RE: Re[4]: new kid on the block

[Guest guest]

Wow Sandy! I'm impressed. Does it stipulate the same for liver transplants also?

Pat Hogan

RE: Re[2]: new kid on the block

Hi Again

I have an issue that just came up on a donor with an open wound that

the

insurance company of the recepient is refusing to pay. Have any of

you run

into this According to the patient he states his insurance also

refuses to

pay. I think the transplant center is ultimately responsible but for

how

long?

Thanks

>>> LAguiar@... 07/06/00 09:25AM >>>

Hi a & welcome back!

Of course, the first thing is to try to read thru all these email

messages

from

all you fellow TFCs!

That's as it should be! :-)

So... just a reminder to all to please at least write your name at

the

bottom of your messages. (thanks!)

Good point, a. In case anyone forgets, though, if you

check the

message board on our eGroups site, the author's name (or e-mail

address) is

listed beside each message. I also want to encourage anyone who

hasn't

already done so to please check the site & complete your individual

entry in

the data base so we can all know who we are!

Is anyone keeping a list of all these great suggestions???

???

Yup, I've got them. Which brings up another friendly

reminder-anyone who hasn't completed the poll re: next year's Forum

on the

eGroups site, please try to do so by the end of the week. Your

feedback is

VERY important in planning these sessions!!

Thanks,

J. Aguiar

Beth Israel Deaconess, Boston

------------------------------------------------------------------------

Where do sports heroes like Jeter, Mia Hamm,

Vince and Peyton Manning hang out? Where else?

Click now and find 'em all here!

http://click./1/6211/1/_/_/_/962890104/

------------------------------------------------------------------------

[Guest guest]

UNOS & Medicare are two different things, don't forget :-) Sandy Gray

already posted that piece re: the 3 mos...

RE: Re[2]: new kid on the block

Hi Again

I have an issue that just came up on a donor with an open wound that the

insurance company of the recepient is refusing to pay. Have any of you run

into this. According to the patient he states his insurance also refuses to

pay. I think the transplant center is ultimately responsible but for how

long?

Thanks

>>> LAguiar@... 07/06/00 09:25AM >>>

Hi a & welcome back!

Of course, the first thing is to try to read thru all these email messages

from

all you fellow TFCs!

That's as it should be! :-)

So... just a reminder to all to please at least write your name at the

bottom of your messages. (thanks!)

Good point, a. In case anyone forgets, though, if you check the

message board on our eGroups site, the author's name (or e-mail address) is

listed beside each message. I also want to encourage anyone who hasn't

already done so to please check the site & complete your individual entry in

the data base so we can all know who we are!

Is anyone keeping a list of all these great suggestions??? ???

Yup, I've got them. Which brings up another friendly

reminder-anyone who hasn't completed the poll re: next year's Forum on the

eGroups site, please try to do so by the end of the week. Your feedback is

VERY important in planning these sessions!!

Thanks,

J. Aguiar

Beth Israel Deaconess, Boston

------------------------------------------------------------------------

Where do sports heroes like Jeter, Mia Hamm,

Vince and Peyton Manning hang out? Where else?

Click now and find 'em all here!

http://click./1/6211/1/_/_/_/962890104/

------------------------------------------------------------------------

[Guest guest]

Sandy; Where are you getting that info from re Medicare does not cover live donor liver transplants? I believe it does if you use CPT code 47134 for live donor. We have been billing for that and getting paid.

Pat Hogan

RE: Re[2]: new kid on the block

Hi Again

I have an issue that just came up on a donor with an open wound that

the

insurance company of the recepient is refusing to pay. Have any of

you run

into this According to the patient he states his insurance also

refuses to

pay. I think the transplant center is ultimately responsible but for

how

long?

Thanks

>>> LAguiar@... 07/06/00 09:25AM >>>

Hi a & welcome back!

Of course, the first thing is to try to read thru all these email

messages

from

all you fellow TFCs!

That's as it should be! :-)

So... just a reminder to all to please at least write your name at

the

bottom of your messages. (thanks!)

Good point, a. In case anyone forgets, though, if you

check the

message board on our eGroups site, the author's name (or e-mail

address) is

listed beside each message. I also want to encourage anyone who

hasn't

already done so to please check the site & complete your individual

entry in

the data base so we can all know who we are!

Is anyone keeping a list of all these great suggestions???

???

Yup, I've got them. Which brings up another friendly

reminder-anyone who hasn't completed the poll re: next year's Forum

on the

eGroups site, please try to do so by the end of the week. Your

feedback is

VERY important in planning these sessions!!

Thanks,

J. Aguiar

Beth Israel Deaconess, Boston

------------------------------------------------------------------------

Where do sports heroes like Jeter, Mia Hamm,

Vince and Peyton Manning hang out? Where else?

Click now and find 'em all here!

http://click./1/6211/1/_/_/_/962890104/

------------------------------------------------------------------------

[Guest guest]

No, Living liver donor transplants are currently considered non covered by

Medicare. We are hoping to change that reall soon.

Sandy

>>> .Hogan@... 07/11/00 02:12PM >>>

Wow Sandy! I'm impressed. Does it stipulate the same for liver transplants

also?

Pat Hogan

RE: Re[2]: new kid on the block

Hi Again

I have an issue that just came up on a donor with an open wound that

the

insurance company of the recepient is refusing to pay. Have any of

you run

into this. According to the patient he states his insurance also

refuses to

pay. I think the transplant center is ultimately responsible but for

how

long?

Thanks

>>> LAguiar@... 07/06/00 09:25AM >>>

Hi a & welcome back!

Of course, the first thing is to try to read thru all these email

messages

from

all you fellow TFCs!

That's as it should be! :-)

So... just a reminder to all to please at least write your name at

the

bottom of your messages. (thanks!)

Good point, a. In case anyone forgets, though, if you

check the

message board on our eGroups site, the author's name (or e-mail

address) is

listed beside each message. I also want to encourage anyone who

hasn't

already done so to please check the site & complete your individual

entry in

the data base so we can all know who we are!

Is anyone keeping a list of all these great suggestions???

???

Yup, I've got them. Which brings up another friendly

reminder-anyone who hasn't completed the poll re: next year's Forum

on the

eGroups site, please try to do so by the end of the week. Your

feedback is

VERY important in planning these sessions!!

Thanks,

J. Aguiar

Beth Israel Deaconess, Boston

------------------------------------------------------------------------

Where do sports heroes like Jeter, Mia Hamm,

Vince and Peyton Manning hang out? Where else?

Click now and find 'em all here!

http://click./1/6211/1/_/_/_/962890104/

------------------------------------------------------------------------

[Guest guest]

Hi - I called Medicare several weeks ago to ask them about coverage for living

donor liver transplantation and I was told that this procedure is not covered by

Medicare on a national basis. However, they told me that the carriers for

Medicare in the individual states can make their own determination on whether to

cover this procedure or not. It would have to be pre-authorized through the

Medicare carrier for your state. Arlene Gatto

>>> .Hogan@... 07/11/00 05:00PM >>>

Sandy; Where are you getting that info from re Medicare does not cover live

donor liver transplants? I believe it does if you use CPT code 47134 for

live donor. We have been billing for that and getting paid.

Pat Hogan

RE: Re[2]: new kid on the block

Hi Again

I have an issue that just came up on a donor with an open wound that

the

insurance company of the recepient is refusing to pay. Have any of

you run

into this. According to the patient he states his insurance also

refuses to

pay. I think the transplant center is ultimately responsible but for

how

long?

Thanks

>>> LAguiar@... 07/06/00 09:25AM >>>

Hi a & welcome back!

Of course, the first thing is to try to read thru all these email

messages

from

all you fellow TFCs!

That's as it should be! :-)

So... just a reminder to all to please at least write your name at

the

bottom of your messages. (thanks!)

Good point, a. In case anyone forgets, though, if you

check the

message board on our eGroups site, the author's name (or e-mail

address) is

listed beside each message. I also want to encourage anyone who

hasn't

already done so to please check the site & complete your individual

entry in

the data base so we can all know who we are!

Is anyone keeping a list of all these great suggestions???

???

Yup, I've got them. Which brings up another friendly

reminder-anyone who hasn't completed the poll re: next year's Forum

on the

eGroups site, please try to do so by the end of the week. Your

feedback is

VERY important in planning these sessions!!

Thanks,

J. Aguiar

Beth Israel Deaconess, Boston

------------------------------------------------------------------------

Where do sports heroes like Jeter, Mia Hamm,

Vince and Peyton Manning hang out? Where else?

Click now and find 'em all here!

http://click./1/6211/1/_/_/_/962890104/

------------------------------------------------------------------------

[Guest guest]

our understanding here is that the donor is covered for up to 1 year for

donation-related services.

>>> " a Summa " 07/11/00 10:39AM >>>

,

Where in the regs does it specify 3 months post? Our data processing

coordinator recently told us that UNOS is asking for post tx followup

info on donors up to 1 year post. Is this not also billable?

a

______________________________ Reply Separator _________________________________

Subject: RE: Re[2]: new kid on the block

Author: <TxFinancialCoordinatorsegroups> at INTERNET

Date: 07/11/2000 10:31 AM

,

Are you talking about a kidney donor? If so, the Medicare regs specify

3 mos post-tx f/u of the donor. This kind of policy issue, f/u care for

donors (lung, liver, kidney) is one tx ctrs should establish & make the

donors aware of during the eval process, in my opinion anyway.

RE: Re[2]: new kid on the block

Hi Again

I have an issue that just came up on a donor with an open wound that the

insurance company of the recepient is refusing to pay. Have any of you run

into this. According to the patient he states his insurance also refuses to

pay. I think the transplant center is ultimately responsible but for how

long?

Thanks

>>> LAguiar@... 07/06/00 09:25AM >>>

Hi a & welcome back!

Of course, the first thing is to try to read thru all these email messages

from

all you fellow TFCs!

That's as it should be! :-)

So... just a reminder to all to please at least write your name at the

bottom of your messages. (thanks!)

Good point, a. In case anyone forgets, though, if you check the

message board on our eGroups site, the author's name (or e-mail address) is

listed beside each message. I also want to encourage anyone who hasn't

already done so to please check the site & complete your individual entry in

the data base so we can all know who we are!

Is anyone keeping a list of all these great suggestions??? ???

Yup, I've got them. Which brings up another friendly

reminder-anyone who hasn't completed the poll re: next year's Forum on the

eGroups site, please try to do so by the end of the week. Your feedback is

VERY important in planning these sessions!!

Thanks,

J. Aguiar

Beth Israel Deaconess, Boston

------------------------------------------------------------------------

Where do sports heroes like Jeter, Mia Hamm,

Vince and Peyton Manning hang out? Where else?

Click now and find 'em all here!

http://click./1/6211/1/_/_/_/962890104/

------------------------------------------------------------------------

[Guest guest]

there are no guidelines yet for living liver transplant donors under the

medicare rules.

>>> Hogan 07/11/00 04:12PM >>>

Wow Sandy! I'm impressed. Does it stipulate the same for liver transplants

also?

Pat Hogan

RE: Re[2]: new kid on the block

Hi Again

I have an issue that just came up on a donor with an open wound that

the

insurance company of the recepient is refusing to pay. Have any of

you run

into this. According to the patient he states his insurance also

refuses to

pay. I think the transplant center is ultimately responsible but for

how

long?

Thanks

>>> LAguiar@... 07/06/00 09:25AM >>>

Hi a & welcome back!

Of course, the first thing is to try to read thru all these email

messages

from

all you fellow TFCs!

That's as it should be! :-)

So... just a reminder to all to please at least write your name at

the

bottom of your messages. (thanks!)

Good point, a. In case anyone forgets, though, if you

check the

message board on our eGroups site, the author's name (or e-mail

address) is

listed beside each message. I also want to encourage anyone who

hasn't

already done so to please check the site & complete your individual

entry in

the data base so we can all know who we are!

Is anyone keeping a list of all these great suggestions???

???

Yup, I've got them. Which brings up another friendly

reminder-anyone who hasn't completed the poll re: next year's Forum

on the

eGroups site, please try to do so by the end of the week. Your

feedback is

VERY important in planning these sessions!!

Thanks,

J. Aguiar

Beth Israel Deaconess, Boston

------------------------------------------------------------------------

Where do sports heroes like Jeter, Mia Hamm,

Vince and Peyton Manning hang out? Where else?

Click now and find 'em all here!

http://click./1/6211/1/_/_/_/962890104/

------------------------------------------------------------------------

[Guest guest]

Hi Everyone

Do those regs apply only to Medicare beneficiaries or to all donors? What if the

recepient does not have Medicare? Also,is there any advantage to having living

related recepients sign up for Medicare if they have commercial insurance? I

know some centers require this but often patients are reluctant to pay. How do

your centers handle this?

Thanks

>>> sdg2944@... 07/11/00 04:37PM >>>

I have a copy of the regs that we follow at . It is called Medicare

Intermediary Manual, Part 3 (HCFA-Pub. 13-3 ) Titled 3178.9 Post-Transplant

Services Provided to Live Donor

It states: Paragraph 2

Coverage of kidney donor services includes postoperative recovery services

directly related to the kidney donation The period of postoperative recovery

ceases when the donor no longer exhibits symptoms related to the kidney

donation. Claims for services rendered more than 3 months after donation

surgery will be reviewed carefully. However, follow-up examinations may be

covered up to 6 months after the donation to monitor for possible complications.

Here at we have paid bills greater than 6 months as long as our docs say

that the problem is due to donation. Per our Medicare " EXPERT " here at the

hospital, as long as we have documention that it is donation related we are

covered.

Sandy Gray

>>> paula_summa@... 07/11/00 08:39AM >>>

,

Where in the regs does it specify 3 months post? Our data processing

coordinator recently told us that UNOS is asking for post tx followup

info on donors up to 1 year post. Is this not also billable?

a

______________________________ Reply Separator _________________________________

Subject: RE: Re[2]: new kid on the block

Author: <TxFinancialCoordinatorsegroups> at INTERNET

Date: 07/11/2000 10:31 AM

,

Are you talking about a kidney donor? If so, the Medicare regs specify

3 mos post-tx f/u of the donor. This kind of policy issue, f/u care for

donors (lung, liver, kidney) is one tx ctrs should establish & make the

donors aware of during the eval process, in my opinion anyway.

RE: Re[2]: new kid on the block

Hi Again

I have an issue that just came up on a donor with an open wound that the

insurance company of the recepient is refusing to pay. Have any of you run

into this. According to the patient he states his insurance also refuses to

pay. I think the transplant center is ultimately responsible but for how

long?

Thanks

>>> LAguiar@... 07/06/00 09:25AM >>>

Hi a & welcome back!

Of course, the first thing is to try to read thru all these email messages

from

all you fellow TFCs!

That's as it should be! :-)

So... just a reminder to all to please at least write your name at the

bottom of your messages. (thanks!)

Good point, a. In case anyone forgets, though, if you check the

message board on our eGroups site, the author's name (or e-mail address) is

listed beside each message. I also want to encourage anyone who hasn't

already done so to please check the site & complete your individual entry in

the data base so we can all know who we are!

Is anyone keeping a list of all these great suggestions??? ???

Yup, I've got them. Which brings up another friendly

reminder-anyone who hasn't completed the poll re: next year's Forum on the

eGroups site, please try to do so by the end of the week. Your feedback is

VERY important in planning these sessions!!

Thanks,

J. Aguiar

Beth Israel Deaconess, Boston

------------------------------------------------------------------------

Where do sports heroes like Jeter, Mia Hamm,

Vince and Peyton Manning hang out? Where else?

Click now and find 'em all here!

http://click./1/6211/1/_/_/_/962890104/

------------------------------------------------------------------------

[Guest guest]

I am with Northwestern Memorial Hospital in Chicago, and as for the Medicare

issue with our Kidney recipients I give them the option if they have a

commercial insurance. I first send a letter to the patient telling them

that they are eligible for Medicare. I than ask the patient how is the

payment of the medications prior to transplant. If it is good I suggest

that they could wait until the transplant to apply for Medicare that way

they are not paying for Medicare and not benefiting from it. Also, Medicare

is a non issue unless they are dialysising.

Karla Christensen

> RE: Re[2]: new kid on the block

>

>

> Hi Again

>

> I have an issue that just came up on a donor with an open wound that the

> insurance company of the recepient is refusing to pay. Have any of you run

>

> into this. According to the patient he states his insurance also refuses

> to

> pay. I think the transplant center is ultimately responsible but for how

> long?

>

> Thanks

>

>

>

> >>> LAguiar@... 07/06/00 09:25AM >>>

> Hi a & welcome back!

>

> Of course, the first thing is to try to read thru all these email messages

>

> from

> all you fellow TFCs!

>

> That's as it should be! :-)

>

> So... just a reminder to all to please at least write your name at the

> bottom of your messages. (thanks!)

>

> Good point, a. In case anyone forgets, though, if you check

> the

> message board on our eGroups site, the author's name (or e-mail address)

> is

> listed beside each message. I also want to encourage anyone who hasn't

> already done so to please check the site & complete your individual entry

> in

> the data base so we can all know who we are!

>

> Is anyone keeping a list of all these great suggestions??? ???

>

> Yup, I've got them. Which brings up another friendly

> reminder-anyone who hasn't completed the poll re: next year's Forum on the

>

> eGroups site, please try to do so by the end of the week. Your feedback

> is

> VERY important in planning these sessions!!

>

> Thanks,

>

> J. Aguiar

> Beth Israel Deaconess, Boston

>

> ------------------------------------------------------------------------

> Where do sports heroes like Jeter, Mia Hamm,

> Vince and Peyton Manning hang out? Where else?

> Click now and find 'em all here!

> http://click./1/6211/1/_/_/_/962890104/

> ------------------------------------------------------------------------

>

>

[Guest guest]

Patients can elect to have Medicare Part A without paying for Part B coverage,

and then they will not have as much of a financial burden for hospital stays and

facility charges.

taylorkb@...

B.

Medical University of South Carolina

ton, South Carolina

>>> kchriste@... 07/12 10:24 AM >>>

I am with Northwestern Memorial Hospital in Chicago, and as for the Medicare

issue with our Kidney recipients I give them the option if they have a

commercial insurance. I first send a letter to the patient telling them

that they are eligible for Medicare. I than ask the patient how is the

payment of the medications prior to transplant. If it is good I suggest

that they could wait until the transplant to apply for Medicare that way

they are not paying for Medicare and not benefiting from it. Also, Medicare

is a non issue unless they are dialysising.

Karla Christensen

> RE: Re[2]: new kid on the block

>

>

> Hi Again

>

> I have an issue that just came up on a donor with an open wound that the

> insurance company of the recepient is refusing to pay. Have any of you run

>

> into this. According to the patient he states his insurance also refuses

> to

> pay. I think the transplant center is ultimately responsible but for how

> long?

>

> Thanks

>

>

>

> >>> LAguiar@... 07/06/00 09:25AM >>>

> Hi a & welcome back!

>

> Of course, the first thing is to try to read thru all these email messages

>

> from

> all you fellow TFCs!

>

> That's as it should be! :-)

>

> So... just a reminder to all to please at least write your name at the

> bottom of your messages. (thanks!)

>

> Good point, a. In case anyone forgets, though, if you check

> the

> message board on our eGroups site, the author's name (or e-mail address)

> is

> listed beside each message. I also want to encourage anyone who hasn't

> already done so to please check the site & complete your individual entry

> in

> the data base so we can all know who we are!

>

> Is anyone keeping a list of all these great suggestions??? ???

>

> Yup, I've got them. Which brings up another friendly

> reminder-anyone who hasn't completed the poll re: next year's Forum on the

>

> eGroups site, please try to do so by the end of the week. Your feedback

> is

> VERY important in planning these sessions!!

>

> Thanks,

>

> J. Aguiar

> Beth Israel Deaconess, Boston

>

> ------------------------------------------------------------------------

> Where do sports heroes like Jeter, Mia Hamm,

> Vince and Peyton Manning hang out? Where else?

> Click now and find 'em all here!

> http://click./1/6211/1/_/_/_/962890104/

> ------------------------------------------------------------------------

>

>

[Guest guest]

But even after transplant Medicare would be secondary for the coordination

period and the only benefit I can see is if they lose their insurance.

>>> kchriste@... 07/12/00 10:24AM >>>

I am with Northwestern Memorial Hospital in Chicago, and as for the Medicare

issue with our Kidney recipients I give them the option if they have a

commercial insurance. I first send a letter to the patient telling them

that they are eligible for Medicare. I than ask the patient how is the

payment of the medications prior to transplant. If it is good I suggest

that they could wait until the transplant to apply for Medicare that way

they are not paying for Medicare and not benefiting from it. Also, Medicare

is a non issue unless they are dialysising.

Karla Christensen

> RE: Re[2]: new kid on the block

>

>

> Hi Again

>

> I have an issue that just came up on a donor with an open wound that the

> insurance company of the recepient is refusing to pay. Have any of you run

>

> into this. According to the patient he states his insurance also refuses

> to

> pay. I think the transplant center is ultimately responsible but for how

> long?

>

> Thanks

>

>

>

> >>> LAguiar@... 07/06/00 09:25AM >>>

> Hi a & welcome back!

>

> Of course, the first thing is to try to read thru all these email messages

>

> from

> all you fellow TFCs!

>

> That's as it should be! :-)

>

> So... just a reminder to all to please at least write your name at the

> bottom of your messages. (thanks!)

>

> Good point, a. In case anyone forgets, though, if you check

> the

> message board on our eGroups site, the author's name (or e-mail address)

> is

> listed beside each message. I also want to encourage anyone who hasn't

> already done so to please check the site & complete your individual entry

> in

> the data base so we can all know who we are!

>

> Is anyone keeping a list of all these great suggestions??? ???

>

> Yup, I've got them. Which brings up another friendly

> reminder-anyone who hasn't completed the poll re: next year's Forum on the

>

> eGroups site, please try to do so by the end of the week. Your feedback

> is

> VERY important in planning these sessions!!

>

> Thanks,

>

> J. Aguiar

> Beth Israel Deaconess, Boston

>

> ------------------------------------------------------------------------

> Where do sports heroes like Jeter, Mia Hamm,

> Vince and Peyton Manning hang out? Where else?

> Click now and find 'em all here!

> http://click./1/6211/1/_/_/_/962890104/

> ------------------------------------------------------------------------

>

>

[Guest guest]

This is my argument exactly with the patients, but most of the time they

cannot afford the premium, so that is why I tell them they could than wait

until a transplant occurs. I have Medicare applications waiting in their

file and submit it to our clinic on the day they are transplanted.

Karla

> RE: Re[2]: new kid on the block

> >

> >

> > Hi Again

> >

> > I have an issue that just came up on a donor with an open wound that the

>

> > insurance company of the recepient is refusing to pay. Have any of you

> run

> >

> > into this. According to the patient he states his insurance also refuses

> > to

> > pay. I think the transplant center is ultimately responsible but for how

>

> > long?

> >

> > Thanks

> >

> >

> >

> > >>> LAguiar@... 07/06/00 09:25AM >>>

> > Hi a & welcome back!

> >

> > Of course, the first thing is to try to read thru all these email

> messages

> >

> > from

> > all you fellow TFCs!

> >

> > That's as it should be! :-)

> >

> > So... just a reminder to all to please at least write your name at the

> > bottom of your messages. (thanks!)

> >

> > Good point, a. In case anyone forgets, though, if you check

> > the

> > message board on our eGroups site, the author's name (or e-mail address)

> > is

> > listed beside each message. I also want to encourage anyone who hasn't

> > already done so to please check the site & complete your individual

> entry

> > in

> > the data base so we can all know who we are!

> >

> > Is anyone keeping a list of all these great suggestions??? ???

> >

> > Yup, I've got them. Which brings up another friendly

> > reminder-anyone who hasn't completed the poll re: next year's Forum on

> the

> >

> > eGroups site, please try to do so by the end of the week. Your feedback

> > is

> > VERY important in planning these sessions!!

> >

> > Thanks,

> >

> > J. Aguiar

> > Beth Israel Deaconess, Boston

> >

> > ------------------------------------------------------------------------

>

> > Where do sports heroes like Jeter, Mia Hamm,

> > Vince and Peyton Manning hang out? Where else?

> > Click now and find 'em all here!

> > http://click./1/6211/1/_/_/_/962890104/

> > ------------------------------------------------------------------------

> >

> >

[Guest guest]

I guess my question is what the benefits are after transplant since commercial

is still primary in most cases.

>>> kchriste@... 07/12/00 10:54AM >>>

This is my argument exactly with the patients, but most of the time they

cannot afford the premium, so that is why I tell them they could than wait

until a transplant occurs. I have Medicare applications waiting in their

file and submit it to our clinic on the day they are transplanted.

Karla

> RE: Re[2]: new kid on the block

> >

> >

> > Hi Again

> >

> > I have an issue that just came up on a donor with an open wound that the

>

> > insurance company of the recepient is refusing to pay. Have any of you

> run

> >

> > into this. According to the patient he states his insurance also refuses

> > to

> > pay. I think the transplant center is ultimately responsible but for how

>

> > long?

> >

> > Thanks

> >

> >

> >

> > >>> LAguiar@... 07/06/00 09:25AM >>>

> > Hi a & welcome back!

> >

> > Of course, the first thing is to try to read thru all these email

> messages

> >

> > from

> > all you fellow TFCs!

> >

> > That's as it should be! :-)

> >

> > So... just a reminder to all to please at least write your name at the

> > bottom of your messages. (thanks!)

> >

> > Good point, a. In case anyone forgets, though, if you check

> > the

> > message board on our eGroups site, the author's name (or e-mail address)

> > is

> > listed beside each message. I also want to encourage anyone who hasn't

> > already done so to please check the site & complete your individual

> entry

> > in

> > the data base so we can all know who we are!

> >

> > Is anyone keeping a list of all these great suggestions??? ???

> >

> > Yup, I've got them. Which brings up another friendly

> > reminder-anyone who hasn't completed the poll re: next year's Forum on

> the

> >

> > eGroups site, please try to do so by the end of the week. Your feedback

> > is

> > VERY important in planning these sessions!!

> >

> > Thanks,

> >

> > J. Aguiar

> > Beth Israel Deaconess, Boston

> >

> > ------------------------------------------------------------------------

>

> > Where do sports heroes like Jeter, Mia Hamm,

> > Vince and Peyton Manning hang out? Where else?

> > Click now and find 'em all here!

> > http://click./1/6211/1/_/_/_/962890104/

> > ------------------------------------------------------------------------

> >

> >

[Guest guest]

and if they have an insurance that does not pay total charges; such as 80-20

policies, etc.

>>> " anne Buccheri " 07/12/00 10:53AM >>>

But even after transplant Medicare would be secondary for the coordination

period and the only benefit I can see is if they lose their insurance.

>>> kchriste@... 07/12/00 10:24AM >>>

I am with Northwestern Memorial Hospital in Chicago, and as for the Medicare

issue with our Kidney recipients I give them the option if they have a

commercial insurance. I first send a letter to the patient telling them

that they are eligible for Medicare. I than ask the patient how is the

payment of the medications prior to transplant. If it is good I suggest

that they could wait until the transplant to apply for Medicare that way

they are not paying for Medicare and not benefiting from it. Also, Medicare

is a non issue unless they are dialysising.

Karla Christensen

> RE: Re[2]: new kid on the block

>

>

> Hi Again

>

> I have an issue that just came up on a donor with an open wound that the

> insurance company of the recepient is refusing to pay. Have any of you run

>

> into this. According to the patient he states his insurance also refuses

> to

> pay. I think the transplant center is ultimately responsible but for how

> long?

>

> Thanks

>

>

>

> >>> LAguiar@... 07/06/00 09:25AM >>>

> Hi a & welcome back!

>

> Of course, the first thing is to try to read thru all these email messages

>

> from

> all you fellow TFCs!

>

> That's as it should be! :-)

>

> So... just a reminder to all to please at least write your name at the

> bottom of your messages. (thanks!)

>

> Good point, a. In case anyone forgets, though, if you check

> the

> message board on our eGroups site, the author's name (or e-mail address)

> is

> listed beside each message. I also want to encourage anyone who hasn't

> already done so to please check the site & complete your individual entry

> in

> the data base so we can all know who we are!

>

> Is anyone keeping a list of all these great suggestions??? ???

>

> Yup, I've got them. Which brings up another friendly

> reminder-anyone who hasn't completed the poll re: next year's Forum on the

>

> eGroups site, please try to do so by the end of the week. Your feedback

> is

> VERY important in planning these sessions!!

>

> Thanks,

>

> J. Aguiar

> Beth Israel Deaconess, Boston

>

> ------------------------------------------------------------------------

> Where do sports heroes like Jeter, Mia Hamm,

> Vince and Peyton Manning hang out? Where else?

> Click now and find 'em all here!

> http://click./1/6211/1/_/_/_/962890104/

> ------------------------------------------------------------------------

>

>

[Guest guest]

Hi - my understanding is that Medicare will not pay for immunosuppression

medications unless Medicare coverage was in effect at the time of transplant and

they paid for the transplant. A copy of the Social Security Act regulation

regarding this matter was faxed to me in March 2000. Does anyone know anything

different from my understanding? Thanks. Arlene Gatto

>>> kchriste@... 07/12/00 10:54AM >>>

This is my argument exactly with the patients, but most of the time they

cannot afford the premium, so that is why I tell them they could than wait

until a transplant occurs. I have Medicare applications waiting in their

file and submit it to our clinic on the day they are transplanted.

Karla

> RE: Re[2]: new kid on the block

> >

> >

> > Hi Again

> >

> > I have an issue that just came up on a donor with an open wound that the

>

> > insurance company of the recepient is refusing to pay. Have any of you

> run

> >

> > into this. According to the patient he states his insurance also refuses

> > to

> > pay. I think the transplant center is ultimately responsible but for how

>

> > long?

> >

> > Thanks

> >

> >

> >

> > >>> LAguiar@... 07/06/00 09:25AM >>>

> > Hi a & welcome back!

> >

> > Of course, the first thing is to try to read thru all these email

> messages

> >

> > from

> > all you fellow TFCs!

> >

> > That's as it should be! :-)

> >

> > So... just a reminder to all to please at least write your name at the

> > bottom of your messages. (thanks!)

> >

> > Good point, a. In case anyone forgets, though, if you check

> > the

> > message board on our eGroups site, the author's name (or e-mail address)

> > is

> > listed beside each message. I also want to encourage anyone who hasn't

> > already done so to please check the site & complete your individual

> entry

> > in

> > the data base so we can all know who we are!

> >

> > Is anyone keeping a list of all these great suggestions??? ???

> >

> > Yup, I've got them. Which brings up another friendly

> > reminder-anyone who hasn't completed the poll re: next year's Forum on

> the

> >

> > eGroups site, please try to do so by the end of the week. Your feedback

> > is

> > VERY important in planning these sessions!!

> >

> > Thanks,

> >

> > J. Aguiar

> > Beth Israel Deaconess, Boston

> >

> > ------------------------------------------------------------------------

>

> > Where do sports heroes like Jeter, Mia Hamm,

> > Vince and Peyton Manning hang out? Where else?

> > Click now and find 'em all here!

> > http://click./1/6211/1/_/_/_/962890104/

> > ------------------------------------------------------------------------

> >

> >

[Guest guest]

You are correct, they have to be on Medicare or Medicare eligible as in

applied to the program (for example never dialyzed, got a TX and applied at

that time,)for Medicare to cover meds.

RE: Re[2]: new kid on the block

> >

> >

> > Hi Again

> >

> > I have an issue that just came up on a donor with an open wound that the

>

> > insurance company of the recepient is refusing to pay. Have any of you

> run

> >

> > into this. According to the patient he states his insurance also refuses

> > to

> > pay. I think the transplant center is ultimately responsible but for how

>

> > long?

> >

> > Thanks

> >

> >

> >

> > >>> LAguiar@... 07/06/00 09:25AM >>>

> > Hi a & welcome back!

> >

> > Of course, the first thing is to try to read thru all these email

> messages

> >

> > from

> > all you fellow TFCs!

> >

> > That's as it should be! :-)

> >

> > So... just a reminder to all to please at least write your name at the

> > bottom of your messages. (thanks!)

> >

> > Good point, a. In case anyone forgets, though, if you check

> > the

> > message board on our eGroups site, the author's name (or e-mail address)

> > is

> > listed beside each message. I also want to encourage anyone who hasn't

> > already done so to please check the site & complete your individual

> entry

> > in

> > the data base so we can all know who we are!

> >

> > Is anyone keeping a list of all these great suggestions??? ???

> >

> > Yup, I've got them. Which brings up another friendly

> > reminder-anyone who hasn't completed the poll re: next year's Forum on

> the

> >

> > eGroups site, please try to do so by the end of the week. Your feedback

> > is

> > VERY important in planning these sessions!!

> >

> > Thanks,

> >

> > J. Aguiar

> > Beth Israel Deaconess, Boston

> >

> > ------------------------------------------------------------------------

>

> > Where do sports heroes like Jeter, Mia Hamm,

> > Vince and Peyton Manning hang out? Where else?

> > Click now and find 'em all here!

> > http://click./1/6211/1/_/_/_/962890104/

> > ------------------------------------------------------------------------

> >

> >

[Guest guest]

That's my understanding too Arlene. Could you fax me a copy of the reg. @

. I like to keep copies of these so I don't have to search

through the registry.

RE: Re[2]: new kid on the

block

> >

> >

> > Hi Again

> >

> > I have an issue that just came up on a donor with an open wound

that the

>

> > insurance company of the recepient is refusing to pay. Have any

of you

> run

> >

> > into this. According to the patient he states his insurance also

refuses

> > to

> > pay. I think the transplant center is ultimately responsible but

for how

>

> > long?

> >

> > Thanks

> >

> >

> >

> > >>> LAguiar@... 07/06/00 09:25AM >>>

> > Hi a & welcome back!

> >

> > Of course, the first thing is to try to read thru all these

email

> messages

> >

> > from

> > all you fellow TFCs!

> >

> > That's as it should be! :-)

> >

> > So... just a reminder to all to please at least write your name

at the

> > bottom of your messages. (thanks!)

> >

> > Good point, a. In case anyone forgets, though, if

you check

> > the

> > message board on our eGroups site, the author's name (or e-mail

address)

> > is

> > listed beside each message. I also want to encourage anyone who

hasn't

> > already done so to please check the site & complete your

individual

> entry

> > in

> > the data base so we can all know who we are!

> >

> > Is anyone keeping a list of all these great suggestions???

???

> >

> > Yup, I've got them. Which brings up another friendly

> > reminder-anyone who hasn't completed the poll re: next year's

Forum on

> the

> >

> > eGroups site, please try to do so by the end of the week. Your

feedback

> > is

> > VERY important in planning these sessions!!

> >

> > Thanks,

> >

> > J. Aguiar

> > Beth Israel Deaconess, Boston

> >

> >

------------------------------------------------------------------------

>

> > Where do sports heroes like Jeter, Mia Hamm,

> > Vince and Peyton Manning hang out? Where else?

> > Click now and find 'em all here!

> > http://click./1/6211/1/_/_/_/962890104/

> >

------------------------------------------------------------------------

> >

> >

[Guest guest]

This is true but few of my living related patients ever reach the point that

Medicare pays because of the 30 month cordination period and most are HMO not

80/20 indemnity plans.

>>> GATTOA@... 07/12/00 11:35AM >>>

Hi - my understanding is that Medicare will not pay for immunosuppression

medications unless Medicare coverage was in effect at the time of transplant and

they paid for the transplant. A copy of the Social Security Act regulation

regarding this matter was faxed to me in March 2000. Does anyone know anything

different from my understanding? Thanks. Arlene Gatto

>>> kchriste@... 07/12/00 10:54AM >>>

This is my argument exactly with the patients, but most of the time they

cannot afford the premium, so that is why I tell them they could than wait

until a transplant occurs. I have Medicare applications waiting in their

file and submit it to our clinic on the day they are transplanted.

Karla

> RE: Re[2]: new kid on the block

> >

> >

> > Hi Again

> >

> > I have an issue that just came up on a donor with an open wound that the

>

> > insurance company of the recepient is refusing to pay. Have any of you

> run

> >

> > into this. According to the patient he states his insurance also refuses

> > to

> > pay. I think the transplant center is ultimately responsible but for how

>

> > long?

> >

> > Thanks

> >

> >

> >

> > >>> LAguiar@... 07/06/00 09:25AM >>>

> > Hi a & welcome back!

> >

> > Of course, the first thing is to try to read thru all these email

> messages

> >

> > from

> > all you fellow TFCs!

> >

> > That's as it should be! :-)

> >

> > So... just a reminder to all to please at least write your name at the

> > bottom of your messages. (thanks!)

> >

> > Good point, a. In case anyone forgets, though, if you check

> > the

> > message board on our eGroups site, the author's name (or e-mail address)

> > is

> > listed beside each message. I also want to encourage anyone who hasn't

> > already done so to please check the site & complete your individual

> entry

> > in

> > the data base so we can all know who we are!

> >

> > Is anyone keeping a list of all these great suggestions??? ???

> >

> > Yup, I've got them. Which brings up another friendly

> > reminder-anyone who hasn't completed the poll re: next year's Forum on

> the

> >

> > eGroups site, please try to do so by the end of the week. Your feedback

> > is

> > VERY important in planning these sessions!!

> >

> > Thanks,

> >

> > J. Aguiar

> > Beth Israel Deaconess, Boston

> >

> > ------------------------------------------------------------------------

>

> > Where do sports heroes like Jeter, Mia Hamm,

> > Vince and Peyton Manning hang out? Where else?

> > Click now and find 'em all here!

> > http://click./1/6211/1/_/_/_/962890104/

> > ------------------------------------------------------------------------

> >

> >

[Guest guest]

Hi Mike - I just tried to fax this over to you. Let me know if you get it.

Take care. Arlene

>>> mchaney@... 07/12/00 11:48AM >>>

That's my understanding too Arlene. Could you fax me a copy of the reg. @

. I like to keep copies of these so I don't have to search

through the registry.

RE: Re[2]: new kid on the

block

> >

> >

> > Hi Again

> >

> > I have an issue that just came up on a donor with an open wound

that the

>

> > insurance company of the recepient is refusing to pay. Have any

of you

> run

> >

> > into this. According to the patient he states his insurance also

refuses

> > to

> > pay. I think the transplant center is ultimately responsible but

for how

>

> > long?

> >

> > Thanks

> >

> >

> >

> > >>> LAguiar@... 07/06/00 09:25AM >>>

> > Hi a & welcome back!

> >

> > Of course, the first thing is to try to read thru all these

email

> messages

> >

> > from

> > all you fellow TFCs!

> >

> > That's as it should be! :-)

> >

> > So... just a reminder to all to please at least write your name

at the

> > bottom of your messages. (thanks!)

> >

> > Good point, a. In case anyone forgets, though, if

you check

> > the

> > message board on our eGroups site, the author's name (or e-mail

address)

> > is

> > listed beside each message. I also want to encourage anyone who

hasn't

> > already done so to please check the site & complete your

individual

> entry

> > in

> > the data base so we can all know who we are!

> >

> > Is anyone keeping a list of all these great suggestions???

???

> >

> > Yup, I've got them. Which brings up another friendly

> > reminder-anyone who hasn't completed the poll re: next year's

Forum on

> the

> >

> > eGroups site, please try to do so by the end of the week. Your

feedback

> > is

> > VERY important in planning these sessions!!

> >

> > Thanks,

> >

> > J. Aguiar

> > Beth Israel Deaconess, Boston

> >

> >

------------------------------------------------------------------------

>

> > Where do sports heroes like Jeter, Mia Hamm,

> > Vince and Peyton Manning hang out? Where else?

> > Click now and find 'em all here!

> > http://click./1/6211/1/_/_/_/962890104/

> >

------------------------------------------------------------------------

> >

> >

[Guest guest]

Got it tnx!!!

RE: Re[2]: new kid on

the

block

> >

> >

> > Hi Again

> >

> > I have an issue that just came up on a donor with an

open wound

that the

>

> > insurance company of the recepient is refusing to pay.

Have any

of you

> run

> >

> > into this. According to the patient he states his

insurance also

refuses

> > to

> > pay. I think the transplant center is ultimately

responsible but

for how

>

> > long?

> >

> > Thanks

> >

> >

> >

> > >>> LAguiar@... 07/06/00 09:25AM >>>

> > Hi a & welcome back!

> >

> > Of course, the first thing is to try to read thru all

these

email

> messages

> >

> > from

> > all you fellow TFCs!

> >

> > That's as it should be! :-)

> >

> > So... just a reminder to all to please at least write

your name

at the

> > bottom of your messages. (thanks!)

> >

> > Good point, a. In case anyone forgets,

though, if

you check

> > the

> > message board on our eGroups site, the author's name (or

e-mail

address)

> > is

> > listed beside each message. I also want to encourage

anyone who

hasn't

> > already done so to please check the site & complete your

individual

> entry

> > in

> > the data base so we can all know who we are!

> >

> > Is anyone keeping a list of all these great

suggestions???

???

> >

> > Yup, I've got them. Which brings up another

friendly

> > reminder-anyone who hasn't completed the poll re: next

year's

Forum on

> the

> >

> > eGroups site, please try to do so by the end of the

week. Your

feedback

> > is

> > VERY important in planning these sessions!!

> >

> > Thanks,

> >

> > J. Aguiar

> > Beth Israel Deaconess, Boston

> >

> >

------------------------------------------------------------------------

>

> > Where do sports heroes like Jeter, Mia Hamm,

> > Vince and Peyton Manning hang out? Where else?

> > Click now and find 'em all here!

> > http://click./1/6211/1/_/_/_/962890104/

> >

------------------------------------------------------------------------

> >

> >

[Guest guest]

Arlene;

Patients are eligible either 3 months following the start of dialysis or the

1st of the month of which a transplant is received. Medicare does not need

to pay for the transplant in order to pay for the immunosuppressive drugs.

I have been doing this for 12 years and this is the rule I always went by.

Karla Christensen

> RE: Re[2]: new kid on the

> block

> > >

> > >

> > > Hi Again

> > >

> > > I have an issue that just came up on a donor with an open wound

> that the

> >

> > > insurance company of the recepient is refusing to pay. Have any

> of you

> > run

> > >

> > > into this. According to the patient he states his insurance also

> refuses

> > > to

> > > pay. I think the transplant center is ultimately responsible but

> for how

> >

> > > long?

> > >

> > > Thanks

> > >

> > >

> > >

> > > >>> LAguiar@... 07/06/00 09:25AM >>>

> > > Hi a & welcome back!

> > >

> > > Of course, the first thing is to try to read thru all these

> email

> > messages

> > >

> > > from

> > > all you fellow TFCs!

> > >

> > > That's as it should be! :-)

> > >

> > > So... just a reminder to all to please at least write your name

> at the

> > > bottom of your messages. (thanks!)

> > >

> > > Good point, a. In case anyone forgets, though, if

> you check

> > > the

> > > message board on our eGroups site, the author's name (or e-mail

> address)

> > > is

> > > listed beside each message. I also want to encourage anyone who

> hasn't

> > > already done so to please check the site & complete your

> individual

> > entry

> > > in

> > > the data base so we can all know who we are!

> > >

> > > Is anyone keeping a list of all these great suggestions???

> ???

> > >

> > > Yup, I've got them. Which brings up another friendly

> > > reminder-anyone who hasn't completed the poll re: next year's

> Forum on

> > the

> > >

> > > eGroups site, please try to do so by the end of the week. Your

> feedback

> > > is

> > > VERY important in planning these sessions!!

> > >

> > > Thanks,

> > >

> > > J. Aguiar

> > > Beth Israel Deaconess, Boston

> > >

> > >

> ------------------------------------------------------------------------

> >

> > > Where do sports heroes like Jeter, Mia Hamm,

> > > Vince and Peyton Manning hang out? Where else?

> > > Click now and find 'em all here!

> > > http://click./1/6211/1/_/_/_/962890104/

> > >

> ------------------------------------------------------------------------

> > >

> > >

[Guest guest]

Hi Karla - thanks for the information. I reread the regulation and it

states.....prescription drugs for immunsuppression therapy....individual who

receives an organ transplant for which payment is made under this

title......during any year after 1997 within 36 months after the date of the

transplant procedure. Does this mean there is still the 36 month coverage for

the medications after the transplant and the coordination of benefits? I can

fax you over a copy of the regulation, if you wish. Just send me your fax

number! Arlene

>>> kchriste@... 07/12/00 12:57PM >>>

Arlene;

Patients are eligible either 3 months following the start of dialysis or the

1st of the month of which a transplant is received. Medicare does not need

to pay for the transplant in order to pay for the immunosuppressive drugs.

I have been doing this for 12 years and this is the rule I always went by.

Karla Christensen

> RE: Re[2]: new kid on the

> block

> > >

> > >

> > > Hi Again

> > >

> > > I have an issue that just came up on a donor with an open wound

> that the

> >

> > > insurance company of the recepient is refusing to pay. Have any

> of you

> > run

> > >

> > > into this. According to the patient he states his insurance also

> refuses

> > > to

> > > pay. I think the transplant center is ultimately responsible but

> for how

> >

> > > long?

> > >

> > > Thanks

> > >

> > >

> > >

> > > >>> LAguiar@... 07/06/00 09:25AM >>>

> > > Hi a & welcome back!

> > >

> > > Of course, the first thing is to try to read thru all these

> email

> > messages

> > >

> > > from

> > > all you fellow TFCs!

> > >

> > > That's as it should be! :-)

> > >

> > > So... just a reminder to all to please at least write your name

> at the

> > > bottom of your messages. (thanks!)

> > >

> > > Good point, a. In case anyone forgets, though, if

> you check

> > > the

> > > message board on our eGroups site, the author's name (or e-mail

> address)

> > > is

> > > listed beside each message. I also want to encourage anyone who

> hasn't

> > > already done so to please check the site & complete your

> individual

> > entry

> > > in

> > > the data base so we can all know who we are!

> > >

> > > Is anyone keeping a list of all these great suggestions???

> ???

> > >

> > > Yup, I've got them. Which brings up another friendly

> > > reminder-anyone who hasn't completed the poll re: next year's

> Forum on

> > the

> > >

> > > eGroups site, please try to do so by the end of the week. Your

> feedback

> > > is

> > > VERY important in planning these sessions!!

> > >

> > > Thanks,

> > >

> > > J. Aguiar

> > > Beth Israel Deaconess, Boston

> > >

> > >

> ------------------------------------------------------------------------

> >

> > > Where do sports heroes like Jeter, Mia Hamm,

> > > Vince and Peyton Manning hang out? Where else?

> > > Click now and find 'em all here!

> > > http://click./1/6211/1/_/_/_/962890104/

> > >

> ------------------------------------------------------------------------

> > >

> > >

[Guest guest]

My fax number is .

Thank you.

Karla

> RE: Re[2]: new kid on the

> > block

> > > >

> > > >

> > > > Hi Again

> > > >

> > > > I have an issue that just came up on a donor with an open wound

> > that the

> > >

> > > > insurance company of the recepient is refusing to pay. Have any

> > of you

> > > run

> > > >

> > > > into this. According to the patient he states his insurance also

> > refuses

> > > > to

> > > > pay. I think the transplant center is ultimately responsible but

> > for how

> > >

> > > > long?

> > > >

> > > > Thanks

> > > >

> > > >

> > > >

> > > > >>> LAguiar@... 07/06/00 09:25AM >>>

> > > > Hi a & welcome back!

> > > >

> > > > Of course, the first thing is to try to read thru all these

> > email

> > > messages

> > > >

> > > > from

> > > > all you fellow TFCs!

> > > >

> > > > That's as it should be! :-)

> > > >

> > > > So... just a reminder to all to please at least write your name

> > at the

> > > > bottom of your messages. (thanks!)

> > > >

> > > > Good point, a. In case anyone forgets, though, if

> > you check

> > > > the

> > > > message board on our eGroups site, the author's name (or e-mail

> > address)

> > > > is

> > > > listed beside each message. I also want to encourage anyone who

> > hasn't

> > > > already done so to please check the site & complete your

> > individual

> > > entry

> > > > in

> > > > the data base so we can all know who we are!

> > > >

> > > > Is anyone keeping a list of all these great suggestions???

> > ???

> > > >

> > > > Yup, I've got them. Which brings up another friendly

> > > > reminder-anyone who hasn't completed the poll re: next year's

> > Forum on

> > > the

> > > >

> > > > eGroups site, please try to do so by the end of the week. Your

> > feedback

> > > > is

> > > > VERY important in planning these sessions!!

> > > >

> > > > Thanks,

> > > >

> > > > J. Aguiar

> > > > Beth Israel Deaconess, Boston

> > > >

> > > >

> > ------------------------------------------------------------------------

> > >

> > > > Where do sports heroes like Jeter, Mia Hamm,

> > > > Vince and Peyton Manning hang out? Where else?

> > > > Click now and find 'em all here!

> > > > http://click./1/6211/1/_/_/_/962890104/

> > > >

> > ------------------------------------------------------------------------

> > > >

> > > >

[Guest guest]

Hi :

Anyone with a live donor is definitely advised to sign up for Medicare; without

it, the recipient will be liable for donor charges not covered by the commercial

ins. if complications arise as a result of the donation. Very few of our

patients actually decline Medicare because the Part B premium is really quite

minimal compared to the copays and deductibles left over after the commercial

insurance pays (most of our patients are covered by 80/20 plans). However, I

always advise patients to speak with a social security representative before

making a final decision not to apply for Medicare.

Also, in response to one of your other questions regarding billing recipient and

donor evaluations to Kidney Acquisition, this is currently the way we handle it.

In the past, we were billing these evals to the commercial insurance of the

recipient if it was primary but in speaking with our " Medicare Expert " recently,

he advised us to bill them all to KACC because if the patient is transplanted

after the 30 month COB period, then Medicare will pay the organ acquisition

charge which includes the cost of evaluation. He said that if you bill the eval

to the commercial ins. and then tx the patient with Medicare primary and include

the organ acquisition charge on your cost report, then you need to reimburse the

commercial insurance for the cost of the evaluation; otherwise, it is double

billing!!! In summary, he felt that this was the safest practice because it

would be too difficult for record keeping purposes. Has anyone else heard

this??? It seems to me like everyone handles these things in a different way

which just adds to all of our confusion!! Hope this helps.

Nadine Gruidl

UMC, Las Vegas

>>> anne Buccheri 07/12/00 06:56AM >>>

Hi Everyone

Do those regs apply only to Medicare beneficiaries or to all donors? What if the

recepient does not have Medicare? Also,is there any advantage to having living

related recepients sign up for Medicare if they have commercial insurance? I

know some centers require this but often patients are reluctant to pay. How do

your centers handle this?

Thanks

>>> sdg2944@... 07/11/00 04:37PM >>>

I have a copy of the regs that we follow at . It is called Medicare

Intermediary Manual, Part 3 (HCFA-Pub. 13-3 ) Titled 3178.9 Post-Transplant

Services Provided to Live Donor

It states: Paragraph 2

Coverage of kidney donor services includes postoperative recovery services

directly related to the kidney donation The period of postoperative recovery

ceases when the donor no longer exhibits symptoms related to the kidney

donation. Claims for services rendered more than 3 months after donation

surgery will be reviewed carefully. However, follow-up examinations may be

covered up to 6 months after the donation to monitor for possible complications.

Here at we have paid bills greater than 6 months as long as our docs say

that the problem is due to donation. Per our Medicare " EXPERT " here at the

hospital, as long as we have documention that it is donation related we are

covered.

Sandy Gray

>>> paula_summa@... 07/11/00 08:39AM >>>

,

Where in the regs does it specify 3 months post? Our data processing

coordinator recently told us that UNOS is asking for post tx followup

info on donors up to 1 year post. Is this not also billable?

a

______________________________ Reply Separator _________________________________

Subject: RE: Re[2]: new kid on the block

Author: <TxFinancialCoordinatorsegroups> at INTERNET

Date: 07/11/2000 10:31 AM

,

Are you talking about a kidney donor? If so, the Medicare regs specify

3 mos post-tx f/u of the donor. This kind of policy issue, f/u care for

donors (lung, liver, kidney) is one tx ctrs should establish & make the

donors aware of during the eval process, in my opinion anyway.

RE: Re[2]: new kid on the block

Hi Again

I have an issue that just came up on a donor with an open wound that the

insurance company of the recepient is refusing to pay. Have any of you run

into this. According to the patient he states his insurance also refuses to

pay. I think the transplant center is ultimately responsible but for how

long?

Thanks

>>> LAguiar@... 07/06/00 09:25AM >>>

Hi a & welcome back!

Of course, the first thing is to try to read thru all these email messages

from

all you fellow TFCs!

That's as it should be! :-)

So... just a reminder to all to please at least write your name at the

bottom of your messages. (thanks!)

Good point, a. In case anyone forgets, though, if you check the

message board on our eGroups site, the author's name (or e-mail address) is

listed beside each message. I also want to encourage anyone who hasn't

already done so to please check the site & complete your individual entry in

the data base so we can all know who we are!

Is anyone keeping a list of all these great suggestions??? ???

Yup, I've got them. Which brings up another friendly

reminder-anyone who hasn't completed the poll re: next year's Forum on the

eGroups site, please try to do so by the end of the week. Your feedback is

VERY important in planning these sessions!!

Thanks,

J. Aguiar

Beth Israel Deaconess, Boston

------------------------------------------------------------------------

Where do sports heroes like Jeter, Mia Hamm,

Vince and Peyton Manning hang out? Where else?

Click now and find 'em all here!

http://click./1/6211/1/_/_/_/962890104/

------------------------------------------------------------------------