FW: CMS: Billing for Donor Post-Kidney Transplant Complication Services - REVISED

[Guest guest]

I just received this today from our

chargemaster specialist…………

From: North, Sharon

Sent: Thursday, April 05, 2012

9:51 AM

To: Cochrane, Barbara E

Subject: FW: CMS: Billing for

Donor Post-Kidney Transplant Complication Services - REVISED

This is from Medicare, FYI.

Thanks!

Sharon

From: Schauer,

(Tacoma)

Sent: Wednesday, April 04, 2012

6:38 PM

To: Boltz, LaVora (Pendleton);

Bridges, (Pendleton); Burg, Dawn (Tacoma); Cortes, ; Eichman,

(Roseburg); , Sharlene (Tacoma); Flewelling, (Tacoma);

Flury, (Roseburg); Forster, Diane; Gibson, (Tacoma); , Rose

(Tacoma); Gwaltney, Wally (Roseburg); Hoffert, (Tacoma); Kasal, Steve

(Tacoma); Marlow, (Tacoma); , Dorinda (Roseburg); Patke, Amalia

(Tacoma); Roach, Carey (Tacoma); Stroud, Holly (Tacoma); Sweborg, Alice

(Tacoma); Tompkins, (Tacoma); Vollmer, LeAnne (Pendleton); Wells, Carol

(Pendleton); Worley, Judith (Tacoma); Zellmer, Sylvia (Tacoma)

Subject: CMS: Billing for Donor

Post-Kidney Transplant Complication Services - REVISED

*The article was revised on 04/03/2012 to correct the

claim examples at the end of the MLN Matters Article. All information provided

below remains unchanged.*

Regulatory Communication

Effective: 11/28/2011; Implementation Date: 04/02/2012

Title:

Billing for Donor Post-Kidney Transplant Complication Services

http://www.cms.gov/transmittals/downloads/R148BP.pdf

http://www.cms.gov/MLNMattersArticles/downloads/MM7523.pdf

Details:

CMS is

clarifying language in the Medicare manuals concerning billing for donor

post-kidney transplant complication services.

The Medicare Benefit Policy Manual, Chapter 11, Section 140.9 will

now include the following:

The donor of an organ for a Medicare transplant is covered for

an unlimited number of days of care in connection with the organ removal

operation. Days of inpatient hospital care used by the donor in connection

with the organ removal operation shall not be charged against either party’s

utilization record.

Regarding donor follow-up:

·

Expenses incurred by the transplant center for routine donor

follow-up care are included in the transplant center’s organ

acquisition cost center.

·

Follow-up services performed by the operating physician are included

in the 90-day global payment for the surgery. Beyond the 90-day global

payment period, follow-up services are billed using the recipient’s

health insurance claim number.

·

Follow-up services billed by a physician other than the

operating physician for up to 3 months should be billed under the

recipient’s health insurance claim number.

Regarding donor complications:

·

Expenses incurred for complications that arise with respect to

the donor are covered only if they are directly attributable to the donation surgery.

Complications that arise after the date of the donor’s discharge will

be billed under the recipient’s health insurance claim number. This is

true of both facility cost and physician services. Billings for donor complications will be

reviewed.

·

In all of these situations, the donor is not responsible for

co-insurance or deductible.

The Medicare Claims Processing Manual, Chapter 3, Section 90.1.3 will

now include the following:

·

Expenses incurred for complications that arise with respect to

the donor are covered and separately billable only if they are directly

attributable to the donation surgery.

·

All covered services (both institutional and professional) for

complications from a Medicare covered transplant that arise after the date of

the donor’s transplant discharge will be billed under the

recipient’s health insurance claim number and are billed to the

Medicare program in the same manner as all Medicare Part B services are billed.

·

All covered donor post-kidney transplant complication services

must be billed to the account of the recipient (i.e., the recipient's

Medicare number).

Schauer

National CDM Coordinator

Catholic Health Initiatives

Phone:

Internal: 180-4026

Email: angelaschauer@...

This electronic mail and any attached documents are intended solely for the named addressee(s) and contain confidential information. If you are not an addressee, or responsible for delivering this email to an addressee, you have received this email in error and are notified that reading, copying, or disclosing this email is prohibited. If you received this email in error, immediately reply to the sender and delete the message completely from your computer system.

[Guest guest]

Hi,

Does this CMS billing revision apply to liver donor complications as well?

Diane Topougis, MBA | Sr.Operations Analyst |General Surgery & Transplant

Cleveland Clinic | 9500 Euclid Ave. Desk A100 | Cleveland, OH 44195

|(216)444-1001

Fax

>

> I just received this today from our chargemaster specialist............

>

>

>

> ________________________________

>

> From: North, Sharon

> Sent: Thursday, April 05, 2012 9:51 AM

> To: Cochrane, Barbara E

> Subject: FW: CMS: Billing for Donor Post-Kidney Transplant Complication

> Services - REVISED

>

>

>

> This is from Medicare, FYI.

>

>

>

> Thanks!

> Sharon

>

>

>

> From: Schauer, (Tacoma)

> Sent: Wednesday, April 04, 2012 6:38 PM

> To: Boltz, LaVora (Pendleton); Bridges, (Pendleton); Burg, Dawn

> (Tacoma); Cortes, ; Eichman, (Roseburg); , Sharlene

> (Tacoma); Flewelling, (Tacoma); Flury, (Roseburg);

> Forster, Diane; Gibson, (Tacoma); , Rose (Tacoma);

> Gwaltney, Wally (Roseburg); Hoffert, (Tacoma); Kasal, Steve

> (Tacoma); Marlow, (Tacoma); , Dorinda (Roseburg); Patke,

> Amalia (Tacoma); Roach, Carey (Tacoma); Stroud, Holly (Tacoma); Sweborg,

> Alice (Tacoma); Tompkins, (Tacoma); Vollmer, LeAnne (Pendleton);

> Wells, Carol (Pendleton); Worley, Judith (Tacoma); Zellmer, Sylvia

> (Tacoma)

> Subject: CMS: Billing for Donor Post-Kidney Transplant Complication

> Services - REVISED

>

>

>

> *The article was revised on 04/03/2012 to correct the claim examples at

> the end of the MLN Matters Article. All information provided below

> remains unchanged.*

>

>

>

>

>

>

>

> Regulatory Communication

>

>

>

>

>

>

>

> Effective: 11/28/2011; Implementation Date: 04/02/2012

>

> Title: Billing for Donor Post-Kidney Transplant Complication Services

>

> http://www.cms.gov/transmittals/downloads/R148BP.pdf

>

> http://www.cms.gov/MLNMattersArticles/downloads/MM7523.pdf

>

> Details:

>

> CMS is clarifying language in the Medicare manuals concerning billing

> for donor post-kidney transplant complication services.

>

>

>

> The Medicare Benefit Policy Manual, Chapter 11, Section 140.9 will now

> include the following:

>

>

>

> The donor of an organ for a Medicare transplant is covered for an

> unlimited number of days of care in connection with the organ removal

> operation. Days of inpatient hospital care used by the donor in

> connection with the organ removal operation shall not be charged against

> either party's utilization record.

>

> Regarding donor follow-up:

>

> * Expenses incurred by the transplant center for routine donor

> follow-up care are included in the transplant center's organ acquisition

> cost center.

>

> * Follow-up services performed by the operating physician are

> included in the 90-day global payment for the surgery. Beyond the 90-day

> global payment period, follow-up services are billed using the

> recipient's health insurance claim number.

>

> * Follow-up services billed by a physician other than the

> operating physician for up to 3 months should be billed under the

> recipient's health insurance claim number.

>

> Regarding donor complications:

>

> * Expenses incurred for complications that arise with respect to

> the donor are covered only if they are directly attributable to the

> donation surgery. Complications that arise after the date of the donor's

> discharge will be billed under the recipient's health insurance claim

> number. This is true of both facility cost and physician services.

> Billings for donor complications will be reviewed.

>

> * In all of these situations, the donor is not responsible for

> co-insurance or deductible.

>

>

>

> The Medicare Claims Processing Manual, Chapter 3, Section 90.1.3 will

> now include the following:

>

>

>

> * Expenses incurred for complications that arise with respect to

> the donor are covered and separately billable only if they are directly

> attributable to the donation surgery.

>

> * All covered services (both institutional and professional) for

> complications from a Medicare covered transplant that arise after the

> date of the donor's transplant discharge will be billed under the

> recipient's health insurance claim number and are billed to the Medicare

> program in the same manner as all Medicare Part B services are billed.

>

> * All covered donor post-kidney transplant complication services

> must be billed to the account of the recipient (i.e., the recipient's

> Medicare number).

>

>

>

>

>

>

>

>

>

> Schauer

>

> National CDM Coordinator

> Catholic Health Initiatives

> Phone:

> Internal: 180-4026

> Email: angelaschauer@...

>

>

> This electronic mail and any attached documents are intended solely for the

named addressee(s) and contain confidential information. If you are not an

addressee, or responsible for delivering this email to an addressee, you have

received this email in error and are notified that reading, copying, or

disclosing this email is prohibited. If you received this email in error,

immediately reply to the sender and delete the message completely from your

computer system.

>