RE: yet another question.... back to the living donor issues....

[Guest guest]

Good question a

I have the last case scenario, pt was organ donor 12 years ago and now needs a

transplant, I was told we are to use the patients insurance and he will gain

points on the list for being an organ donor.

re:can't be proven that the actual donation lead to his ESRD

Let me know if anyone else hears differently

Financial Coordinator

WPAHS

mmartin1@...

>>> a.Summa@... 07/29/04 07:54AM >>>

Me again....

this time I'm going back to the living donor post-transplant follow-up care

issues....

My Medical Director has asked me to pose these questions to the group.

Here is a quote from his email:

Section 1881 (d) of the Act, states that " Notwithstanding any provision to

the contrary in Section 226, any individual who donates a kidney for

transplant surgery shall be entitled to benefits under Part A B of this

title with respect to such donation "

Accordingly, the donor is entitled to reasonable coverage of services

without regard to deductible, premium or coinsurance.

So... the question is, what exactly is covered in regards to the living

donor post transplant? Are well-care follow up visits covered? If so, for

how long? (UNOS is asking for 6 months and a year follow-ups now... who pays

for them? I hear they might ask for annual follow-ups...) Are donor

complications covered for an unlimited time? Here is a far-fetched question

that one of our nurses asked: What if a living donor develops problems 10

years down the road and it's determined it's due to organ donation? Do we

still bill the recipient's Medicare? Does is state anywhere in the Medicare

regs exactly what is covered for the living donor and for what time frame?

Thanks in advance for your feedback....

a

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[Guest guest]

That is correct

>>> a.Summa@... 07/29/04 08:50AM >>>

,

This is exactly another question posed by one of our nurses... but I would

think the donor who is now being evaluated for a tx would be eligible for

Medicare on his own (ESRD) and there would be no need to bill under the

original recipient's Medicare... correct?

Re: yet another question.... back to

the living donor issues....

Good question a

I have the last case scenario, pt was organ donor 12 years ago and now needs

a transplant, I was told we are to use the patients insurance and he will

gain points on the list for being an organ donor.

re:can't be proven that the actual donation lead to his ESRD

Let me know if anyone else hears differently

Financial Coordinator

WPAHS

mmartin1@...

>>> a.Summa@... 07/29/04 07:54AM >>>

Me again....

this time I'm going back to the living donor post-transplant follow-up care

issues....

My Medical Director has asked me to pose these questions to the group.

Here is a quote from his email:

Section 1881 (d) of the Act, states that " Notwithstanding any provision to

the contrary in Section 226, any individual who donates a kidney for

transplant surgery shall be entitled to benefits under Part A B of this

title with respect to such donation "

Accordingly, the donor is entitled to reasonable coverage of services

without regard to deductible, premium or coinsurance.

So... the question is, what exactly is covered in regards to the living

donor post transplant? Are well-care follow up visits covered? If so, for

how long? (UNOS is asking for 6 months and a year follow-ups now... who pays

for them? I hear they might ask for annual follow-ups...) Are donor

complications covered for an unlimited time? Here is a far-fetched question

that one of our nurses asked: What if a living donor develops problems 10

years down the road and it's determined it's due to organ donation? Do we

still bill the recipient's Medicare? Does is state anywhere in the Medicare

regs exactly what is covered for the living donor and for what time frame?

Thanks in advance for your feedback....

a

The information contained in this message may be privileged and/or

confidential and protected from disclosure. If the reader of this message

is not the intended recipient or agent responsible for delivering this

message to the intended recipient, you are hereby notified that any

dissemination, distribution or copying of this communication is strictly

prohibited. If you have received this communication in error, please notify

the sender immediately by replying to this message and deleting the material

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[Guest guest]

HI ,

If the patient has insurance it probably means that he is Medicare Entitled.

The transplant center would evaluate the patient in the normal manner and be

financially responsible for the evaluation process. At the time of

transplant, you would bill whomever the appropriate payer is.

What do you mean by " use the patients insurance " ?

The patient should be treated as a normal (what ever that it) ESRD patient.

He may get additional points because he was a donor but that has no effect

on how he should be treated financially.

Hope this helps,

Thanks,

Bill

Re: yet another question.... back to the

living donor issues....

Good question a

I have the last case scenario, pt was organ donor 12 years ago and now needs

a transplant, I was told we are to use the patients insurance and he will

gain points on the list for being an organ donor.

re:can't be proven that the actual donation lead to his ESRD

Let me know if anyone else hears differently

Financial Coordinator

WPAHS

mmartin1@...

>>> a.Summa@... 07/29/04 07:54AM >>>

Me again....

this time I'm going back to the living donor post-transplant follow-up care

issues....

My Medical Director has asked me to pose these questions to the group.

Here is a quote from his email:

Section 1881 (d) of the Act, states that " Notwithstanding any provision to

the contrary in Section 226, any individual who donates a kidney for

transplant surgery shall be entitled to benefits under Part A B of this

title with respect to such donation "

Accordingly, the donor is entitled to reasonable coverage of services

without regard to deductible, premium or coinsurance.

So... the question is, what exactly is covered in regards to the living

donor post transplant? Are well-care follow up visits covered? If so, for

how long? (UNOS is asking for 6 months and a year follow-ups now... who pays

for them? I hear they might ask for annual follow-ups...) Are donor

complications covered for an unlimited time? Here is a far-fetched question

that one of our nurses asked: What if a living donor develops problems 10

years down the road and it's determined it's due to organ donation? Do we

still bill the recipient's Medicare? Does is state anywhere in the Medicare

regs exactly what is covered for the living donor and for what time frame?

Thanks in advance for your feedback....

a

The information contained in this message may be privileged and/or

confidential and protected from disclosure. If the reader of this message

is not the intended recipient or agent responsible for delivering this

message to the intended recipient, you are hereby notified that any

dissemination, distribution or copying of this communication is strictly

prohibited. If you have received this communication in error, please notify

the sender immediately by replying to this message and deleting the material

from any computer.

[Guest guest]

Hi a,

I love Live Donor Issues and I love partial quotes of law and

regulation.

The whole paragraph of law states:

Section 1881(d) of the Social Security Act:

(d) Notwithstanding any provision to the contrary in section 226, any

individual who donates a kidney for transplant surgery shall be entitled to

benefits under parts A and B of this title with respect to such donation.

Reimbursement for the reasonable expenses incurred by such an individual with

respect to a kidney donation shall be made (without regard to the deductible,

premium, and coinsurance provisions of this title), in such manner as may be

prescribed by the Secretary in regulations, for all reasonable preparatory,

operation, and post operation recovery expenses associated with such donation,

including but not limited to the expenses for which payment could be made if he

were an eligible individual for purposes of parts A and B of this title without

regard to this subsection. Payments for post operation recovery expenses

shall be limited to the actual period of recovery.

The key to your question and that we are working with post transplant

is, " Payments for postoperation recovery expenses shall be limited to the

actual period of recovery. "

The actual period of recovery is very hard to define since we know of

instances where patients have come back to the transplant center over a year

later with herniated incisions, and Medicare has paid the surgeons fees and

other related physicians fees to reduce the hernia and the hospital was able to

claim the surgery in KACC.

Medicare generally does not question normal “surgical follow up”

for 90 days, anything over 6 months will have to be clearly documented that it

is a complication. Also, Medicare does not care what UNOS wants, a UNOS

directive does not equal Medicare coverage. If you tell a donor that they

have to pay for the “well baby” visit at six months and they

refuse, then you do not get the data.

We believe that we as an industry have done a very poor job of

educating our Live Donors about their rights and responsibilities. We

believe that all potential live donors should be given a number to call if they

think that they are having a problem due to donation. That number should

connect them with the transplant center that recovered the kidney. It is

up to that center to “coordinate” their care and determine if the

problem is donation related. If the surgeon/physician assigned the case

can document that it is, then we have seen problems taken car of years down the

road.

Part of the challenge is also contracting in such a manner that if

Medicare is in second place at the time of donation, the other primary payer

will pay the physician fees, the Part A facility fees are always the transplant

center’s responsibility.

Now, if down the line the donor develops ESRD and needs dialysis or

transplant, they will be covered under their own entitlement to Medicare and it

is not considered a complication due to donation. We also think that if

the potential live donor shows and signs, no matter how minor of ESRD they

should be ruled out. We do not believe that there is any such thing as a “marginal”

live donor.

Hope this helps,

Thanks,

Bill

yet another question.... back to the living

donor issues....

Me again....

this time I'm going back to the living donor post-transplant follow-up

care

issues....

My Medical Director has asked me to pose these questions to the group.

Here is a quote from his email:

Section 1881 (d) of the Act, states that " Notwithstanding any

provision to

the contrary in Section 226, any individual who donates a kidney for

transplant surgery shall be entitled to benefits under Part A B

of this

title with respect to such donation "

Accordingly, the donor is entitled to reasonable coverage of services

without regard to deductible, premium or coinsurance.

So... the question is, what exactly is covered in regards to the living

donor post transplant? Are well-care follow up visits covered? If so,

for

how long? (UNOS is asking for 6 months and a year follow-ups now... who

pays

for them? I hear they might ask for annual follow-ups...) Are donor

complications covered for an unlimited time? Here is a far-fetched

question

that one of our nurses asked: What if a living donor develops problems

10

years down the road and it's determined it's due to organ donation? Do

we

still bill the recipient's Medicare? Does is state anywhere in

the Medicare

regs exactly what is covered for the living donor and for what time

frame?

Thanks in advance for your feedback....

a

The information contained in this message may be privileged and/or

confidential and protected from disclosure. If the reader of this

message

is not the intended recipient or agent responsible for delivering this

message to the intended recipient, you are hereby notified that any

dissemination, distribution or copying of this communication is

strictly

prohibited. If you have received this communication in error,

please notify

the sender immediately by replying to this message and deleting the

material

from any computer.

[Guest guest]

Hello Bill

What I ment by " use the patients insurance " was at the time of transplant the

pts insurance would be billed in the usual manor for the transplant.

And yes what you have written below is exactly we handled this case.

Transplant Financial Coordinator

>>> Vaughan@... 07/29/04 08:09PM >>>

HI ,

If the patient has insurance it probably means that he is Medicare Entitled.

The transplant center would evaluate the patient in the normal manner and be

financially responsible for the evaluation process. At the time of

transplant, you would bill whomever the appropriate payer is.

What do you mean by " use the patients insurance " ?

The patient should be treated as a normal (what ever that it) ESRD patient.

He may get additional points because he was a donor but that has no effect

on how he should be treated financially.

Hope this helps,

Thanks,

Bill

Re: yet another question.... back to the

living donor issues....

Good question a

I have the last case scenario, pt was organ donor 12 years ago and now needs

a transplant, I was told we are to use the patients insurance and he will

gain points on the list for being an organ donor.

re:can't be proven that the actual donation lead to his ESRD

Let me know if anyone else hears differently

Financial Coordinator

WPAHS

mmartin1@...

>>> a.Summa@... 07/29/04 07:54AM >>>

Me again....

this time I'm going back to the living donor post-transplant follow-up care

issues....

My Medical Director has asked me to pose these questions to the group.

Here is a quote from his email:

Section 1881 (d) of the Act, states that " Notwithstanding any provision to

the contrary in Section 226, any individual who donates a kidney for

transplant surgery shall be entitled to benefits under Part A B of this

title with respect to such donation "

Accordingly, the donor is entitled to reasonable coverage of services

without regard to deductible, premium or coinsurance.

So... the question is, what exactly is covered in regards to the living

donor post transplant? Are well-care follow up visits covered? If so, for

how long? (UNOS is asking for 6 months and a year follow-ups now... who pays

for them? I hear they might ask for annual follow-ups...) Are donor

complications covered for an unlimited time? Here is a far-fetched question

that one of our nurses asked: What if a living donor develops problems 10

years down the road and it's determined it's due to organ donation? Do we

still bill the recipient's Medicare? Does is state anywhere in the Medicare

regs exactly what is covered for the living donor and for what time frame?

Thanks in advance for your feedback....

a

The information contained in this message may be privileged and/or

confidential and protected from disclosure. If the reader of this message

is not the intended recipient or agent responsible for delivering this

message to the intended recipient, you are hereby notified that any

dissemination, distribution or copying of this communication is strictly

prohibited. If you have received this communication in error, please notify

the sender immediately by replying to this message and deleting the material

from any computer.