Medicare Advantage Plans

[Guest guest]

We discourage them. They dont keep up with the COB period and we cant get state

help for their Part D since it is all rolled into one A<B<D

Whitney Folsom, TFC

ETMC Transplant Program

1100 E Lake St ste 340

Tyler, TX 75701

phone

fax

wlfolsom@...

>>> " R. Simon (Transplant Admin) " 5/20/2010 9:18 AM >>>

While I know Medicare Advantage Plans are anything but advantageous to

patients, I'm wondering if transplant programs have policies that either

will or will not accept these patients for active listing for

transplant?

Besides the patient problems, it is my understanding these transplants

are reimbursed on the DRG and additional payment for the actually organ

charge does not occur as I'm told these are not considered Medicare

organs for the cost report. I'm wondering if centers have had success

contracting with specific advantage plans to enhance reimbursement or

have other information about these policies?

Thanks,

Simon, MSW

Manager, Transplant Financial Operations

Froedtert Memorial Lutheran Hospital

9200 W. Wisconsin Avenue

Milwaukee, WI 53226

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[Guest guest]

We currently take them on a case by case basis..We sometimes already contract with the health plan and use that guideline for payment..If we don't contract with the health plan we do a letter of agreement for the pre-evaluation,actual transplant and post transplant care...this includes the organ..Most of our patient's will and can qualify for our state program as a secondary...for those who do not we make sure they are in the right advantage plan for them..ie,co-pays, ded,and rx plan..to assure the patient can afford all expenses..

Cruz

Transplant Financial Coordinator

UCSD Medical Center

elcruz@...

To: TxFinancialCoordinators Sent: Thu, May 20, 2010 7:18:52 AMSubject: Medicare Advantage Plans

While I know Medicare Advantage Plans are anything but advantageous to patients, I'm wondering if transplant programs have policies that either will or will not accept these patients for active listing for transplant?

Besides the patient problems, it is my understanding these transplants are reimbursed on the DRG and additional payment for the actually organ charge does not occur as I'm told these are not considered Medicare organs for the cost report. I'm wondering if centers have had success contracting with specific advantage plans to enhance reimbursement or have other information about these policies?

Thanks,

Simon, MSW

Manager, Transplant Financial Operations

Froedtert Memorial Lutheran Hospital 9200 W. Wisconsin Avenue Milwaukee, WI 53226