Re: A brand new question: Medicare coverage for the living donor

[Guest guest]

a, send me your fax # and I will send a copy of some documents which

states how professional charges are to be billed. -

a Summa wrote:

> Hi all!

> I would like to get some feed back from you on the following issue:

>

> I have a kidney recipient who's living donor's professional fees

> for the transplant admission are not being paid. Apparently, the

> pro-fees were initally being billed to the recipient's managed care

> plan. They denied- " no coverage for this service " . Rather than bill

> the recipient's Medicare, the provider billed the donor's insurance!

> After recving a denial, now they are billing the donor directly.

> When we asked them to bill the recipient's Medicare instead, they are

> asking for " proof that Medicare will pay this " ...

> thus, my question to you is:

> Is there anything, anywhere, in writing, that states how Medicare

> covers the living donor's hospital professional fees? We all know that

> the evaulation goes to Kidney Acquisition, as well as the hospital

> admit. But, where does it say that the " pro-fees " go directly to the

> recipient's Medicare? We know this is how it is done... but I am being

> asked for something from the Medicare regs showing this to be factual.

>

> If anyone can steer me in the right direction, I would greatly

> appreciate it! Thanking you all in advance.....

> a

>

>

>

[Guest guest]

a

I believe this is stated in the Medicare reqs. 3178.10 Physicians Services-

Expenses for physicians services to the donor are treated as though they had

been incurred by the recipient. Hope this helps

B.

Hartford Transplant Program

>>> paula_summa@... 11/10/00 01:33PM >>>

Hi all!

I would like to get some feed back from you on the following issue:

I have a kidney recipient who's living donor's professional fees

for the transplant admission are not being paid. Apparently, the

pro-fees were initally being billed to the recipient's managed care

plan. They denied- " no coverage for this service " . Rather than bill

the recipient's Medicare, the provider billed the donor's insurance!

After recving a denial, now they are billing the donor directly.

When we asked them to bill the recipient's Medicare instead, they are

asking for " proof that Medicare will pay this " ...

thus, my question to you is:

Is there anything, anywhere, in writing, that states how Medicare

covers the living donor's hospital professional fees? We all know that

the evaulation goes to Kidney Acquisition, as well as the hospital

admit. But, where does it say that the " pro-fees " go directly to the

recipient's Medicare? We know this is how it is done... but I am being

asked for something from the Medicare regs showing this to be factual.

If anyone can steer me in the right direction, I would greatly

appreciate it! Thanking you all in advance.....

a