Guest guest Posted March 9, 2010 Report Share Posted March 9, 2010 Very likely on both your questions. Medicare retros back 12 months. Our hospital has a high percentage of EGHP HMO plans that provide what patients feel is excellent coverage. A handful of these patients then don’t want to complete the Medicare process after we’ve submitted the 2728. If they haven’t enrolled in Medicare at the 9th month, our hospital begins the process of sending notification letters to patients. We send two 21-days apart and, if there is no response, we call them. Once eligible, your business office must submit a claim to Medicare to trigger patient’s lifetime immunosuppressive coverage through part B. It isn’t enough to just have the patient retro eligible. There was a previous discussion thread on Medicare as a Secondary Payer (MSP) on Feb 22 that had more information on this. Medicare eligibility is an extremely important financial issue for the hospital. Even though hospital won’t receive actual payment when Medicare is 2nd for the transplant, when your business office submits a notification claim to Medicare after it becomes effective, you increase the % of Medicare transplants at your hospital which directly affects the portion you claim on the cost report. Sheila Kantor Manager, Patient Access Services Department Sharp Metropolitan Medical Campus (fax) (pgr) From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of LaVinia Pitts Sent: Tuesday, March 09, 2010 10:13 AM To: TxFinancialCoordinators Subject: (unknown) Hello Fellow TFC's, Scenario: Patient was transplanted 10 months ago with EGHP coverage, never on dialysis. 2728 form submitted 10 months status post. What is the likelihood that Medicare will back date his effective date to the first of the month in which he was transplanted so that he is able to obtain immunos thru Medicare? What is the likelihood that EGHP will assume secondary payor status after 30 months of being transplanted? All responnses are greatly appreciated. Thanks La'Vinia Pitts Temple University Health System Philadelphia, PA la'vinia.pittstuhs (DOT) temple.edu 1 of 1 File(s) Apply for Medicare post transplant-LIVE DONOR LETTER.doc Quote Link to comment Share on other sites More sharing options...
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