IVIG

[Guest guest]

Hi :

Cedars is approved locally for IVIG. Please call me tomorrow and I will

help you. .

M.

Sr Financial Managment Analyst

Supervisor, Transplant Financial Coordinators

Cedars-Sinai Medical Center

Comprehensive Transplant Center

-Office (310)423-1694-FAX

ivig

Hi-

We are working on getting our local Medicare intermediary to approve IVIG

therapy for sensitized patients who need a kidney transplant.

Has anyone else worked on this recently?

I am trying to find others who have gotten this approved. If we submit

information that other centers are doing this/have policies in place, it

will help us to get our center approved.

Anyone willing to help me? I would really appreciate any help available.

Donovan

Transplant Financial Coordinator

SUNY Upstate Medical University

750 East Street

Syracuse, New York 13210

Phone: 315 464-6290

Fax: 315 464-6288

Donovanl@...

The information contained in this email is confidential intended only for

the use of the party to whom it is addressed. If you are not the intended

recipient, please be aware that you are strictly prohibited from sharing,

distributing, or copying this email. If you have received this email by

mistake, please notify the sender. Thank you.

[Guest guest]

Hi n,

If I remember correctly there has been no

national coverage policy issued. If that is correct, the hospital would

need to approach its Medicare Intermediary for a Local Medical Determination to

receive payment. It would then want to approach its Medicare r for

approval for physician coverage. This parallels the process for kidney.

Hope this helps,

Thanks,

Bill

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of Melton, n

Sent: Tuesday, May 17, 2005 8:58

AM

To:

TxFinancialCoordinators

Subject:

IVIG

Hi all,

I know this has been discussed in the past but

could anyone refresh my

memory regarding IVIG Medicare reimbursement for

Pre HEART Transplant

patients? Bill, are you out there?

Thanks

n

This email message is for the sole use of the

intended recipient(s) and

may contain confidential and privileged

information. Any unauthorized

review, use, disclosure or distribution is

prohibited. If you are not

the intended recipient, please contact the sender

by reply email and

destroy all copies of the original message.

[Guest guest]

The CMS representative at the TFCA conference mentioned new information may be coming out on IVIG coverage.

Any information on that ?

Thanks

-----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of VaughanSent: Tuesday, May 17, 2005 8:17 AMTo: TxFinancialCoordinators Subject: RE: IVIG

Hi n,

If I remember correctly there has been no national coverage policy issued. If that is correct, the hospital would need to approach its Medicare Intermediary for a Local Medical Determination to receive payment. It would then want to approach its Medicare r for approval for physician coverage. This parallels the process for kidney.

Hope this helps,

Thanks,

Bill

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Melton, nSent: Tuesday, May 17, 2005 8:58 AMTo: TxFinancialCoordinators Subject: IVIG

Hi all,I know this has been discussed in the past but could anyone refresh mymemory regarding IVIG Medicare reimbursement for Pre HEART Transplantpatients? Bill, are you out there?ThanksnThis email message is for the sole use of the intended recipient(s) andmay contain confidential and privileged information. Any unauthorizedreview, use, disclosure or distribution is prohibited. If you are notthe intended recipient, please contact the sender by reply email anddestroy all copies of the original message.

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[Guest guest]

thanks Bill

This email message is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply email and destroy all copies of the original message.

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of VaughanSent: Tuesday, May 17, 2005 8:17 AMTo: TxFinancialCoordinators Subject: RE: IVIG

Hi n,

If I remember correctly there has been no national coverage policy issued. If that is correct, the hospital would need to approach its Medicare Intermediary for a Local Medical Determination to receive payment. It would then want to approach its Medicare r for approval for physician coverage. This parallels the process for kidney.

Hope this helps,

Thanks,

Bill

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Melton, nSent: Tuesday, May 17, 2005 8:58 AMTo: TxFinancialCoordinators Subject: IVIG

Hi all,I know this has been discussed in the past but could anyone refresh mymemory regarding IVIG Medicare reimbursement for Pre HEART Transplantpatients? Bill, are you out there?ThanksnThis email message is for the sole use of the intended recipient(s) andmay contain confidential and privileged information. Any unauthorizedreview, use, disclosure or distribution is prohibited. If you are notthe intended recipient, please contact the sender by reply email anddestroy all copies of the original message.

[Guest guest]

Does anyone know if NY Medicaid pays for ivig?

[Guest guest]

Hi ,

we are working on this in our facility/region. Medical Director with

our fiscal intermediary for Medicare wants to know what other regions

have approved coverage. Can you tell me what region you are in and if

possible, the Medical Director for Medicare who approved the therapy.

Appreciate your help so much! Thanks.

Craycraft

Transplant Financial Coordinator

University of Kansas Medical Center

Fax

lcraycraft@...

>>> .@... 01/10/05 2:51 PM >>>

Hi :

Cedars is approved locally for IVIG. Please call me tomorrow and I

will

help you. .

M.

Sr Financial Managment Analyst

Supervisor, Transplant Financial Coordinators

Cedars-Sinai Medical Center

Comprehensive Transplant Center

-Office (310)423-1694-FAX

ivig

Hi-

We are working on getting our local Medicare intermediary to approve

IVIG

therapy for sensitized patients who need a kidney transplant.

Has anyone else worked on this recently?

I am trying to find others who have gotten this approved. If we submit

information that other centers are doing this/have policies in place,

it

will help us to get our center approved.

Anyone willing to help me? I would really appreciate any help

available.

Donovan

Transplant Financial Coordinator

SUNY Upstate Medical University

750 East Street

Syracuse, New York 13210

Phone: 315 464-6290

Fax: 315 464-6288

Donovanl@...

The information contained in this email is confidential intended only

for

the use of the party to whom it is addressed. If you are not the

intended

recipient, please be aware that you are strictly prohibited from

sharing,

distributing, or copying this email. If you have received this email

by

mistake, please notify the sender. Thank you.

[Guest guest]

Here's the scoop from my research in doing an approximate 200 page appeal on IVIG and Plasmapheresis for desensitization of kidney recipient when an insurance company denied it

Mr. Vaughn - let us know if I missed anything.

Step 1

National Coverage Decision (NCD)- there is not one - it is left to " local medical review policy "

Each Medicare Region is NOT required to establish a policy unless the intermediary determines a policy is necessary to provide guidance to their specific geographic area of coverage

If insurance appeal/request - You will need to provide this info to the insurance company and can be printed from:

http://www.cms.hhs.gov/providers/mr/lmrp.asp

http://www.cms.hhs.gov/glossary/search - print out definition of " National Coverage Determinations " AND " Local Medical Review Policy " AND " " Local Coverage Determination "

Step 2

http://www.cms.hhs.gov/mcd/index_chapter_list.asp - print Chapter 230 and 260 (so the subchapters can be seen - i.e. " expand the chapter) these support that there is no NCD for IVIG or Plasmapheresis but you need to make a note on the page that this is what the page is for and also include statement that this supports that these treatments are NOT listed as an exclusion either

Step 3

The following is for regional info:

(print and send all of them if you have to prove this is nationally accepted standard of care or establish the other intermediaries who cover these)

http://www.hhs.gov/mcd/viewarticle.asp?article_id=16030 - this is an example of how article id# will be on bottom of printed page

Also keep in mind that some of the intermediaries wrote a separate policy for each state/area in their geographic coverage area so not all the policies I listed for the Medicare Region will apply to everyone in that region.

Here's the list of documents

Region I Region VI

L445, L508,L658 L17363, L13424, L18676, L13471

Region II - no policies found Region VII

L2371

Region III Region VIII - no policies found

L819

Region IV Region IX

L1073 American Samoa, Guam & Commonwealth of N. na Islands

Region V Region X - no policies found

L13297, L1725

Also - per CMS - intermediaries are not required to do local policy if they feel is not necessary but they can't exclude a service unless they have a policy. If listed as an exclusion then have to follow their appeal process.

Step 4

Literature research and support - your transplant surgeons have to help with this because they are the experts - you can do medical peer review literature search and then have surgeons tell you which ones are best articles to use (medical librarians can do the search for you also)

Look for authors like A Montgomery from Hopkins - wrote the first protocol

Step 5

You need the exact protocol you are using at your facility and letters from your transplant surgeons giving reasons why these treatments need to be covered.

That's all the info I could pull together quickly. Hope it helps

Debbie Meneely RN, CPN

Transplant Financial Coordinator

Kidney, Pancreas & Pediatrics

Clarian Transplant Center

Indianapolis, IN 46202

ph:

fax:

dmeneely@...

ivig

Hi-

We are working on getting our local Medicare intermediary to approve

IVIG

therapy for sensitized patients who need a kidney transplant.

Has anyone else worked on this recently?

I am trying to find others who have gotten this approved. If we submit

information that other centers are doing this/have policies in place,

it

will help us to get our center approved.

Anyone willing to help me? I would really appreciate any help

available.

Donovan

Transplant Financial Coordinator

SUNY Upstate Medical University

750 East Street

Syracuse, New York 13210

Phone: 315 464-6290

Fax: 315 464-6288

Donovanl@...

The information contained in this email is confidential intended only

for

the use of the party to whom it is addressed. If you are not the

intended

recipient, please be aware that you are strictly prohibited from

sharing,

distributing, or copying this email. If you have received this email

by

mistake, please notify the sender. Thank you.

[Guest guest]

HI Debbie

You did wonderfully, bottom line, it is up to the local Intermediary

first and then the Regional Office. Most of the time, the local

Intermediary may well be the easiest approach.

Thanks,

Bill

From:

TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of Meneely, Debra Kay

Sent: Tuesday, November 29, 2005

3:00 PM

To:

TxFinancialCoordinators ; .@...

Subject: RE:

ivig

Here's

the scoop from my research in doing an approximate 200 page appeal on

IVIG and Plasmapheresis for desensitization of kidney recipient when an

insurance company denied it

Mr.

Vaughn - let us know if I missed anything.

Step 1

National Coverage Decision (NCD)- there is not one - it is left to " local

medical review policy "

Each Medicare Region is NOT required to establish a policy unless the

intermediary determines a policy is necessary to provide guidance to their

specific geographic area of coverage

If

insurance appeal/request - You will need to provide this info to the insurance

company and can be printed from:

http://www.cms.hhs.gov/providers/mr/lmrp.asp

http://www.cms.hhs.gov/glossary/search

- print out definition of " National Coverage Determinations " AND

" Local Medical Review Policy " AND " " Local Coverage

Determination "

Step 2

http://www.cms.hhs.gov/mcd/index_chapter_list.asp

- print Chapter 230 and 260 (so the subchapters can be seen - i.e. " expand

the chapter) these support that there is no NCD

for IVIG or Plasmapheresis but you need to make a note on the page that this is

what the page is for and also include statement that this supports that these

treatments are NOT listed as an exclusion either

Step 3

The following is for regional info:

(print and send all of them if you

have to prove this is nationally accepted standard of care or establish the

other intermediaries who cover these)

http://www.hhs.gov/mcd/viewarticle.asp?article_id=16030

- this is an example of how article id# will be on bottom of printed page

Also keep

in mind that some of the intermediaries wrote a separate policy for each

state/area in their geographic coverage area so not all the policies I listed

for the Medicare Region will apply to everyone in that region.

Here's

the list of documents

Region I

Region VI

L445, L508,L658

L17363, L13424, L18676, L13471

Region II - no policies found

Region VII

L2371

Region III

Region VIII - no

policies found

L819

Region IV

Region IX

L1073

American Samoa,

Guam & Commonwealth

of N. na Islands

Region V

Region X - no

policies found

L13297, L1725

Also -

per CMS - intermediaries are not required to do local policy if they feel

is not necessary but they can't exclude a service unless they have a policy. If

listed as an exclusion then have to follow their appeal process.

Step 4

Literature research and support - your transplant surgeons have to help with

this because they are the experts - you can do medical peer review

literature search and then have surgeons tell you which ones are best

articles to use (medical librarians can do the search for you also)

Look for

authors like A Montgomery from Hopkins - wrote the first protocol

Step 5

You need the exact protocol you are using at your facility and letters from

your transplant surgeons giving reasons why these treatments need to be

covered.

That's

all the info I could pull together quickly. Hope it helps

Debbie

Meneely RN, CPN

Transplant

Financial Coordinator

Kidney,

Pancreas & Pediatrics

Clarian

Transplant Center

Indianapolis,

IN 46202

ph:

fax:

dmeneely@...

-----Original

Message-----

From:

TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf

Of Craycraft

Sent:

Tuesday, November 29, 2005 1:20 PM

To:

.@...; TxFinancialCoordinators

Subject:

RE: ivig

Hi

,

we are

working on this in our facility/region. Medical Director with

our

fiscal intermediary for Medicare wants to know what other regions

have

approved coverage. Can you tell me what region you are in and if

possible,

the Medical Director for Medicare who approved the therapy.

Appreciate

your help so much! Thanks.

Craycraft

Transplant

Financial Coordinator

University

of Kansas Medical Center

Fax

lcraycraft@...

>>>

.@... 01/10/05 2:51 PM >>>

Hi

:

Cedars

is approved locally for IVIG. Please call me tomorrow and I

will

help

you. .

M.

Sr

Financial Managment Analyst

Supervisor,

Transplant Financial Coordinators

Cedars-Sinai Medical Center

Comprehensive Transplant Center

(310)

423-3170-Office (310)423-1694-FAX

-----Original

Message-----

From:

Donovan

Sent:

Monday, January 10, 2005 8:37 AM

To:

TxFinancialCoordinators

Subject:

ivig

Hi-

We are

working on getting our local Medicare intermediary to approve

IVIG

therapy

for sensitized patients who need a kidney transplant.

Has

anyone else worked on this recently?

I

am trying to find others who have gotten this approved. If we submit

information

that other centers are doing this/have policies in place,

it

will

help us to get our center approved.

Anyone

willing to help me? I would really appreciate any help

available.

Donovan

Transplant

Financial Coordinator

SUNY Upstate Medical

University

750 East Street

Syracuse, New York

13210

Phone:

315 464-6290

Fax:

315 464-6288

Donovanl@...

The

information contained in this email is confidential intended only

for

the

use of the party to whom it is addressed. If you are not the

intended

recipient,

please be aware that you are strictly prohibited from

sharing,

distributing,

or copying this email. If you have received this email

by

mistake,

please notify the sender. Thank you.

Yahoo!

Groups Links

Important

Warning: This message is intended for the use of the person

or

entity

to which it is addressed and may contain information that is

privileged

and confidential, the disclosure of which is governed by

applicable

law. If the reader of this message is not the intended

recipient,

or the employee or agent responsible for delivering it to

the

intended

recipient, you are hereby notified that any dissemination,

distribution

or copying of this information is STRICTLY PROHIBITED.

If

you have received this message in error, please notify us

immediately

by

calling

-- and destroy the related message. Thank you

for

your

cooperation.

Yahoo!

Groups Links

------------------------

[Guest guest]

Additionally, those of you that have had

success with your intermediaries may want to share the contact name and the

name of the individual that signed the Local Medical Determination. This

will help the others because they can reference specific contacts at other

intermediaries in their request to their intermediary. Just a thought.

Thanks,

Bill

From:

TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of Vaughan

Sent: Tuesday, November 29, 2005

3:08 PM

To:

TxFinancialCoordinators

Subject: RE:

ivig

HI Debbie

You did wonderfully, bottom line, it is up to the local Intermediary

first and then the Regional Office. Most of the time, the local

Intermediary may well be the easiest approach.

Thanks,

Bill

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of Meneely, Debra Kay

Sent: Tuesday, November 29, 2005

3:00 PM

To:

TxFinancialCoordinators ; .@...

Subject: RE:

ivig

Here's

the scoop from my research in doing an approximate 200 page appeal on

IVIG and Plasmapheresis for desensitization of kidney recipient when an

insurance company denied it

Mr.

Vaughn - let us know if I missed anything.

Step 1

National Coverage Decision (NCD)- there is not one - it is left to " local

medical review policy "

Each Medicare Region is NOT required to establish a policy unless the

intermediary determines a policy is necessary to provide guidance to their

specific geographic area of coverage

If

insurance appeal/request - You will need to provide this info to the insurance

company and can be printed from:

http://www.cms.hhs.gov/providers/mr/lmrp.asp

http://www.cms.hhs.gov/glossary/search

- print out definition of " National Coverage Determinations " AND

" Local Medical Review Policy " AND " " Local Coverage

Determination "

Step 2

http://www.cms.hhs.gov/mcd/index_chapter_list.asp

- print Chapter 230 and 260 (so the subchapters can be seen - i.e. " expand

the chapter) these support that there is no NCD

for IVIG or Plasmapheresis but you need to make a note on the page that this is

what the page is for and also include statement that this supports that these

treatments are NOT listed as an exclusion either

Step 3

The following is for regional info:

(print and send all of them if you

have to prove this is nationally accepted standard of care or establish the

other intermediaries who cover these)

http://www.hhs.gov/mcd/viewarticle.asp?article_id=16030

- this is an example of how article id# will be on bottom of printed page

Also keep

in mind that some of the intermediaries wrote a separate policy for each

state/area in their geographic coverage area so not all the policies I listed

for the Medicare Region will apply to everyone in that region.

Here's

the list of documents

Region I

Region VI

L445, L508,L658

L17363, L13424, L18676, L13471

Region II - no policies found

Region VII

L2371

Region III

Region VIII - no

policies found

L819

Region IV

Region IX

L1073

American Samoa,

Guam & Commonwealth

of N. na Islands

Region V

Region X - no

policies found

L13297, L1725

Also -

per CMS - intermediaries are not required to do local policy if they feel

is not necessary but they can't exclude a service unless they have a policy. If

listed as an exclusion then have to follow their appeal process.

Step 4

Literature research and support - your transplant surgeons have to help with

this because they are the experts - you can do medical peer review

literature search and then have surgeons tell you which ones are best

articles to use (medical librarians can do the search for you also)

Look for

authors like A Montgomery from Hopkins - wrote the first protocol

Step 5

You need the exact protocol you are using at your facility and letters from

your transplant surgeons giving reasons why these treatments need to be

covered.

That's

all the info I could pull together quickly. Hope it helps

Debbie

Meneely RN, CPN

Transplant

Financial Coordinator

Kidney,

Pancreas & Pediatrics

Clarian

Transplant Center

Indianapolis,

IN 46202

ph:

fax:

dmeneely@...

-----Original

Message-----

From:

TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf

Of Craycraft

Sent:

Tuesday, November 29, 2005 1:20 PM

To:

.@...; TxFinancialCoordinators

Subject:

RE: ivig

Hi

,

we are

working on this in our facility/region. Medical Director with

our

fiscal intermediary for Medicare wants to know what other regions

have

approved coverage. Can you tell me what region you are in and if

possible,

the Medical Director for Medicare who approved the therapy.

Appreciate

your help so much! Thanks.

Craycraft

Transplant

Financial Coordinator

University

of Kansas Medical Center

Fax

lcraycraft@...

>>>

.@... 01/10/05 2:51 PM >>>

Hi

:

Cedars

is approved locally for IVIG. Please call me tomorrow and I

will

help

you. .

M.

Sr

Financial Managment Analyst

Supervisor,

Transplant Financial Coordinators

Cedars-Sinai Medical Center

Comprehensive Transplant Center

(310)

423-3170-Office (310)423-1694-FAX

-----Original

Message-----

From:

Donovan

Sent:

Monday, January 10, 2005 8:37 AM

To:

TxFinancialCoordinators

Subject:

ivig

Hi-

We are

working on getting our local Medicare intermediary to approve

IVIG

therapy

for sensitized patients who need a kidney transplant.

Has

anyone else worked on this recently?

I

am trying to find others who have gotten this approved. If we submit

information

that other centers are doing this/have policies in place,

it

will

help us to get our center approved.

Anyone

willing to help me? I would really appreciate any help

available.

Donovan

Transplant

Financial Coordinator

SUNY Upstate Medical

University

750 East Street

Syracuse, New York

13210

Phone:

315 464-6290

Fax:

315 464-6288

Donovanl@...

The

information contained in this email is confidential intended only

for

the

use of the party to whom it is addressed. If you are not the

intended

recipient,

please be aware that you are strictly prohibited from

sharing,

distributing,

or copying this email. If you have received this email

by

mistake,

please notify the sender. Thank you.

Yahoo!

Groups Links

Important

Warning: This message is intended for the use of the person

or

entity

to which it is addressed and may contain information that is

privileged

and confidential, the disclosure of which is governed by

applicable

law. If the reader of this message is not the intended

recipient,

or the employee or agent responsible for delivering it to

the

intended

recipient, you are hereby notified that any dissemination,

distribution

or copying of this information is STRICTLY PROHIBITED.

If

you have received this message in error, please notify us

immediately

by

calling

-- and destroy the related message. Thank you

for

your

cooperation.

Yahoo!

Groups Links

------------------------