Guest guest Posted May 15, 2001 Report Share Posted May 15, 2001 If he is transplanted within 60 days of his initial visit for work-up for living related it goes back to the 1st day in the month the work-up began. Otherwise, he is eligible for Medicare the 1st day of the month in which he is transplanted. Bev Larson, Sentara NGH Norfolk 668-3676 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 3, 2001 Report Share Posted August 3, 2001 Hi , As long as the patient is Medicare eligible, the Medicare will be secondary to the HMO for the first 30 months (effective the first date of the month of the transplant). After the 30 month COB, Medicare will become primary. My understanding is that as long as there is Medicare secondary, the patient is not responsible for the copay/deductible with their private insurance, Medicare can be billed for those charges. (altho Medicare won't actually pay it, the patient should not be billed) This is how we handle it here. a Summa TransLife/Florida Hospital Medicare Hello everyone ! Happy Friday ! I have a question. Say that a pt not yet on dialysis recs kidney tx. He/She will be eligible for Medicare at time of tx. I understand that. Patient has HMO insurance also. Would the Medicare be primary from date of transplant? If the patient has a inpatient copay/deductible with their private insurance, would they still be responsible for that copay/deductible? I'm confused. Any input would be appreciated. Thanks Donovan Transplant Financial Coordinator SUNY Upstate Medical University Syracuse, New York 13210 PH: FAX: Donovanl@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 3, 2001 Report Share Posted August 3, 2001 > Hello everyone ! > Happy Friday ! > I have a question. Say that a pt not yet on dialysis recs kidney tx. He/She will be eligible for Medicare at time of tx. I understand that. Patient has HMO insurance also. Would the Medicare be primary from date of transplant? [Aguiar, ] The standard ESRD COB rules will still apply, but instead of starting the 30 month clock @ the time the pt starts dialysis, you'll be starting it @ the time the pt has the tx. The pt doesn't automatically become Medicare primary just because he/she has a tx. > If the patient has a inpatient copay/deductible with their private > insurance, would they still be responsible for that pay/deductible? [Aguiar, ] If the private ins is primary, yes. Of course, it should be billed into Medicare & , hopefully picked up by Medicare, but the benefits on the private insurance don't necessarily change because the pt has picked up a secondary ins. J. Aguiar Beth Israel Deaconess, Boston Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2001 Report Share Posted October 17, 2001 : This issue came up at my program recently and I was told by the pharmacy (StatScript) that Mcre will pay the copay for the IMS drugs. I think the key is to have the meds filled by a pharmacy that will bill Mcre. Hope this helps. Nadine Gruidl UMC Las Vegas >>> Donovanl@... 10/16/01 09:56AM >>> I have a question on Medicare coverage for immunosuppression medications. If a patient has a kidney transplant without starting dialysis, I know that Medicare will begin at time of tranplant as secondary. Here is my question. Patient has private insurance as primary with a prescription policy that they will be responsible for a $10 copay for each medication. Will Medicare pick up 80% of that copay? The Medicare coverage of kidney transplants book does not answer that question. Hopefully, you can help me out. Thanks. Donovan Transplant Financial Coordinator SUNY Upstate Medical University 750 East Street Syracuse, New York 13210 PH: FAX: Donovanl@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 20, 2002 Report Share Posted December 20, 2002 The Center for Medicare and Medicaid (formerly HCFA) has a congressional liaison that is very helpful. The only way to access her is to have the patient contact their representative's office and go thru them. This has worked for me in the past on many different issues. Debbie Lamberger, MPASocial Work SpecialistClinical TransplantOregon Health & Sciences University phone faxLamberge@...>>> Donovanl@... 12/20/02 07:05AM >>>Good morning.I have a question. I have a patient who started dialysis 4/96 and hadapplied for Medicare at that time. He had a kidney transplant in 5/96, butthe effective date of the Medicare is 7/96 as they went by the dialysisstart date with the 3 month waiting period. This was never corrected once hewas transplanted. He now needs to use the Medicare benefits to help him withhis immunos. Medicare will not pay as the effective date was incorrect. Isthere any way to correct this? He was Medicare eligible at the time of histransplant, and Medicare must have made an error somewhere and the patientdid not notice this as he had private insurance at the time, and Medicarewas secondary. Any suggestions? DonovanTransplant Financial CoordinatorSUNY Upstate Medical University750 East StreetSyracuse, New York 13210PH: FAX: Donovanl@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2003 Report Share Posted March 5, 2003 We've had this experience before & I researched it at that time. Even though a patient has the option of applying for Medicare, their primary insurance during the 30 month coordination period can decide to pay as a secondary after the 30 months coord. period ends. They feel they should not have to pay the brunt of the cost if there is another insurance that should be primary. >>> Donovanl@... 03/05/03 07:55AM >>> I was hoping that someone can help me with this. Are patients who are eligible for Medicare due to esrd required to purchase it? It says in the book that it is optional but I am finding if they opt not to take it once the 30 month cob period is over and Medicare would have been primary, the private insurance company expects Medicare to pay first and will not process claims until they do. Do patients who opt not to take the Medicare become responsible after the 30 months? Confusing! Any advise would be appreciated. Donovan Transplant Financial Coordinator SUNY Upstate Medical University 750 East Street Syracuse, New York 13210 PH: FAX: Donovanl@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 1, 2003 Report Share Posted April 1, 2003 Yes, for the life or the organ under Part B if the pt is enrolled in Part B and Medicare PAID for the organ tx. MSC medicare Good afternoon- I had a patient ask me something today and I need a little assistance. My facility has a kidney, k/p program so I am not educated very much on the other organs. Patients question is this: If you are Medicare eligible and receive an organ (heart, liver, etc...not kidney) will Medicare cover the same immuno's that they cover for kidneys? or is this only an esrd covered service? thanks Donovan Transplant Financial Coordinator SUNY Upstate Medical University 750 East Street Syracuse, New York 13210 PH: FAX: Donovanl@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2003 Report Share Posted November 4, 2003 For the life of me I can't remember the rule to the following question. When a patient is drawing Medicare based on age at the time they have a kidney transplant does Medicare pay for their anti rejections drugs for the rest of their life? I have looked over my data and can't find the answer ---thanks in advance for your help. LJM in OKC LEONA JOYCE MOSELEY,SR. PSR OU MEDICAL CENTER ADMITTING & TRANSPLANT FINANCIAL SERVICES PHONE # FAX # E-MAIL ADDRESS: Leona.Moseley@... BE AN ORGAN DONOR Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2003 Report Share Posted November 4, 2003 If a patient has Medicare Part A in place at time of transplant & receives the transplant at a Medicare approved center for transplant, the patient will have immunos benefits so long as Medicare stays in effect. They must have Part B at time of purchase of the meds. MEDICARE For the life of me I can't remember the rule to the following question. When a patient is drawing Medicare based on age at the time they have a kidney transplant does Medicare pay for their anti rejections drugs for the rest of their life? I have looked over my data and can't find the answer ---thanks in advance for your help. LJM in OKC LEONA JOYCE MOSELEY,SR. PSR OU MEDICAL CENTER ADMITTING & TRANSPLANT FINANCIAL SERVICES PHONE # FAX # E-MAIL ADDRESS: Leona.Moseley@... BE AN ORGAN DONOR Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2003 Report Share Posted November 4, 2003 The patient has to send in the #2728 form after transplant, assuming that is the qualifying event, so he has ESRD entitlement flagged on his SS record. Otherwise Rx claims would not be paid. Fred Forsthoffer, MBA Financial Analyst Banner Good Samaritan Transplant Services Ph: ; Fax: MEDICARE For the life of me I can't remember the rule to the following question. When a patient is drawing Medicare based on age at the time they have a kidney transplant does Medicare pay for their anti rejections drugs for the rest of their life? I have looked over my data and can't find the answer ---thanks in advance for your help. LJM in OKC LEONA JOYCE MOSELEY,SR. PSR OU MEDICAL CENTER ADMITTING & TRANSPLANT FINANCIAL SERVICES PHONE # FAX # E-MAIL ADDRESS: Leona.Moseley@... BE AN ORGAN DONOR Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2003 Report Share Posted November 5, 2003 I did not think a patient could submit at 2728. The claim should still be paid because he already has Medicare due to age. L. Woodward Renal Transplant Financial Coordinator Univ of Ark for Med Sciences (501)603-1007 FAX Quote Link to comment Share on other sites More sharing options...
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