Guest guest Posted March 1, 2005 Report Share Posted March 1, 2005 It's my understanding that Medicare will pay as secondary in this case. If Medicare pays $1 or more, you can count it as a Medicare case on your cost report. Out of Network We have a new referral for kidney transplant. We are out of network for transplant. Her primary payor will pay 60% and patient's co insurance is 40% . The patient has Medicare as Secondary. How will Medicare coordinates benefit for the Transplant Admission. If the primary payor payment does not cover the organ cost, can we include this kidney in our Medicare cost report? Austria Specialty Contracting Managed Care Department Methodist Hospital System P Fax > CONFIDENTIALITY NOTICE > This electronic transmission contains information from Methodist Hospitals > of Dallas. This information is confidential and proprietary and is > intended only for the use of the individual(s) and entity(ies) named above > and is not to be disclosed to any third parties. If you are not the > intended recipient, be aware that any disclosure, copying, distribution or > use of the information is prohibited. If you have received this > transmission in error, please notify the Office of Managed Care > immediately by telephone at or by email ( > mariaaustria@...). 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 March 2, 2005 Report Share Posted March 2, 2005 Even though Medicare is presently the 2ndry payor, on the day that the patient is admitted for transplant Medicare automatically becomes primary for the next 3 years for all services related to the transplant due to ESRD entitlement. If at the end of the 3 years the Medicare entitlement is still due to ESRD and not disability or old age, Medicare will terminate and the patient's other insurance if any will become the primary payor. Keep in mind that the patient must have active Medicare A & B at the time of transplant. If I were you, I'd reverify benefits with the other insurance carrier for out of network benefits as the 2ndry payor..... they may not be as restricted. Hope that helps Out of Network We have a new referral for kidney transplant. We are out of network for transplant. Her primary payor will pay 60% and patient's co insurance is 40% . The patient has Medicare as Secondary. How will Medicare coordinates benefit for the Transplant Admission. If the primary payor payment does not cover the organ cost, can we include this kidney in our Medicare cost report? Austria Specialty Contracting Managed Care Department Methodist Hospital System P Fax > CONFIDENTIALITY NOTICE > This electronic transmission contains information from Methodist Hospitals > of Dallas. This information is confidential and proprietary and is > intended only for the use of the individual(s) and entity(ies) named above > and is not to be disclosed to any third parties. If you are not the > intended recipient, be aware that any disclosure, copying, distribution or > use of the information is prohibited. If you have received this > transmission in error, please notify the Office of Managed Care > immediately by telephone at or by email ( > mariaaustria@...). 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 March 2, 2005 Report Share Posted March 2, 2005 ESRD Medicare does not automatically become primary just because a patient is admitted for a renal txp. A patient that has this significant reduction of benefits for being out of network, we would certainly encourage them to reroute to an innetwork facility to maximize their reimbursement for txp services. By using a network facility, there is more than likely a travel and lodging benefit included. Marcia J. Fisher Sr. Transplant Financial Coordinator Michigan Transplant Center This message is confidential, intended for the named recipient(s). If you receive this message in error, please notify the sender by email or at , and delete this email. Thank you. >>> .@... 3/2/2005 8:41:28 AM >>> Even though Medicare is presently the 2ndry payor, on the day that the patient is admitted for transplant Medicare automatically becomes primary for the next 3 years for all services related to the transplant due to ESRD entitlement. If at the end of the 3 years the Medicare entitlement is still due to ESRD and not disability or old age, Medicare will terminate and the patient's other insurance if any will become the primary payor. Keep in mind that the patient must have active Medicare A & B at the time of transplant. If I were you, I'd reverify benefits with the other insurance carrier for out of network benefits as the 2ndry payor..... they may not be as restricted. Hope that helps Out of Network We have a new referral for kidney transplant. We are out of network for transplant. Her primary payor will pay 60% and patient's co insurance is 40% . The patient has Medicare as Secondary. How will Medicare coordinates benefit for the Transplant Admission. If the primary payor payment does not cover the organ cost, can we include this kidney in our Medicare cost report? Austria Specialty Contracting Managed Care Department Methodist Hospital System P Fax > CONFIDENTIALITY NOTICE > This electronic transmission contains information from Methodist Hospitals > of Dallas. This information is confidential and proprietary and is > intended only for the use of the individual(s) and entity(ies) named above > and is not to be disclosed to any third parties. If you are not the > intended recipient, be aware that any disclosure, copying, distribution or > use of the information is prohibited. If you have received this > transmission in error, please notify the Office of Managed Care > immediately by telephone at or by email ( > mariaaustria@...). 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 March 2, 2005 Report Share Posted March 2, 2005 I agree with , you still have the 30 month COB which needs completed, we also would encourage patient to use an in network transplant provider which would provide a higher coverage for them. Financial Coordinator Allegheny General Hospital Transplant Service mmartin1@... >>> mafi@... 03/02/05 08:55AM >>> ESRD Medicare does not automatically become primary just because a patient is admitted for a renal txp. A patient that has this significant reduction of benefits for being out of network, we would certainly encourage them to reroute to an innetwork facility to maximize their reimbursement for txp services. By using a network facility, there is more than likely a travel and lodging benefit included. Marcia J. Fisher Sr. Transplant Financial Coordinator Michigan Transplant Center This message is confidential, intended for the named recipient(s). If you receive this message in error, please notify the sender by email or at , and delete this email. Thank you. >>> .@... 3/2/2005 8:41:28 AM >>> Even though Medicare is presently the 2ndry payor, on the day that the patient is admitted for transplant Medicare automatically becomes primary for the next 3 years for all services related to the transplant due to ESRD entitlement. If at the end of the 3 years the Medicare entitlement is still due to ESRD and not disability or old age, Medicare will terminate and the patient's other insurance if any will become the primary payor. Keep in mind that the patient must have active Medicare A & B at the time of transplant. If I were you, I'd reverify benefits with the other insurance carrier for out of network benefits as the 2ndry payor..... they may not be as restricted. Hope that helps Out of Network We have a new referral for kidney transplant. We are out of network for transplant. Her primary payor will pay 60% and patient's co insurance is 40% . The patient has Medicare as Secondary. How will Medicare coordinates benefit for the Transplant Admission. If the primary payor payment does not cover the organ cost, can we include this kidney in our Medicare cost report? Austria Specialty Contracting Managed Care Department Methodist Hospital System P Fax > CONFIDENTIALITY NOTICE > This electronic transmission contains information from Methodist Hospitals > of Dallas. This information is confidential and proprietary and is > intended only for the use of the individual(s) and entity(ies) named above > and is not to be disclosed to any third parties. If you are not the > intended recipient, be aware that any disclosure, copying, distribution or > use of the information is prohibited. If you have received this > transmission in error, please notify the Office of Managed Care > immediately by telephone at or by email ( > mariaaustria@...). 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 March 2, 2005 Report Share Posted March 2, 2005 Thanks to all. Austria Specialty Contracting Managed Care Department Methodist Hospital System P Fax > CONFIDENTIALITY NOTICE > This electronic transmission contains information from Methodist Hospitals of Dallas. This information is confidential and proprietary and is intended only for the use of the individual(s) and entity(ies) named above and is not to be disclosed to any third parties. If you are not the intended recipient, be aware that any disclosure, copying, distribution or use of the information is prohibited. If you have received this transmission in error, please notify the Office of Managed Care immediately by telephone at (214) 947-4525 or by email ( mariaaustria@...). Methodist Health System, its subsidiaries and affiliates, hereby claim all applicable privileges related to the transmission of this communication. > > Out of Network We have a new referral for kidney transplant. We are out of network for transplant. Her primary payor will pay 60% and patient's co insurance is 40% . The patient has Medicare as Secondary. How will Medicare coordinates benefit for the Transplant Admission. If the primary payor payment does not cover the organ cost, can we include this kidney in our Medicare cost report? Austria Specialty Contracting Managed Care Department Methodist Hospital System P Fax > CONFIDENTIALITY NOTICE > This electronic transmission contains information from Methodist Hospitals > of Dallas. This information is confidential and proprietary and is > intended only for the use of the individual(s) and entity(ies) named above > and is not to be disclosed to any third parties. If you are not the > intended recipient, be aware that any disclosure, copying, distribution or > use of the information is prohibited. If you have received this > transmission in error, please notify the Office of Managed Care > immediately by telephone at or by email ( > mariaaustria@...). 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...
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