Guest guest Posted May 1, 2006 Report Share Posted May 1, 2006 I've never had this situation but would think a new COB goes with a new entitlement, and since dialysis came while she was still in the entitlement period, no new entitlement = no new COB. 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 Felecia Sent: Monday, May 01, 2006 6:42 AMTo: TxFinancialCoordinators Subject: Medicare COB Issue Good morning all, I need some clarification on Medicare coverage.....I have a patient that received a kidney transplant 9/9/02 and returned to dialysis 9/13/05. The dialysis social worker states her COB starts over because her transplant was successful for 3 yrs and a 1 day, however I was under the impression the patient would have to complete the entire month in order for her to get a new COB. Any feed back would be appreciated. Felecia Transplant Financial CoordinatorSaint 's Health Care-Transplant ProgramGrand Rapids, MI 49503PH Fax# 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2006 Report Share Posted May 1, 2006 I always thought entitlement was 36 months from discharge, so would need discharge date. If after 13th, which is probably was then is still in original entitlement period. susan From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH TrnsplntSent: Monday, May 01, 2006 12:44 PMTo: TxFinancialCoordinators Subject: RE: Medicare COB Issue I've never had this situation but would think a new COB goes with a new entitlement, and since dialysis came while she was still in the entitlement period, no new entitlement = no new COB. 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 Felecia Sent: Monday, May 01, 2006 6:42 AMTo: TxFinancialCoordinators Subject: Medicare COB Issue Good morning all, I need some clarification on Medicare coverage.....I have a patient that received a kidney transplant 9/9/02 and returned to dialysis 9/13/05. The dialysis social worker states her COB starts over because her transplant was successful for 3 yrs and a 1 day, however I was under the impression the patient would have to complete the entire month in order for her to get a new COB. Any feed back would be appreciated. Felecia Transplant Financial CoordinatorSaint 's Health Care-Transplant ProgramGrand Rapids, MI 49503PH Fax# 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2006 Report Share Posted May 1, 2006 I believe the regs state that the 36-month period ends 36 months from the month of the transplant discharge. It does not go from the actual date of the discharge. Fred L. Forsthoffer, MBA Financial Analyst Banner Good Samaritan Transplant Services , , F- From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of , Stoops Sent: Monday, May 01, 2006 9:51 AM To: TxFinancialCoordinators Subject: RE: Medicare COB Issue I always thought entitlement was 36 months from discharge, so would need discharge date. If after 13th, which is probably was then is still in original entitlement period. susan From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH Trnsplnt Sent: Monday, May 01, 2006 12:44 PM To: TxFinancialCoordinators Subject: RE: Medicare COB Issue I've never had this situation but would think a new COB goes with a new entitlement, and since dialysis came while she was still in the entitlement period, no new entitlement = no new COB. on Financial Counselor Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 toll free fax lmorriso@... " 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 Felecia Sent: Monday, May 01, 2006 6:42 AM To: TxFinancialCoordinators Subject: Medicare COB Issue Good morning all, I need some clarification on Medicare coverage.....I have a patient that received a kidney transplant 9/9/02 and returned to dialysis 9/13/05. The dialysis social worker states her COB starts over because her transplant was successful for 3 yrs and a 1 day, however I was under the impression the patient would have to complete the entire month in order for her to get a new COB. Any feed back would be appreciated. Felecia Transplant Financial Coordinator Saint 's Health Care-Transplant Program Grand Rapids, MI 49503 PH Fax# 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2006 Report Share Posted May 1, 2006 The regs state” The last day of the 36th month after the month the person receives a kidney transplant.” So if the patient receives a kidney transplant 09/02, the 36 months start 10/02 and end 09/30/05. The patient should be Medicare primary since patient is Medicare primary at the time patient reinitiated dialysis. Austria Specialty Contracting Methodist Health System 1441 North Beckley Avenue Dallas,Texas 75203 Phone: Fax: From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] Sent: Monday, May 01, 2006 12:24 PM To: TxFinancialCoordinators Subject: RE: Medicare COB Issue I believe the regs state that the 36-month period ends 36 months from the month of the transplant discharge. It does not go from the actual date of the discharge. Fred L. Forsthoffer, MBA Financial Analyst Banner Good Samaritan Transplant Services , , F- From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of , Stoops Sent: Monday, May 01, 2006 9:51 AM To: TxFinancialCoordinators Subject: RE: Medicare COB Issue I always thought entitlement was 36 months from discharge, so would need discharge date. If after 13th, which is probably was then is still in original entitlement period. susan From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH Trnsplnt Sent: Monday, May 01, 2006 12:44 PM To: TxFinancialCoordinators Subject: RE: Medicare COB Issue I've never had this situation but would think a new COB goes with a new entitlement, and since dialysis came while she was still in the entitlement period, no new entitlement = no new COB. on Financial Counselor Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 toll free fax lmorriso@... " 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 Medicare COB Issue Good morning all, I need some clarification on Medicare coverage.....I have a patient that received a kidney transplant 9/9/02 and returned to dialysis 9/13/05. The dialysis social worker states her COB starts over because her transplant was successful for 3 yrs and a 1 day, however I was under the impression the patient would have to complete the entire month in order for her to get a new COB. Any feed back would be appreciated. Felecia Transplant Financial Coordinator Saint 's Health Care-Transplant Program Grand Rapids, MI 49503 PH Fax# 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. *********************************************************************** This electronic transmission contains information from Methodist Health System and should be considered confidential and privileged. The information contained in the above messages is intended only for the use of the individual(s) and entity(ies) named above. If you are not the intended recipient, be aware that any disclosure, copying, distribution, or use of this information is prohibited. If you receive this transmission in error, please notify the sender immediately by return e-mail. Methodist Health System, its subsidiaries and affiliates hereby claim all applicable privileges related to the transmission of this communication. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2006 Report Share Posted May 1, 2006 Do you know where I can find those regs.>>> Austria@... 05/01/2006 1:57 PM >>> The regs state” The last day of the 36th month after the month the person receives a kidney transplant.” So if the patient receives a kidney transplant 09/02, the 36 months start 10/02 and end 09/30/05. The patient should be Medicare primary since patient is Medicare primary at the time patient reinitiated dialysis. Austria Specialty Contracting Methodist Health System 1441 North Beckley Avenue Dallas,Texas 75203 Phone: Fax: From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] Sent: Monday, May 01, 2006 12:24 PMTo: TxFinancialCoordinators Subject: RE: Medicare COB Issue I believe the regs state that the 36-month period ends 36 months from the month of the transplant discharge. It does not go from the actual date of the discharge. Fred L. Forsthoffer, MBA Financial Analyst Banner Good Samaritan Transplant Services , , F- From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of , StoopsSent: Monday, May 01, 2006 9:51 AMTo: TxFinancialCoordinators Subject: RE: Medicare COB Issue I always thought entitlement was 36 months from discharge, so would need discharge date. If after 13th, which is probably was then is still in original entitlement period. susan From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH TrnsplntSent: Monday, May 01, 2006 12:44 PMTo: TxFinancialCoordinators Subject: RE: Medicare COB Issue I've never had this situation but would think a new COB goes with a new entitlement, and since dialysis came while she was still in the entitlement period, no new entitlement = no new COB. on Financial Counselor Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 toll free fax lmorriso@... "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 Felecia Sent: Monday, May 01, 2006 6:42 AMTo: TxFinancialCoordinators Subject: Medicare COB Issue Good morning all, I need some clarification on Medicare coverage.....I have a patient that received a kidney transplant 9/9/02 and returned to dialysis 9/13/05. The dialysis social worker states her COB starts over because her transplant was successful for 3 yrs and a 1 day, however I was under the impression the patient would have to complete the entire month in order for her to get a new COB. Any feed back would be appreciated. Felecia Transplant Financial CoordinatorSaint 's Health Care-Transplant ProgramGrand Rapids, MI 49503PH Fax# 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. ***********************************************************************This electronic transmission contains information from Methodist Health System and should be considered confidential and privileged. The information contained in the above messages is intended only for the use of the individual(s) and entity(ies) named above. If you are not the intended recipient, be aware that any disclosure, copying, distribution, or use of this information is prohibited. If you receive this transmission in error, please notify the sender immediately by return e-mail. Methodist Health System, its subsidiaries and affiliates hereby claim all applicable privileges related to the transmission of this communication. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2006 Report Share Posted May 1, 2006 I have never seen any language like that either. Where is that exact wording?? Fred L. Forsthoffer, MBA Financial Analyst Banner Good Samaritan Transplant Services , , F- From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Felecia Sent: Monday, May 01, 2006 10:59 AM To: TxFinancialCoordinators Subject: RE: Medicare COB Issue Do you know where I can find those regs. >>> Austria@... 05/01/2006 1:57 PM >>> The regs state” The last day of the 36th month after the month the person receives a kidney transplant.” So if the patient receives a kidney transplant 09/02, the 36 months start 10/02 and end 09/30/05. The patient should be Medicare primary since patient is Medicare primary at the time patient reinitiated dialysis. Austria Specialty Contracting Methodist Health System 1441 North Beckley Avenue Dallas,Texas 75203 Phone: Fax: From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] Sent: Monday, May 01, 2006 12:24 PM To: TxFinancialCoordinators Subject: RE: Medicare COB Issue I believe the regs state that the 36-month period ends 36 months from the month of the transplant discharge. It does not go from the actual date of the discharge. Fred L. Forsthoffer, MBA Financial Analyst Banner Good Samaritan Transplant Services , , F- From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of , Stoops Sent: Monday, May 01, 2006 9:51 AM To: TxFinancialCoordinators Subject: RE: Medicare COB Issue I always thought entitlement was 36 months from discharge, so would need discharge date. If after 13th, which is probably was then is still in original entitlement period. susan From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH Trnsplnt Sent: Monday, May 01, 2006 12:44 PM To: TxFinancialCoordinators Subject: RE: Medicare COB Issue I've never had this situation but would think a new COB goes with a new entitlement, and since dialysis came while she was still in the entitlement period, no new entitlement = no new COB. on Financial Counselor Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 toll free fax lmorriso@... " 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 Felecia Sent: Monday, May 01, 2006 6:42 AM To: TxFinancialCoordinators Subject: Medicare COB Issue Good morning all, I need some clarification on Medicare coverage.....I have a patient that received a kidney transplant 9/9/02 and returned to dialysis 9/13/05. The dialysis social worker states her COB starts over because her transplant was successful for 3 yrs and a 1 day, however I was under the impression the patient would have to complete the entire month in order for her to get a new COB. Any feed back would be appreciated. Felecia Transplant Financial Coordinator Saint 's Health Care-Transplant Program Grand Rapids, MI 49503 PH Fax# 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. *********************************************************************** This electronic transmission contains information from Methodist Health System and should be considered confidential and privileged. The information contained in the above messages is intended only for the use of the individual(s) and entity(ies) named above. If you are not the intended recipient, be aware that any disclosure, copying, distribution, or use of this information is prohibited. If you receive this transmission in error, please notify the sender immediately by return e-mail. Methodist Health System, its subsidiaries and affiliates hereby claim all applicable privileges related to the transmission of this communication. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2006 Report Share Posted May 1, 2006 I got it from the Medicare Manual under Medicare General Information, eligibility and entitlement. End of Coverage Based on ESRD. http://www.cms.hhs.gov/manuals/ Austria Specialty Contracting Methodist Health System 1441 North Beckley Avenue Dallas,Texas 75203 Phone: Fax: From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] Sent: Monday, May 01, 2006 12:59 PM To: TxFinancialCoordinators Subject: RE: Medicare COB Issue Do you know where I can find those regs. >>> Austria@... 05/01/2006 1:57 PM >>> The regs state” The last day of the 36th month after the month the person receives a kidney transplant.” So if the patient receives a kidney transplant 09/02, the 36 months start 10/02 and end 09/30/05. The patient should be Medicare primary since patient is Medicare primary at the time patient reinitiated dialysis. Austria Specialty Contracting Methodist Health System 1441 North Beckley Avenue Dallas,Texas 75203 Phone: Fax: From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] Sent: Monday, May 01, 2006 12:24 PM To: TxFinancialCoordinators Subject: RE: Medicare COB Issue I believe the regs state that the 36-month period ends 36 months from the month of the transplant discharge. It does not go from the actual date of the discharge. Fred L. Forsthoffer, MBA Financial Analyst Banner Good Samaritan Transplant Services , , F- From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of , Stoops Sent: Monday, May 01, 2006 9:51 AM To: TxFinancialCoordinators Subject: RE: Medicare COB Issue I always thought entitlement was 36 months from discharge, so would need discharge date. If after 13th, which is probably was then is still in original entitlement period. susan From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH Trnsplnt Sent: Monday, May 01, 2006 12:44 PM To: TxFinancialCoordinators Subject: RE: Medicare COB Issue I've never had this situation but would think a new COB goes with a new entitlement, and since dialysis came while she was still in the entitlement period, no new entitlement = no new COB. on Financial Counselor Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 toll free fax lmorriso@... " 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 Felecia Sent: Monday, May 01, 2006 6:42 AM To: TxFinancialCoordinators Subject: Medicare COB Issue Good morning all, I need some clarification on Medicare coverage.....I have a patient that received a kidney transplant 9/9/02 and returned to dialysis 9/13/05. The dialysis social worker states her COB starts over because her transplant was successful for 3 yrs and a 1 day, however I was under the impression the patient would have to complete the entire month in order for her to get a new COB. Any feed back would be appreciated. Felecia Transplant Financial Coordinator Saint 's Health Care-Transplant Program Grand Rapids, MI 49503 PH Fax# 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. *********************************************************************** This electronic transmission contains information from Methodist Health System and should be considered confidential and privileged. The information contained in the above messages is intended only for the use of the individual(s) and entity(ies) named above. If you are not the intended recipient, be aware that any disclosure, copying, distribution, or use of this information is prohibited. If you receive this transmission in error, please notify the sender immediately by return e-mail. Methodist Health System, its subsidiaries and affiliates hereby claim all applicable privileges related to the transmission of this communication. *********************************************************************** This electronic transmission contains information from Methodist Health System and should be considered confidential and privileged. The information contained in the above messages is intended only for the use of the individual(s) and entity(ies) named above. If you are not the intended recipient, be aware that any disclosure, copying, distribution, or use of this information is prohibited. If you receive this transmission in error, please notify the sender immediately by return e-mail. Methodist Health System, its subsidiaries and affiliates hereby claim all applicable privileges related to the transmission of this communication. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2006 Report Share Posted May 1, 2006 Fred, that is the exact wording from the Medicare Manual. End of Coverage Based on ESRD. Austria Specialty Contracting Methodist Health System 1441 North Beckley Avenue Dallas,Texas 75203 Phone: Fax: From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] Sent: Monday, May 01, 2006 1:08 PM To: TxFinancialCoordinators Subject: RE: Medicare COB Issue I have never seen any language like that either. Where is that exact wording?? Fred L. Forsthoffer, MBA Financial Analyst Banner Good Samaritan Transplant Services , , F- From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Felecia Sent: Monday, May 01, 2006 10:59 AM To: TxFinancialCoordinators Subject: RE: Medicare COB Issue Do you know where I can find those regs. >>> Austria@... 05/01/2006 1:57 PM >>> The regs state” The last day of the 36th month after the month the person receives a kidney transplant.” So if the patient receives a kidney transplant 09/02, the 36 months start 10/02 and end 09/30/05. The patient should be Medicare primary since patient is Medicare primary at the time patient reinitiated dialysis. Austria Specialty Contracting Methodist Health System 1441 North Beckley Avenue Dallas,Texas 75203 Phone: Fax: From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] Sent: Monday, May 01, 2006 12:24 PM To: TxFinancialCoordinators Subject: RE: Medicare COB Issue I believe the regs state that the 36-month period ends 36 months from the month of the transplant discharge. It does not go from the actual date of the discharge. Fred L. Forsthoffer, MBA Financial Analyst Banner Good Samaritan Transplant Services , , F- From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of , Stoops Sent: Monday, May 01, 2006 9:51 AM To: TxFinancialCoordinators Subject: RE: Medicare COB Issue I always thought entitlement was 36 months from discharge, so would need discharge date. If after 13th, which is probably was then is still in original entitlement period. susan From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH Trnsplnt Sent: Monday, May 01, 2006 12:44 PM To: TxFinancialCoordinators Subject: RE: Medicare COB Issue I've never had this situation but would think a new COB goes with a new entitlement, and since dialysis came while she was still in the entitlement period, no new entitlement = no new COB. on Financial Counselor Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 toll free fax lmorriso@... " 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 Felecia Sent: Monday, May 01, 2006 6:42 AM To: TxFinancialCoordinators Subject: Medicare COB Issue Good morning all, I need some clarification on Medicare coverage.....I have a patient that received a kidney transplant 9/9/02 and returned to dialysis 9/13/05. The dialysis social worker states her COB starts over because her transplant was successful for 3 yrs and a 1 day, however I was under the impression the patient would have to complete the entire month in order for her to get a new COB. Any feed back would be appreciated. Felecia Transplant Financial Coordinator Saint 's Health Care-Transplant Program Grand Rapids, MI 49503 PH Fax# 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. *********************************************************************** This electronic transmission contains information from Methodist Health System and should be considered confidential and privileged. The information contained in the above messages is intended only for the use of the individual(s) and entity(ies) named above. If you are not the intended recipient, be aware that any disclosure, copying, distribution, or use of this information is prohibited. If you receive this transmission in error, please notify the sender immediately by return e-mail. Methodist Health System, its subsidiaries and affiliates hereby claim all applicable privileges related to the transmission of this communication. *********************************************************************** This electronic transmission contains information from Methodist Health System and should be considered confidential and privileged. The information contained in the above messages is intended only for the use of the individual(s) and entity(ies) named above. If you are not the intended recipient, be aware that any disclosure, copying, distribution, or use of this information is prohibited. If you receive this transmission in error, please notify the sender immediately by return e-mail. Methodist Health System, its subsidiaries and affiliates hereby claim all applicable privileges related to the transmission of this communication. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2006 Report Share Posted May 1, 2006 Here is Section 226A to which I was referring: ( My bolding ) SPECIAL PROVISIONS RELATING TO COVERAGE UNDER MEDICARE PROGRAM FOR END STAGE RENAL DISEASE SEC. 226A. [42 U.S.C. 426-1] (a) Notwithstanding any provision to the contrary in section 226 or title XVIII, every individual who— (1)(A) is fully or currently insured (as such terms are defined in section 214), or would be fully or currently insured if (i) his service as an employee (as defined in the Railroad Retirement Act of 1974[225]) after December 31, 1936, were included within the meaning of the term “employment” for purposes of this title, and (ii) his Medicare qualified government employment (as defined in section 210(p)) were included within the meaning of the term “employment” for purposes of this title; ((i) is entitled to monthly insurance benefits under this title, (ii) is entitled to an annuity under the Railroad Retirement Act of 1974, or (iii) would be entitled to a monthly insurance benefit under this title if Medicare qualified government employment (as defined in section 210(p)) were included within the meaning of the term “employment” for purposes of this title; or © is the spouse or dependent child (as defined in regulations) of an individual described in subparagraph (A) or (; (2) is medically determined to have end stage renal disease; and (3) has filed an application for benefits under this section; shall, in accordance with the succeeding provisions of this section, be entitled to benefits under part A and eligible to enroll under part B of title XVIII, subject to the deductible, premium, and coinsurance provisions of that title. ( Subject to subsection ©, entitlement of an individual to benefits under part A and eligibility to enroll under part B of title XVIII by reasons of this section on the basis of end stage renal disease— (1) shall begin with— (A) the third month after the month in which a regular course of renal dialysis is initiated, or ( the month in which such individual receives a kidney transplant, or (if earlier) the first month in which such individual is admitted as an inpatient to an institution which is a hospital meeting the requirements of section 1861(e) (and such additional requirements as the Secretary may prescribe under section 1881( for such institutions) in preparation for or anticipation of kidney transplantation, but only if such transplantation occurs in that month or in either of the next two months, whichever first occurs (but no earlier than one year preceding the month of the filing of an application for benefits under this section); and (2) shall end, in the case of an individual who receives a kidney transplant, with the thirty-sixth month after the month in which such individual receives such transplant or, in the case of an individual who has not received a kidney transplant and no longer requires a regular course of dialysis, with the twelfth month after the month in which such course of dialysis is terminated. © Notwithstanding the provisions of subsection (— (1) in the case of any individual who participates in a self-care dialysis training program prior to the third month after the month in which such individual initiates a regular course of renal dialysis in a renal dialysis facility or provider of services meeting the requirements of section 1881(, entitlement to benefits under part A and eligibility to enroll under part B of title XVIII shall begin with the month in which such regular course of renal dialysis is initiated; (2) in any case in which a kidney transplant fails (whether during or after the thirty-six-month period specified in subsection ((2)) and as a result the individual who received such transplant initiates or resumes a regular course of renal dialysis, entitlement to benefits under part A and eligibility to enroll under part B of title XVIII shall begin with the month in which such course is initiated or resumed; and (3) in any case in which a regular course of renal dialysis is resumed subsequent to the termination of an earlier course, entitlement to benefits under part A and eligibility to enroll under part B of title XVIII shall begin with the month in which such regular course of renal dialysis is resumed. ©[226] For purposes of this section, each person whose monthly insurance benefit for any month is terminated or is otherwise not payable solely by reason of paragraph (1) or (7) of section 225© shall be treated as entitled to such benefit for such month. [225] P.L. 75-162 [as amended by P.L. 93-445]. [226] As in original. P.L. 103-296, §201(a)(3)(D)(ii), added a second subsection ©. Fred L. Forsthoffer, MBA Financial Analyst Banner Good Samaritan Transplant Services , , F- From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Austria, Sent: Monday, May 01, 2006 11:24 AM To: TxFinancialCoordinators Subject: RE: Medicare COB Issue Fred, that is the exact wording from the Medicare Manual. End of Coverage Based on ESRD. Austria Specialty Contracting Methodist Health System 1441 North Beckley Avenue Dallas,Texas 75203 Phone: Fax: From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] Sent: Monday, May 01, 2006 1:08 PM To: TxFinancialCoordinators Subject: RE: Medicare COB Issue I have never seen any language like that either. Where is that exact wording?? Fred L. Forsthoffer, MBA Financial Analyst Banner Good Samaritan Transplant Services , , F- From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Felecia Sent: Monday, May 01, 2006 10:59 AM To: TxFinancialCoordinators Subject: RE: Medicare COB Issue Do you know where I can find those regs. >>> Austria@... 05/01/2006 1:57 PM >>> The regs state” The last day of the 36th month after the month the person receives a kidney transplant.” So if the patient receives a kidney transplant 09/02, the 36 months start 10/02 and end 09/30/05. The patient should be Medicare primary since patient is Medicare primary at the time patient reinitiated dialysis. Austria Specialty Contracting Methodist Health System 1441 North Beckley Avenue Dallas,Texas 75203 Phone: Fax: From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] Sent: Monday, May 01, 2006 12:24 PM To: TxFinancialCoordinators Subject: RE: Medicare COB Issue I believe the regs state that the 36-month period ends 36 months from the month of the transplant discharge. It does not go from the actual date of the discharge. Fred L. Forsthoffer, MBA Financial Analyst Banner Good Samaritan Transplant Services , , F- From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of , Stoops Sent: Monday, May 01, 2006 9:51 AM To: TxFinancialCoordinators Subject: RE: Medicare COB Issue I always thought entitlement was 36 months from discharge, so would need discharge date. If after 13th, which is probably was then is still in original entitlement period. susan From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH Trnsplnt Sent: Monday, May 01, 2006 12:44 PM To: TxFinancialCoordinators Subject: RE: Medicare COB Issue I've never had this situation but would think a new COB goes with a new entitlement, and since dialysis came while she was still in the entitlement period, no new entitlement = no new COB. on Financial Counselor Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 toll free fax lmorriso@... " 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 Felecia Sent: Monday, May 01, 2006 6:42 AM To: TxFinancialCoordinators Subject: Medicare COB Issue Good morning all, I need some clarification on Medicare coverage.....I have a patient that received a kidney transplant 9/9/02 and returned to dialysis 9/13/05. The dialysis social worker states her COB starts over because her transplant was successful for 3 yrs and a 1 day, however I was under the impression the patient would have to complete the entire month in order for her to get a new COB. Any feed back would be appreciated. Felecia Transplant Financial Coordinator Saint 's Health Care-Transplant Program Grand Rapids, MI 49503 PH Fax# 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. 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