Re: ESRD & Medicare COB

[Guest guest]

Dear Joanie,Any time a patient has large group employer insurance through a spouse or parent it will always be primary over Medicare.Dorinda S. Frye, ARC RepHematology/Oncology AkronHematology/Oncology Mahoning ValleyCraniofacial Office FaxJoanie Sage Joanie Sage Sent by: <TxFinancialCoordinators >11/11/2009 01:14 PMPlease respond to<TxFinancialCoordinators >To<TxFinancialCoordinators >ccSubject ESRD & Medicare COB Hello Everyone: My name is Joanie Sage. I am the new Transplant Financial Coordinator at Gulf Coast Med Center in Ft. Myers, FL. I took Pat Kreci's place. I have a question about Medicare COB and ESRD: If a patient took MC A based on age, but didn't take B right away, then took B based on ESRD, but the spouse still works and has BCBS of FL, how is the COB figured? Is it figured on the date they took A, the date they took B, or will Medicare remain secondary because the spouse works for a large group employer with more than 20 employees? Thank you!Joanie SageTransplant Financial CoordinatorGulf Coast Medical Center Rental Transplantjoan.sage@...

[Guest guest]

Medicare due to ESRD with EGHP-- First 30 months of Medicare

entitlement or eligibility, EGHP pays first, after 30 months, Medicare

becomes primary...EGHP size is not a factor...  

dfrye@... wrote:

 

Dear Joanie,

Any time a patient has large group employer insurance through a spouse

or parent it will always be primary over Medicare.

Dorinda S. Frye, ARC Rep

Hematology/Oncology Akron

Hematology/Oncology Mahoning Valley

Craniofacial

Office

Fax

Joanie

Sage <gulfcoastrenal@ yahoo.com>

Joanie Sage <gulfcoastrenal@ yahoo.com>

Sent by: <TxFinancialCoordina tors@yahoogroups .com>

11/11/2009 01:14 PM

Please respond to

<TxFinancialCoordina tors@yahoogroups .com>

To

<TxFinancialCoordina tors@yahoogroups .com>

cc

Subject

[TxFinancialCoordin ators] ESRD & Medicare COB

Hello Everyone:

My name is Joanie Sage. I am the new Transplant Financial

Coordinator at Gulf Coast Med Center in Ft. Myers, FL. I took Pat

Kreci's place. I have a question about Medicare COB and ESRD:

If a patient took MC A based on age, but didn't take B right

away, then took B based on ESRD, but the spouse still works and has

BCBS of FL, how is the COB figured? Is it figured on the date they took

A, the date they took B, or will Medicare remain secondary because the

spouse works for a large group employer with more than 20 employees?

Thank you!

Joanie Sage

Transplant Financial Coordinator

Gulf Coast Medical Center Rental Transplant

joan.sage@leememori al.org

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

This electronic message is intended to be for the use only of the named recipient, and may contain information that is confidential or privileged. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or use of the contents of this message is strictly prohibited. If you have received this message in error or are not the named recipient, please notify us immediately by contacting the sender at the electronic mail address noted above, and delete and destroy all copies of this message. Thank you.

[Guest guest]

Thank you, everyone, for your responses. I have been reading all the listserv e-mails every day since I started, and this is such a helpful tool!

To: TxFinancialCoordinators Sent: Wed, November 11, 2009 2:19:36 PMSubject: Re: ESRD & Medicare COB

Medicare due to ESRD with EGHP-- First 30 months of Medicare entitlement or eligibility, EGHP pays first, after 30 months, Medicare becomes primary...EGHP size is not a factor... dfrye@... wrote:

Dear Joanie,Any time a patient has large group employer insurance through a spouse or parent it will always be primary over Medicare.Dorinda S. Frye, ARC RepHematology/Oncology AkronHematology/Oncology Mahoning ValleyCraniofacial Office FaxJoanie Sage <gulfcoastrenal@ yahoo.com>

Joanie Sage <gulfcoastrenal@ yahoo.com> Sent by: <TxFinancialCoordina tors@yahoogroups .com> 11/11/2009 01:14 PM

Please respond to<TxFinancialCoordina tors@yahoogroups .com>

To

<TxFinancialCoordina tors@yahoogroups .com>

cc

Subject

[TxFinancialCoordin ators] ESRD & Medicare COB

Hello Everyone:

My name is Joanie Sage. I am the new Transplant Financial Coordinator at Gulf Coast Med Center in Ft. Myers, FL. I took Pat Kreci's place. I have a question about Medicare COB and ESRD:

If a patient took MC A based on age, but didn't take B right away, then took B based on ESRD, but the spouse still works and has BCBS of FL, how is the COB figured? Is it figured on the date they took A, the date they took B, or will Medicare remain secondary because the spouse works for a large group employer with more than 20 employees?

Thank you!

Joanie Sage

Transplant Financial Coordinator

Gulf Coast Medical Center Rental Transplant

joan.sage@leememori al.org

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

This electronic message is intended to be for the use only of the named recipient, and may contain information that is confidential or privileged. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or use of the contents of this message is strictly prohibited. If you have received this message in error or are not the named recipient, please notify us immediately by contacting the sender at the electronic mail address noted above, and delete and destroy all copies of this message. Thank you.

[Guest guest]

It’s my understanding that MSP regulations

detail that the original entitlement to Medicare drives the MSP rules. Joanie,

from your note it seems that the original entitlement is based upon age.

That means the LGHP rules apply. If the original entitlement was instead ESRD,

size of employer is unimportant and it’s all based upon months of

coordination.

You can use the Medicare enrollment system,

DDE, to identify the entitlement reason. That reason is a code

represented enxt to the DI label about ½ way down the DDE and on the

right. DI of 000 is age, 001 disabilty, 002 ESRD. There are more

when dual entitlement is involved.

Sheila Kantor

Manager, Patient Access Services Department

Sharp Metropolitan Medical Campus

(fax)

(pgr)

From:

TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of dfrye@...

Sent: Wednesday, November 11, 2009

10:26 AM

To:

TxFinancialCoordinators

Subject: Re:

ESRD & Medicare COB

Dear Joanie,

Any time a patient has large group employer insurance through a spouse or

parent it will always be primary over Medicare.

Dorinda S. Frye, ARC Rep

Hematology/Oncology Akron

Hematology/Oncology Mahoning Valley

Craniofacial

Office

Fax

Joanie

Sage <gulfcoastrenal>A

Joanie

Sage <gulfcoastrenal>

Sent by: <TxFinancialCoordinators >

11/11/2009 01:14 PM

Please respond to

<TxFinancialCoordinators >

To

<TxFinancialCoordinators >

cc

Subject

ESRD & Medicare COB

Hello

Everyone:

My name

is Joanie Sage. I am the new Transplant Financial Coordinator at Gulf Coast Med Center

in Ft. Myers, FL. I took Pat Kreci's place. I have a

question about Medicare COB and ESRD:

If a

patient took MC A based on age, but didn't take B right away, then took B based

on ESRD, but the spouse still works and has BCBS of FL, how is the COB figured?

Is it figured on the date they took A, the date they took B, or will Medicare

remain secondary because the spouse works for a large group employer with more

than 20 employees?

Thank

you!

Joanie

Sage

Transplant

Financial Coordinator

Gulf Coast

Medical Center Rental Transplant

(239)

343-1125

joan.sageleememorial (DOT) org

[Guest guest]

I believe that the

ESRD coordination rules will supersede the EGHP rules for this patient,

however. I might be wrong…

Blues primary initially

yes, because the patient’s wife actively works for LGHP, but after the

coordination period, even if wife still actively working, Medicare will be

primary. Sounds to me like perhaps your patient didn’t necessarily need

to sign up for part B just yet…

I’m a liver

girl, so forgive me if I’m wrong… so if another TFC is out there

who is an ESRD guru, chime in—I’m curious to double check my initial

thought on this one…

Meredith Gray

Liver Transplant Financial Coordinator

University of Rochester Medical

Center

601

Elmwood Avenue Box 602

Rochester,

NY 14642

(fax)

(pager)

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please advise sender by reply email and delete the message. Thank you!

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Joanie Sage

Sent: Wednesday, November 11, 2009

2:25 PM

To: TxFinancialCoordinators

Subject: Re:

ESRD & Medicare COB

Thank you, everyone, for your responses. I have been reading all

the listserv e-mails every day since I started, and this is such a helpful

tool!

From: Teressa Lawrence

<tel9017nyp (DOT) org>

To: TxFinancialCoordinators

Sent: Wed, November 11, 2009

2:19:36 PM

Subject: Re:

ESRD & Medicare COB

Medicare due to ESRD with EGHP-- First 30 months of Medicare entitlement or

eligibility, EGHP pays first, after 30 months, Medicare becomes primary...EGHP

size is not a factor...

dfryechmca (DOT) org wrote:

Dear Joanie,

Any time a patient has large group employer insurance through a spouse or

parent it will always be primary over Medicare.

Dorinda S. Frye, ARC Rep

Hematology/Oncology Akron

Hematology/Oncology Mahoning Valley

Craniofacial

Office

Fax

Joanie

Sage <gulfcoastrenal@ yahoo.com>

Joanie

Sage <gulfcoastrenal@ yahoo.com>

Sent by: <TxFinancialCoordina tors@yahoogroups .com>

11/11/2009 01:14 PM

Please respond to

<TxFinancialCoordina tors@yahoogroups .com>

To

<TxFinancialCoordina tors@yahoogroups .com>

cc

Subject

[TxFinancialCoordin ators] ESRD & Medicare COB

Hello

Everyone:

My name

is Joanie Sage. I am the new Transplant Financial Coordinator at Gulf Coast Med Center

in Ft. Myers, FL. I took Pat Kreci's place. I have a

question about Medicare COB and ESRD:

If a

patient took MC A based on age, but didn't take B right away, then took B based

on ESRD, but the spouse still works and has BCBS of FL, how is the COB figured?

Is it figured on the date they took A, the date they took B, or will Medicare

remain secondary because the spouse works for a large group employer with more

than 20 employees?

Thank

you!

Joanie

Sage

Transplant

Financial Coordinator

Gulf

Coast Medical

Center Rental Transplant

(239)

343-1125

joan.sage@leememori al.org

-------------------- This electronic message is intended to be for the use only of the named recipient, and may contain information that is confidential or privileged. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or use of the contents of this message is strictly prohibited. If you have received this message in error or are not the named recipient, please notify us immediately by contacting the sender at the electronic mail address noted above, and delete and destroy all copies of this message. Thank you.

[Guest guest]

I agree with Meredith. Since the pt added entitlement through the Renal program, those COB rules will be applied and after 30 months Medicare will go primary regardless of group size. Had the group been small when pt's only entitlement was due to age, Medicare would have been primary then and would remain primary despite the new Renal entitlement.

Re: ESRD & Medicare COBMedicare due to ESRD with EGHP-- First 30 months of Medicare entitlement or eligibility, EGHP pays first, after 30 months, Medicare becomes primary...EGHP size is not a factor... dfryechmca (DOT) org wrote:

Dear Joanie,Any time a patient has large group employer insurance through a spouse or parent it will always be primary over Medicare.Dorinda S. Frye, ARC RepHematology/Oncology AkronHematology/Oncology Mahoning ValleyCraniofacial Office FaxJoanie Sage <gulfcoastrenal@ yahoo.com>

Joanie Sage <gulfcoastrenal@ yahoo.com> Sent by: <TxFinancialCoordina tors@yahoogroups .com>

11/11/2009 01:14 PM

Please respond to<TxFinancialCoordina tors@yahoogroups .com>

To

<TxFinancialCoordina tors@yahoogroups .com>

cc

Subject

[TxFinancialCoordin ators] ESRD & Medicare COB

Hello Everyone:

My name is Joanie Sage. I am the new Transplant Financial Coordinator at Gulf Coast Med Center in Ft. Myers, FL. I took Pat Kreci's place. I have a question about Medicare COB and ESRD:

If a patient took MC A based on age, but didn't take B right away, then took B based on ESRD, but the spouse still works and has BCBS of FL, how is the COB figured? Is it figured on the date they took A, the date they took B, or will Medicare remain secondary because the spouse works for a large group employer with more than 20 employees?

Thank you!

Joanie Sage

Transplant Financial Coordinator

Gulf Coast Medical Center Rental Transplant

joan.sage@leememori al.org -------------------- This electronic message is intended to be for the use only of the named recipient, and may contain information that is confidential or privileged. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or use of the contents of this message is strictly prohibited. If you have received this message in error or are not the named recipient, please notify us immediately by contacting the sender at the electronic mail address noted above, and delete and destroy all copies of this message. Thank you.

[Guest guest]

I agree! Please see

Bill Vaughan’s presentation on the TFCA website from the workshop. MSP

rules are explained nicely there.

Debbie Mast

Financial/Database

Manager

Stanford Hospital and Clinics

750 Welch Road, Suite

220

Palo Alto, CA 94304

Trustee, TFCA

Heart, Lung,

Heart/Lung, Liver, Kidney, Pancreas, Intestinal Transplant Programs

Phone:

Fax:

www.donateLIFEcalifornia.org

This email communication and any

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Thank you.

From:

TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH Trnsplnt

Sent: Wednesday, November 11, 2009

11:42 AM

To:

TxFinancialCoordinators

Subject: RE:

ESRD & Medicare COB

I agree

with Meredith. Since the pt added entitlement through the Renal program,

those COB rules will be applied and after 30 months Medicare will go primary

regardless of group size. Had the group been small when pt's only

entitlement was due to age, Medicare would have been primary then and

would remain primary despite the new Renal entitlement.

Re:

ESRD & Medicare COB

Medicare due to ESRD with EGHP-- First 30 months of Medicare entitlement or

eligibility, EGHP pays first, after 30 months, Medicare becomes primary...EGHP

size is not a factor...

dfryechmca (DOT) org wrote:

Dear

Joanie,

Any time a patient has large group employer insurance through a spouse or

parent it will always be primary over Medicare.

Dorinda S. Frye, ARC Rep

Hematology/Oncology Akron

Hematology/Oncology Mahoning Valley

Craniofacial

Office

Fax

Joanie

Sage <gulfcoastrenal@ yahoo.com>

Joanie

Sage <gulfcoastrenal@ yahoo.com>

Sent by: <TxFinancialCoordina tors@yahoogroups .com>

11/11/2009

01:14 PM

Please

respond to

<TxFinancialCoordina tors@yahoogroups .com>

To

<TxFinancialCoordina tors@yahoogroups .com>

cc

Subject

[TxFinancialCoordin ators] ESRD & Medicare COB

Hello

Everyone:

My name

is Joanie Sage. I am the new Transplant Financial Coordinator at Gulf Coast

Med Center in Ft. Myers, FL.

I took Pat Kreci's place. I have a question about Medicare COB and ESRD:

If a

patient took MC A based on age, but didn't take B right away, then took B based

on ESRD, but the spouse still works and has BCBS of FL, how is the COB figured?

Is it figured on the date they took A, the date they took B, or will Medicare

remain secondary because the spouse works for a large group employer with more

than 20 employees?

Thank

you!

Joanie

Sage

Transplant

Financial Coordinator

Gulf

Coast Medical Center

Rental Transplant

(239)

343-1125

joan.sage@leememori al.org

-------------------- This electronic message is intended to be for the use only of the named recipient, and may contain information that is confidential or privileged. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or use of the contents of this message is strictly prohibited. If you have received this message in error or are not the named recipient, please notify us immediately by contacting the sender at the electronic mail address noted above, and delete and destroy all copies of this message. Thank you.

[Guest guest]

The COB will start when the patient became

ESRD and Medicare will be secondary to the spouse EGHP for 30 months.

Let say Patient A has Medicare due to age

but the spouse is actively working. Medicare is secondary to EGHP. If the patient

becomes eligible for Renal Medicare this month,

the COB starts 11/01/09. EGHP will be primary for 30 months as long as the

spouse is actively working.

Let say Patient‘s spouse then

retires on 01/01/2010 due to age but remains covers by the EGHP as retirement benefits.

Medicare becomes primary for both the patient and spouse and the EGHP will be

secondary to Medicare.

Austria

Specialty Contracting

Methodist Health System

1441 North Beckley Avenue

Dallas,Texas 75203

Phone:

Fax:

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Joanie Sage

Sent: Wednesday, November 11,

2009 12:14 PM

To: TxFinancialCoordinators

Subject:

ESRD & Medicare COB

Hello Everyone:

My name is Joanie Sage. I am the new Transplant Financial

Coordinator at Gulf Coast Med Center in Ft.

Myers, FL. I took Pat Kreci's place. I have a

question about Medicare COB and ESRD:

If a patient took MC A based on age,

but didn't take B right away, then

took B based on ESRD, but the spouse

still works and has BCBS of FL, how

is the COB figured? Is it figured on the date they took A, the date they took B,

or will Medicare remain secondary because the spouse works for a large group

employer with more than 20 employees?

Thank you!

Joanie Sage

Transplant Financial Coordinator

Gulf

Coast Medical

Center Rental Transplant

joan.sageleememorial (DOT) org

***********************************************************************

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.

[Guest guest]

Thank you, again, to everyone. This information is a great help!

To: TxFinancialCoordinators Sent: Wed, November 11, 2009 5:04:40 PMSubject: RE: ESRD & Medicare COB

The COB will start when the patient became ESRD and Medicare will be secondary to the spouse EGHP for 30 months.

Let say Patient A has Medicare due to age but the spouse is actively working. Medicare is secondary to EGHP. If the patient becomes eligible for Renal Medicare this month , the COB starts 11/01/09. EGHP will be primary for 30 months as long as the spouse is actively working.

Let say Patient‘s spouse then retires on 01/01/2010 due to age but remains covers by the EGHP as retirement benefits. Medicare becomes primary for both the patient and spouse and the EGHP will be secondary to Medicare.

Austria

Specialty Contracting

Methodist Health System

1441 North Beckley Avenue

Dallas,Texas 75203

Phone:

Fax:

From: TxFinancialCoordina tors@yahoogroups .com [mailto: TxFinancialCoordina tors@yahoogroups .com ] On Behalf Of Joanie SageSent: Wednesday , November 11 , 2009 12:14 PMTo: TxFinancialCoordina tors@yahoogroups .comSubject: [TxFinancialCoordin ators] ESRD & Medicare COB

Hello Everyone:

My name is Joanie Sage. I am the new Transplant Financial Coordinator at Gulf Coast Med Center in Ft. Myers , FL. I took Pat Kreci's place. I have a question about Medicare COB and ESRD:

If a patient took MC A based on age , but didn't take B right away , then took B based on ESRD , but the spouse still works and has BCBS of FL , how is the COB figured? Is it figured on the date they took A , the date they took B , or will Medicare remain secondary because the spouse works for a large group employer with more than 20 employees?

Thank you!

Joanie Sage

Transplant Financial Coordinator

Gulf Coast Medical Center Rental Transplant

joan.sage@leememori al.org

************ ********* ********* ********* ********* ********* ********* *****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.