RE: Re: donor charges

[Guest guest]

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#

[Guest guest]

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#

[Guest guest]

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#

[Guest guest]

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#

[Guest guest]

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#

[Guest guest]

, 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

[Guest guest]

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#

[Guest guest]

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