Guest guest Posted March 2, 2005 Report Share Posted March 2, 2005 If the primary payor's 60% payment is more than Medicare liability , what is the patient remaining liability? Are the facilities and physicians collecting the remaining 40% from the patient? The patient is still a Medicare patient eventhough Medicare is secondary. Could a Medicare participating provider bill and collect more than the Medicare allowable fees? 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...
Guest guest Posted March 2, 2005 Report Share Posted March 2, 2005 Hi , From what I remember in the past, Medicare being a secondary payer will consider charge(s) and pay according to their guidelines/fee schedule. It can get very confusing. Even though Medicare is the secondary payer, they will consider charges as if they are primary. There may not be any addtional payments made by Medicare for approved charges IF the primary payment from the commercial payer is more than the Medicare approved amount. In this respect, if the provider is participating, they may have to write off the difference to be compliant. Hope this helps ! Austria, wrote: > >If the primary payor's 60% payment is more than Medicare liability , what >is the patient remaining liability? Are the facilities and physicians >collecting the remaining 40% from the patient? The patient is still a >Medicare patient eventhough Medicare is secondary. Could a Medicare >participating provider bill and collect more than the Medicare allowable >fees? > > 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...
Guest guest Posted March 2, 2005 Report Share Posted March 2, 2005 we do not look to the pt to pay the balance if the primary pd as much or more than the Medicare allowable on Financial Counselor Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 toll free fax lmorriso@... "Ring out old shapes of foul disease Ring out the narrowing lust of gold; Ring out the thousand wars of old, Ring in the thousand years of peace." - Alfred, Lord Tennyson Out of NetworkWe have a new referral for kidney transplant. We are out of networkfortransplant. Her primary payor will pay 60% and patient's co insuranceis40% . The patient has Medicare as Secondary. How will Medicarecoordinatesbenefit for the Transplant Admission. If the primary payor paymentdoesnotcover the organ cost, can we include this kidney in our Medicare costreport? AustriaSpecialty ContractingManaged Care DepartmentMethodist Hospital SystemP Fax > CONFIDENTIALITY NOTICE> This electronic transmission contains information from MethodistHospitals> of Dallas. This information is confidential and proprietary and is> intended only for the use of the individual(s) and entity(ies) namedabove> 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 HealthSystem 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 receivethis 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 p.s. we do bill Medicare for the denial nevertheless on Financial Counselor Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 toll free fax lmorriso@... "Ring out old shapes of foul disease Ring out the narrowing lust of gold; Ring out the thousand wars of old, Ring in the thousand years of peace." - Alfred, Lord Tennyson Out of NetworkWe have a new referral for kidney transplant. We are out of networkfortransplant. Her primary payor will pay 60% and patient's co insuranceis40% . The patient has Medicare as Secondary. How will Medicarecoordinatesbenefit for the Transplant Admission. If the primary payor paymentdoesnotcover the organ cost, can we include this kidney in our Medicare costreport? AustriaSpecialty ContractingManaged Care DepartmentMethodist Hospital SystemP Fax > CONFIDENTIALITY NOTICE> This electronic transmission contains information from MethodistHospitals> of Dallas. This information is confidential and proprietary and is> intended only for the use of the individual(s) and entity(ies) namedabove> 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 HealthSystem 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 receivethis 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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