordinator

University Hospital of Arkansas

FAX

[Guest guest]

This has always been my understanding as

well. If you think about it, CMS does not have the capability to change

Medicare payer priority back and forth depending on the diagnosis when they

process claims. They have a hard enough time ending ESRD Medicare 36

months after transplant.

COB for D/E Medicare and GHP

Ok... I hope everyone has had their

coffee or coke. If a patient is coded as a 3 in Medicare (has/had ESRD and

currently disabled) is currently off dialysis (last treatment in March) and has

GHP through their spouse. Who is primary? I was under the impression that when

they are listed as a 3 (dually entitled) that ESRD takes precedence so the

Medicare would be primary, but I am not sure since he is currently off

dialysis. Help!!!!

L. Woodward, BS, TFC

Renal Transplant Financial

Coordinator

University Hospital of Arkansas

FAX