RE: No Medicare Allowable /Reimbursement

[Guest guest]

Mrs. Gay,

Thank you for you help.

Re:

No Medicare Allowable /Reimbursement

We have just emplimented

a new protocal, we send a letter with all

medical records when the patient is scheduled advising that we reimburse

at medicare reimbursible. (a sample was found in the 2006 TFCA handbook

for LRD)

We previously reimbursed at 100% billed charges when we had no contract

or agreement with the provider.

Amellia Gay

ETMC Transplant

Tyler Texas

God grant me the serentity to accept the people I cannot change,

the courage to change the ONE I can change,

and the wisdom to know that it's ME.

>>> glorjsumma-health (DOT) org

12/20/06 3:25 PM >>>

Hello to all,

Our center uses a Kidney Acquisition fund to reimburse payment (in

full)

for Pre-Kidney Transplant testing. We reimburse at 100% MC fee

scheduled rate.

I have an issue with a vender concerning a pap visit that we ordered.

We were initially billed with the consult code only which there is no

MC

allowable for as it is preventative. After conversation with the

vender, they will re-bill us with the allowable G and Q codes along

with

the initial consult code.

She explained that with true Medicare patients, the patients are held

responsible for the consult portion of the bill.

I explained that per Medicare kidney transplant evaluation regulations

the patient should not be balance billed.

She stated that they will hold patient financially responsible for the

balance, as they do not have a contract with our office.

So, to avoid $ responsibility on the patient, I stated that we will

investigate a proper payment for her service.

Q: Is there any way to figure out an appropriate payment per Medicare

guidelines even though it is " not allowable " .

I remember a possible reimbursement of 60%, but am unsure where this

percentage came from.

Thank you in advance for your advise.

Glor

Renal Services Financial Counselor

Summa Health System

Office #

Fax #

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