RE: Pharmacy billing Part B for immunos

[Guest guest]

Patient should be responsible for the 20%

of Medicare allowable. Why don't you try checking with mail order Transplant

Pharmacy?

Austria

Specialty Contracting

Methodist Health System

1441 North Beckley Avenue

Dallas,Texas 75203

Phone:

Fax:

From:

TxFinancialCoordinators [mailto:TxFinancialCoordinators ]

On Behalf Of Sbalbi, Sherri

Sent: Tuesday, February 21, 2006

11:55 AM

To: TFCA

Subject:

Pharmacy billing Part B for immunos

Hi

all...

Is

anyone knowledgeable in Part B pharmacy billing for immunos? One of

our patients w/large out of pocket (secondary) rx plan was quoted an estimate

of $700 (20% copay after Part for one month supply of Rapamune...seems kind

of excessive to me. They contacted 3 pharmacies in the area & was

given the same $$. Does pharmacy billing work the same way as medical

billing (patient responsible for 20% of Mcare allowable)? Any assistance

would be greatful!

Sherri Sbalbi

Financial

Counselor

Transplant

Services

Baystate

Medical Center

300

Birnie Avenue - Suite 301

Springfield,

MA 01107

(413)

787-5309

(413)

787-5311 fax

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[Guest guest]

Hi,

Does the patient have secondary medical coverage? We were having an issue similiar to this. Since Medicare pays for immunes through Part B it is considered medical coverage. If the patient has secondary medical coverage the pharmacy should be billing them for the 20%. The secondary coverage will cover the 20% as medical if the Medicare EOB is submitted with the claim. We contacted several the insurance carriers and they stated that this is the process.

Still and all $700 sounds like a lot of money for it to be 20%. Is this for a mail in order or retail?

Hope this helps.

Celenia Mane

Transplant Operations Analyst

Mount Sinai Medical Center

New York, NY 10029

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Sbalbi, SherriSent: Tuesday, February 21, 2006 12:55 PMTo: TFCASubject: Pharmacy billing Part B for immunos

Hi all... Is anyone knowledgeable in Part B pharmacy billing for immunos? One of our patients w/large out of pocket (secondary) rx plan was quoted an estimate of $700 (20% copay after Part for one month supply of Rapamune...seems kind of excessive to me. They contacted 3 pharmacies in the area & was given the same $$. Does pharmacy billing work the same way as medical billing (patient responsible for 20% of Mcare allowable)? Any assistance would be greatful!

Sherri Sbalbi Financial Counselor Transplant Services Baystate Medical Center 300 Birnie Avenue - Suite 301 Springfield, MA 01107 fax

[Guest guest]

The information that I have gathered by calling some of small / local

pharmacies, is that alot of them do not have the billing capability to

submit medications as a "medical claim" to Medicare nor supplemental

plans.

Mane, Celenia wrote:

Pharmacy billing Part B for immunos

Hi,

Does the patient have secondary medical coverage? We

were having an issue similiar to this. Since Medicare pays for immunes

through Part B it is considered medical coverage. If the patient has

secondary medical coverage the pharmacy should be billing them for the

20%. The secondary coverage will cover the 20% as medical if the

Medicare EOB is submitted with the claim. We contacted several the

insurance carriers and they stated that this is the process.

Still and all $700 sounds like a lot of money for it

to be 20%. Is this for a mail in order or retail?

Hope this helps.

Celenia

Mane

Transplant

Operations Analyst

Mount

Sinai Medical Center

New

York, NY 10029

From:

TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of Sbalbi,

Sherri

Sent: Tuesday, February 21, 2006 12:55 PM

To: TFCA

Subject: Pharmacy billing Part B for

immunos

Hi all...

Is anyone knowledgeable in Part B

pharmacy billing for immunos? One of our patients w/large out of

pocket (secondary) rx plan was quoted an estimate of $700 (20% copay

after Part for one month supply of Rapamune...seems kind of

excessive to me. They contacted 3 pharmacies in the area & was

given the same $$. Does pharmacy billing work the same way as medical

billing (patient responsible for 20% of Mcare allowable)? Any

assistance would be greatful!

Sherri Sbalbi

Financial Counselor

Transplant Services

Baystate Medical Center

300 Birnie Avenue - Suite 301

Springfield, MA 01107

fax

[Guest guest]

Sounds like your pt would be better off at least getting the immunos thru some place like PharmaCare who DOES know how to bill these to Part B & the balance into the 2ndy ins.

J. Aguiar

Beth Israel Deaconess, Boston

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of SiosonSent: Tuesday, February 21, 2006 1:22 PMTo: TxFinancialCoordinators Subject: Re: Pharmacy billing Part B for immunos

The information that I have gathered by calling some of small / local pharmacies, is that alot of them do not have the billing capability to submit medications as a "medical claim" to Medicare nor supplemental plans. Mane, Celenia wrote:

Hi,

Does the patient have secondary medical coverage? We were having an issue similiar to this. Since Medicare pays for immunes through Part B it is considered medical coverage. If the patient has secondary medical coverage the pharmacy should be billing them for the 20%. The secondary coverage will cover the 20% as medical if the Medicare EOB is submitted with the claim. We contacted several the insurance carriers and they stated that this is the process.

Still and all $700 sounds like a lot of money for it to be 20%. Is this for a mail in order or retail?

Hope this helps.

Celenia Mane

Transplant Operations Analyst

Mount Sinai Medical Center

New York, NY 10029

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Sbalbi, SherriSent: Tuesday, February 21, 2006 12:55 PMTo: TFCASubject: Pharmacy billing Part B for immunos

Hi all... Is anyone knowledgeable in Part B pharmacy billing for immunos? One of our patients w/large out of pocket (secondary) rx plan was quoted an estimate of $700 (20% copay after Part for one month supply of Rapamune...seems kind of excessive to me. They contacted 3 pharmacies in the area & was given the same $$. Does pharmacy billing work the same way as medical billing (patient responsible for 20% of Mcare allowable)? Any assistance would be greatful!

Sherri Sbalbi Financial Counselor Transplant Services Baystate Medical Center 300 Birnie Avenue - Suite 301 Springfield, MA 01107 fax

[Guest guest]

The retail pharmacy must be a pharmacy

approved provider to bill for immunos under DMERC.

Austria

Specialty Contracting

Methodist Health System

1441 North Beckley Avenue

Dallas,Texas

75203

Phone:

Fax:

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of Sioson

Sent: Tuesday, February 21, 2006

12:22 PM

To:

TxFinancialCoordinators

Subject: Re:

Pharmacy billing Part B for immunos

The information that I have gathered by calling some

of small / local pharmacies, is that alot of them do not have the billing

capability to submit medications as a " medical claim " to Medicare nor

supplemental plans.

Mane, Celenia wrote:

Hi,

Does the patient have secondary medical

coverage? We were having an issue similiar to this. Since Medicare

pays for immunes through Part B it is considered medical coverage. If the

patient has secondary medical coverage the pharmacy should be billing them for

the 20%. The secondary coverage will cover the 20% as medical if the

Medicare EOB is submitted with the claim. We contacted several

the insurance carriers and they stated that this is the process.

Still and all $700 sounds like a lot of

money for it to be 20%. Is this for a mail in order or retail?

Hope this helps.

Celenia Mane

Transplant Operations Analyst

Mount Sinai

Medical Center

New York,

NY 10029

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ]

On Behalf Of Sbalbi, Sherri

Sent: Tuesday, February 21, 2006

12:55 PM

To: TFCA

Subject:

Pharmacy billing Part B for immunos

Hi all...

Is

anyone knowledgeable in Part B pharmacy billing for immunos? One of

our patients w/large out of pocket (secondary) rx plan was quoted an estimate

of $700 (20% copay after Part for one month supply of Rapamune...seems kind

of excessive to me. They contacted 3 pharmacies in the area & was

given the same $$. Does pharmacy billing work the same way as medical

billing (patient responsible for 20% of Mcare allowable)? Any assistance

would be greatful!

Sherri Sbalbi

Financial

Counselor

Transplant

Services

Baystate

Medical Center

300

Birnie Avenue - Suite 301

Springfield,

MA 01107

(413)

787-5309

(413)

787-5311 fax

[Guest guest]

>>> LAguiar@... 2/21/2006 12:35:25 PM >>>

Sounds like your pt would be better off at least getting the immunos

thru some place like PharmaCare who DOES know how to bill these to

Part

B & the balance into the 2ndy ins.

J. Aguiar

Beth Israel Deaconess, Boston

________________________________

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of

Sioson

Sent: Tuesday, February 21, 2006 1:22 PM

To: TxFinancialCoordinators

Subject: Re: Pharmacy billing Part B for

immunos

The information that I have gathered by calling some of small / local

pharmacies, is that alot of them do not have the billing capability to

submit medications as a " medical claim " to Medicare nor supplemental

plans.

Mane, Celenia wrote:

Hi,

Does the patient have secondary medical coverage? We were

having an issue similiar to this. Since Medicare pays for immunes

through Part B it is considered medical coverage. If the patient has

secondary medical coverage the pharmacy should be billing them for the

20%. The secondary coverage will cover the 20% as medical if the

Medicare EOB is submitted with the claim. We contacted several the

insurance carriers and they stated that this is the process.

Still and all $700 sounds like a lot of money for it to be 20%.

Is this for a mail in order or retail?

Hope this helps.

Celenia Mane

Transplant Operations Analyst

Mount Sinai Medical Center

New York, NY 10029

________________________________

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of Sbalbi,

Sherri

Sent: Tuesday, February 21, 2006 12:55 PM

To: TFCA

Subject: Pharmacy billing Part B for

immunos

Hi all...

Is anyone knowledgeable in Part B pharmacy billing for immunos?

One of our patients w/large out of pocket (secondary) rx plan was

quoted

an estimate of $700 (20% copay after Part for one month supply of

Rapamune...seems kind of excessive to me. They contacted 3 pharmacies

in the area & was given the same $$. Does pharmacy billing work the

same way as medical billing (patient responsible for 20% of Mcare

allowable)? Any assistance would be greatful!

Sherri Sbalbi

Financial Counselor

Transplant Services

Baystate Medical Center

300 Birnie Avenue - Suite 301

Springfield, MA 01107

fax

________________________________

[Guest guest]

Hi Tara, re: Is anyone in the group running into the HMO Medicare problem of billingthe immuno's directly to Medicare D vs. B; i.e.: capping out on MedicareD with the first order. Have they had any success with advocatingotherwise...getting them to bill from Medicare B for the immuno's?

I just discovered a new notation in the Rx benefits summary of BCBS of Oregon's Medicare plan that reads "Medicare Part B drugs covered" and references the same copay structure as the Part D drugs. Don't like the sound of that, I'll let you know what I find out. Does anyone out there disagree that these plans are obligated to cover immunos as a Part B benefit if Medicare OR Managed Medicare was in place at the time of transplant?

on Financial Counselor Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 toll free fax lmorrisolhs (DOT) org

"The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little." FDR

Pharmacy billing Part B forimmunos Hi all... Is anyone knowledgeable in Part B pharmacy billing for immunos?One of our patients w/large out of pocket (secondary) rx plan wasquotedan estimate of $700 (20% copay after Part for one month supply ofRapamune...seems kind of excessive to me. They contacted 3 pharmaciesin the area & was given the same $$. Does pharmacy billing work thesame way as medical billing (patient responsible for 20% of Mcareallowable)? Any assistance would be greatful! Sherri Sbalbi Financial Counselor Transplant Services Baystate Medical Center 300 Birnie Avenue - Suite 301 Springfield, MA 01107 fax ________________________________

[Guest guest]

I just discovered a new notation in the Rx benefits summary of BCBS of Oregon's Medicare plan that reads "Medicare Part B drugs covered" and references the same copay structure as the Part D drugs. Don't like the sound of that, I'll let you know what I find out. Does anyone out there disagree that these plans are obligated to cover immunos as a Part B benefit if Medicare OR Managed Medicare was in place at the time of transplant?[Aguiar, (Surgery)] Agree 100%, -as far as I know, the standard w/re: to the Medicare HMO's, regardless of whether they were 'Advantage' or not, is that they can't provide less coverage than Medicare would, but they can provide more.

J. Aguiar

Beth Israel Deaconess, Boston

[Guest guest]

thanks !

on Financial Counselor Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 toll free fax lmorrisolhs (DOT) org

"The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little." FDR

-----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of LAguiar@...Sent: Wednesday, February 22, 2006 9:16 AMTo: TxFinancialCoordinators Subject: RE: Pharmacy billing Part B for immunos

I just discovered a new notation in the Rx benefits summary of BCBS of Oregon's Medicare plan that reads "Medicare Part B drugs covered" and references the same copay structure as the Part D drugs. Don't like the sound of that, I'll let you know what I find out. Does anyone out there disagree that these plans are obligated to cover immunos as a Part B benefit if Medicare OR Managed Medicare was in place at the time of transplant?[Aguiar, (Surgery)] Agree 100%, -as far as I know, the standard w/re: to the Medicare HMO's, regardless of whether they were 'Advantage' or not, is that they can't provide less coverage than Medicare would, but they can provide more.

J. Aguiar

Beth Israel Deaconess, Boston

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.