Guest guest Posted May 10, 2006 Report Share Posted May 10, 2006 Hi Felicia, I have had this happen twice this year so far. Bottom line I wind up paying the charges in full. However, I send a letter explaining Medicare regulations, and I tell them that as a Medicare provider themself I am sure they can understand we cannot afford to pay full charges and be reimbursed at Medicare rates and that we will never refer patients to their facility again ! On one occassion this opened a renogiation to 80% of charges, and the other time it resulted in them holding up an agreement form for 2 months before they signed it. When this happens I tell the nurse who coordinates the living donor testing we will not use this facility or physician, and she makes note of it. Kreci Transplant Financial Coordinator Southwest Florida Regional Medical Center 2727 Winkler Ave Fort Myers, FL 33910 This email may contain CONFIDENTIAL PATIENT INFORMATION, which may also be legally PRIVILEGED, and which is intended to be read and or used only by the individual entity named above. If the reader of this e-mail is NOT the intended recipient, you are hereby notified that you are in possession of confidential and privileged information. Any disclosure, dissemination, distribution, copying or the taking of any action in reliance of the contents of this information is strictly prohibited. If you have received this e-mail in error, please immediately notify the sender by telephone, and return the original. Redisclosure of this information is prohibited without the written authorization of the patient to whom it pertains. -----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of Felecia Sent: Wednesday, May 10, 2006 2:21 PMTo: TxFinancialCoordinators Subject: Re: donor charges Good afternoon all, I was wondering if someone has advice on how to handle a facility that refuses to accept Medicare reimbursement rate for donor charges. Prior to donor receiving services an order was sent w/message of KACC Medicare reimbursement guidelines. This facility states donor will be billed if charges are not paid in full. Felecia Transplant Financial CoordinatorSaint 's Health Care-Transplant ProgramGrand Rapids, MI 49503PH Fax# Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 10, 2006 Report Share Posted May 10, 2006 Hello Felecia, I call the facility before setting up the donor eval and talk to somebody who is in charge of billing. If they give me the okay, we send our potential donor to their facility. If they have a problem with medicare rate reimbursement, I make a notation and won’t attempt to use this facility again. Sonja Kohlgraf University of Iowa Hospitals & Clincs, Transplant Center Ph: From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Felecia Sent: Wednesday, May 10, 2006 1:21 PM To: TxFinancialCoordinators Subject: Re: donor charges Good afternoon all, I was wondering if someone has advice on how to handle a facility that refuses to accept Medicare reimbursement rate for donor charges. Prior to donor receiving services an order was sent w/message of KACC Medicare reimbursement guidelines. This facility states donor will be billed if charges are not paid in full. Felecia Transplant Financial Coordinator Saint 's Health Care-Transplant Program Grand Rapids, MI 49503 PH Fax# Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 10, 2006 Report Share Posted May 10, 2006 I believe that a facility that accepts Medicare assignment is "required" to follow the guidelines, & the guidelines are that reimbursement is in the form of the Medicare Fee Schedule, just as if Medicare had made the payment directly. And since transplant evaluations fall under Medicare guidelines, any Medicare provider must abide by them & they cannot bill anyone for the balance. Otherwise, they would be noncompliant. Bill, is that correct? 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 Kohlgraf, SonjaSent: Wednesday, May 10, 2006 1:46 PMTo: TxFinancialCoordinators Subject: RE: Re: donor charges Hello Felecia, I call the facility before setting up the donor eval and talk to somebody who is in charge of billing. If they give me the okay, we send our potential donor to their facility. If they have a problem with medicare rate reimbursement, I make a notation and won’t attempt to use this facility again. Sonja Kohlgraf University of Iowa Hospitals & Clincs, Transplant Center Ph: From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Felecia Sent: Wednesday, May 10, 2006 1:21 PMTo: TxFinancialCoordinators Subject: Re: donor charges Good afternoon all, I was wondering if someone has advice on how to handle a facility that refuses to accept Medicare reimbursement rate for donor charges. Prior to donor receiving services an order was sent w/message of KACC Medicare reimbursement guidelines. This facility states donor will be billed if charges are not paid in full. Felecia Transplant Financial CoordinatorSaint 's Health Care-Transplant ProgramGrand Rapids, MI 49503PH Fax# Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 11, 2006 Report Share Posted May 11, 2006 Hi n, What you have said is very true, but if the patient is not currently a Medicare Beneficiary many hospitals don’t think that the ESRD portion of the regulations apply to them and I am aware of no way to enforce them. I would rather see a list of providers, including transplant centers, that will not honor the request of other centers and accept payment at Medicare circulated so that other centers can avoid sending patients to those centers and putting the patient and the refereeing transplant center at risk. Hope this helps, Thanks, Bill From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Melton, n Sent: Wednesday, May 10, 2006 3:08 PM To: TxFinancialCoordinators Subject: RE: Re: donor charges I believe that a facility that accepts Medicare assignment is " required " to follow the guidelines, & the guidelines are that reimbursement is in the form of the Medicare Fee Schedule, just as if Medicare had made the payment directly. And since transplant evaluations fall under Medicare guidelines, any Medicare provider must abide by them & they cannot bill anyone for the balance. Otherwise, they would be noncompliant. Bill, is that correct? 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 Kohlgraf, Sonja Sent: Wednesday, May 10, 2006 1:46 PM To: TxFinancialCoordinators Subject: RE: Re: donor charges Hello Felecia, I call the facility before setting up the donor eval and talk to somebody who is in charge of billing. If they give me the okay, we send our potential donor to their facility. If they have a problem with medicare rate reimbursement, I make a notation and won’t attempt to use this facility again. Sonja Kohlgraf University of Iowa Hospitals & Clincs, Transplant Center Ph: From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Felecia Sent: Wednesday, May 10, 2006 1:21 PM To: TxFinancialCoordinators Subject: Re: donor charges Good afternoon all, I was wondering if someone has advice on how to handle a facility that refuses to accept Medicare reimbursement rate for donor charges. Prior to donor receiving services an order was sent w/message of KACC Medicare reimbursement guidelines. This facility states donor will be billed if charges are not paid in full. Felecia Transplant Financial Coordinator Saint 's Health Care-Transplant Program Grand Rapids, MI 49503 PH Fax# Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 11, 2006 Report Share Posted May 11, 2006 Bill I think this is a great idea since most donors are out of the immediate area of the transplant center. I know here, almost all my donors are in other states or different parts of Florida. We would prefer they come here but we don't require it until a week before transplant. By having a list that we have all entered our "negative" centers, would help us tremendously when we refer for donor testing. , do you think on the website or the yahoo group site we would be able to start a list and as we encounter these problems we could enter the information? Kreci Transplant Financial Coordinator Southwest Florida Regional Medical Center 2727 Winkler Ave Fort Myers, FL 33910 This email may contain CONFIDENTIAL PATIENT INFORMATION, which may also be legally PRIVILEGED, and which is intended to be read and or used only by the individual entity named above. If the reader of this e-mail is NOT the intended recipient, you are hereby notified that you are in possession of confidential and privileged information. Any disclosure, dissemination, distribution, copying or the taking of any action in reliance of the contents of this information is strictly prohibited. If you have received this e-mail in error, please immediately notify the sender by telephone, and return the original. Redisclosure of this information is prohibited without the written authorization of the patient to whom it pertains. -----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of VaughanSent: Wednesday, May 10, 2006 11:00 PMTo: TxFinancialCoordinators Subject: RE: Re: donor charges Hi n, What you have said is very true, but if the patient is not currently a Medicare Beneficiary many hospitals don’t think that the ESRD portion of the regulations apply to them and I am aware of no way to enforce them. I would rather see a list of providers, including transplant centers, that will not honor the request of other centers and accept payment at Medicare circulated so that other centers can avoid sending patients to those centers and putting the patient and the refereeing transplant center at risk. Hope this helps, Thanks, Bill From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Melton, nSent: Wednesday, May 10, 2006 3:08 PMTo: TxFinancialCoordinators Subject: RE: Re: donor charges I believe that a facility that accepts Medicare assignment is "required" to follow the guidelines, & the guidelines are that reimbursement is in the form of the Medicare Fee Schedule, just as if Medicare had made the payment directly. And since transplant evaluations fall under Medicare guidelines, any Medicare provider must abide by them & they cannot bill anyone for the balance. Otherwise, they would be noncompliant. Bill, is that correct? 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 Kohlgraf, SonjaSent: Wednesday, May 10, 2006 1:46 PMTo: TxFinancialCoordinators Subject: RE: Re: donor charges Hello Felecia, I call the facility before setting up the donor eval and talk to somebody who is in charge of billing. If they give me the okay, we send our potential donor to their facility. If they have a problem with medicare rate reimbursement, I make a notation and won’t attempt to use this facility again. Sonja Kohlgraf University of Iowa Hospitals & Clincs, Transplant Center Ph: From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Felecia Sent: Wednesday, May 10, 2006 1:21 PMTo: TxFinancialCoordinators Subject: Re: donor charges Good afternoon all, I was wondering if someone has advice on how to handle a facility that refuses to accept Medicare reimbursement rate for donor charges. Prior to donor receiving services an order was sent w/message of KACC Medicare reimbursement guidelines. This facility states donor will be billed if charges are not paid in full. Felecia Transplant Financial CoordinatorSaint 's Health Care-Transplant ProgramGrand Rapids, MI 49503PH Fax# Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 11, 2006 Report Share Posted May 11, 2006 , do you think on the website or the yahoo group site we would be able to start a list and as we encounter these problems we could enter the information?[Aguiar, (Surgery)] My preference would be to keep something like that on the listserv homepage, vs. the TFCA site which is public & accessible to anyone. But yes, the listserv homepage has a section where files can be shared & stored, however, as I've stated repeatedly over the years, only those who have registered w/Yahoo Groups would be able to access this information. Pat & Felecia, if you want to put something together & send it to me privately @ LAguiar@..., I'm happy to post it & send out a group alert when it is for others to add to. J. Aguiar Beth Israel Deaconess, Boston Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 11, 2006 Report Share Posted May 11, 2006 A combined list would be a great idea. I would be happy to add the names of the facilities that I have contacted and did not want to accept the Medicare rate as payment for donor evals. I also have encountered “critical care facilities” that did not want to give me the medicare rate, however were willing to reduce the charge to their “critical care” percentage. That’s at least a compromise and still a savings on our end. Sonja Kohlgraf, University of Iowa Hospitals & Clinics, Transplant Center From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Kreci Sent: Thursday, May 11, 2006 8:11 AM To: TxFinancialCoordinators Subject: RE: Re: donor charges Bill I think this is a great idea since most donors are out of the immediate area of the transplant center. I know here, almost all my donors are in other states or different parts of Florida. We would prefer they come here but we don't require it until a week before transplant. By having a list that we have all entered our " negative " centers, would help us tremendously when we refer for donor testing. , do you think on the website or the yahoo group site we would be able to start a list and as we encounter these problems we could enter the information? Kreci Transplant Financial Coordinator Southwest Florida Regional Medical Center 2727 Winkler Ave Fort Myers, FL 33910 This email may contain CONFIDENTIAL PATIENT INFORMATION, which may also be legally PRIVILEGED, and which is intended to be read and or used only by the individual entity named above. If the reader of this e-mail is NOT the intended recipient, you are hereby notified that you are in possession of confidential and privileged information. Any disclosure, dissemination, distribution, copying or the taking of any action in reliance of the contents of this information is strictly prohibited. If you have received this e-mail in error, please immediately notify the sender by telephone, and return the original. Redisclosure of this information is prohibited without the written authorization of the patient to whom it pertains. Re: donor charges Good afternoon all, I was wondering if someone has advice on how to handle a facility that refuses to accept Medicare reimbursement rate for donor charges. Prior to donor receiving services an order was sent w/message of KACC Medicare reimbursement guidelines. This facility states donor will be billed if charges are not paid in full. Felecia Transplant Financial Coordinator Saint 's Health Care-Transplant Program Grand Rapids, MI 49503 PH Fax# Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 11, 2006 Report Share Posted May 11, 2006 When putting this together, please put the date of the experience with the center. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of LAguiar@... Sent: Thursday, May 11, 2006 9:19 AM To: TxFinancialCoordinators Subject: RE: Re: donor charges , do you think on the website or the yahoo group site we would be able to start a list and as we encounter these problems we could enter the information? [Aguiar, (Surgery)] My preference would be to keep something like that on the listserv homepage, vs. the TFCA site which is public & accessible to anyone. But yes, the listserv homepage has a section where files can be shared & stored, however, as I've stated repeatedly over the years, only those who have registered w/Yahoo Groups would be able to access this information. Pat & Felecia, if you want to put something together & send it to me privately @ LAguiar@..., I'm happy to post it & send out a group alert when it is for others to add to. J. Aguiar Beth Israel Deaconess, Boston Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.