Guest guest Posted June 28, 2012 Report Share Posted June 28, 2012 Hi Mckenzie,First if the Donor was readmitted within 90 days, the technical services go to the Cost Report, if the admission was after 90 days the hospital bill goes to the recipients payer. In both cases, the physicians bills go to the recipients payer.Second, regardless of the recipients payer, the inpatient stay for the actual donor surgery goes to the Cost Report, they do NOT go to the Recipients Insurance. Physician fees for the donor actual surgery go to the recipients payer, regardless of payer.Hope this helps,Thanks,BillReply-To: <TxFinancialCoordinators >Date: Thursday, June 28, 2012 11:44 AMTo: <TxFinancialCoordinators >Subject: Donor Complications I think I might be a little confused on how these are supposed to be paid/billed. I have two seperate circumstances. The First, the recipient has Medicare primary. Donor was re-admitted for complications. Is this something that goes on the Cost Report, or is it billed to the recipient's Medicare? The second, the recipient has BCBS primary. Charges are for the actual surgery. They should be billed to the recipient's BCBS plan, right? Just need some clarification. Your help is so appreciated. Makenzie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 29, 2012 Report Share Posted June 29, 2012 Good morning Bill, Clarification on Routine vs. Complication re-admissions/visits. Routine donor services within 90 days & beyond (up to 6 months to monitor for complications), the transplanting hospital costs are included in the KACC. Complication re-admissions/visits, both technical & professional components are billed to Medicare or the recipient’s insurance. Are these correct? As usual thanks for your advice. Mila From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Thursday, June 28, 2012 3:29 PMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi Mckenzie, First if the Donor was readmitted within 90 days, the technical services go to the Cost Report, if the admission was after 90 days the hospital bill goes to the recipients payer. In both cases, the physicians bills go to the recipients payer. Second, regardless of the recipients payer, the inpatient stay for the actual donor surgery goes to the Cost Report, they do NOT go to the Recipients Insurance. Physician fees for the donor actual surgery go to the recipients payer, regardless of payer. Hope this helps,Thanks,Bill Reply-To: <TxFinancialCoordinators >Date: Thursday, June 28, 2012 11:44 AMTo: <TxFinancialCoordinators >Subject: Donor Complications I think I might be a little confused on how these are supposed to be paid/billed. I have two seperate circumstances. The First, the recipient has Medicare primary. Donor was re-admitted for complications. Is this something that goes on the Cost Report, or is it billed to the recipient's Medicare?The second, the recipient has BCBS primary. Charges are for the actual surgery. They should be billed to the recipient's BCBS plan, right?Just need some clarification. Your help is so appreciated. :)Makenzie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 29, 2012 Report Share Posted June 29, 2012 OK, now I’m really confused! I thought we just had something recently come through our list serve stating:1. Routine donor f/u visits go to KAC; Medicare and Non-Medicare recipients2. Donor complications post surgery (within 90 days) -Facility charges: go to the recipient’s payer for those with Medicare and reimbursed via the SAC for Non-Medicare recipients-Physician charges: Medicare recipients reimbursed via cost report and Non-Medicare is billed to the recipient’s payerI feel like this is different from what you just sent Bill?Thanks! M. Christiansen, BAS, RN From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Thursday, June 28, 2012 4:29 PMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi Mckenzie, First if the Donor was readmitted within 90 days, the technical services go to the Cost Report, if the admission was after 90 days the hospital bill goes to the recipients payer. In both cases, the physicians bills go to the recipients payer. Second, regardless of the recipients payer, the inpatient stay for the actual donor surgery goes to the Cost Report, they do NOT go to the Recipients Insurance. Physician fees for the donor actual surgery go to the recipients payer, regardless of payer. Hope this helps,Thanks,Bill Reply-To: <TxFinancialCoordinators >Date: Thursday, June 28, 2012 11:44 AMTo: <TxFinancialCoordinators >Subject: Donor Complications I think I might be a little confused on how these are supposed to be paid/billed. I have two seperate circumstances. The First, the recipient has Medicare primary. Donor was re-admitted for complications. Is this something that goes on the Cost Report, or is it billed to the recipient's Medicare?The second, the recipient has BCBS primary. Charges are for the actual surgery. They should be billed to the recipient's BCBS plan, right?Just need some clarification. Your help is so appreciated. :)Makenzie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 29, 2012 Report Share Posted June 29, 2012 OK, now I’m really confused! I thought we just had something recently come through our list serve stating:1. Routine donor f/u visits go to KAC; Medicare and Non-Medicare recipients2. Donor complications post surgery (within 90 days) -Facility charges: go to the recipient’s payer for those with Medicare and reimbursed via the SAC for Non-Medicare recipients-Physician charges: Medicare recipients reimbursed via cost report and Non-Medicare is billed to the recipient’s payerI feel like this is different from what you just sent Bill?Thanks! M. Christiansen, BAS, RN From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Thursday, June 28, 2012 4:29 PMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi Mckenzie, First if the Donor was readmitted within 90 days, the technical services go to the Cost Report, if the admission was after 90 days the hospital bill goes to the recipients payer. In both cases, the physicians bills go to the recipients payer. Second, regardless of the recipients payer, the inpatient stay for the actual donor surgery goes to the Cost Report, they do NOT go to the Recipients Insurance. Physician fees for the donor actual surgery go to the recipients payer, regardless of payer. Hope this helps,Thanks,Bill Reply-To: <TxFinancialCoordinators >Date: Thursday, June 28, 2012 11:44 AMTo: <TxFinancialCoordinators >Subject: Donor Complications I think I might be a little confused on how these are supposed to be paid/billed. I have two seperate circumstances. The First, the recipient has Medicare primary. Donor was re-admitted for complications. Is this something that goes on the Cost Report, or is it billed to the recipient's Medicare?The second, the recipient has BCBS primary. Charges are for the actual surgery. They should be billed to the recipient's BCBS plan, right?Just need some clarification. Your help is so appreciated. :)Makenzie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 3, 2012 Report Share Posted July 3, 2012 I have a questions that relates to this thread – Our donor had complications and was seen at their local emergency room and then transferred to our facility via ambulance. Do I pay the technical charges for the ED visit at the local hospital and then give them the recipient insurance info to bill the professional fees? How would the ambulance fees be considered – professional or technical? Thanks, Deidra Deidra M. Simano Transplant Operations Analyst Department of Transplant Surgery Dartmouth-Hitchcock Lebanon Phone: (603) 653.3689 / Fax: (603) 676.4287 Transplant Secretary (603) 653.3931 Dartmouth-Hitchcock.org From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Thursday, June 28, 2012 4:29 PM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi Mckenzie, First if the Donor was readmitted within 90 days, the technical services go to the Cost Report, if the admission was after 90 days the hospital bill goes to the recipients payer. In both cases, the physicians bills go to the recipients payer. Second, regardless of the recipients payer, the inpatient stay for the actual donor surgery goes to the Cost Report, they do NOT go to the Recipients Insurance. Physician fees for the donor actual surgery go to the recipients payer, regardless of payer. Hope this helps, Thanks, Bill From: MakenzieS Reply-To: <TxFinancialCoordinators > Date: Thursday, June 28, 2012 11:44 AM To: <TxFinancialCoordinators > Subject: Donor Complications I think I might be a little confused on how these are supposed to be paid/billed. I have two seperate circumstances. The First, the recipient has Medicare primary. Donor was re-admitted for complications. Is this something that goes on the Cost Report, or is it billed to the recipient's Medicare? The second, the recipient has BCBS primary. Charges are for the actual surgery. They should be billed to the recipient's BCBS plan, right? Just need some clarification. Your help is so appreciated. Makenzie IMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE: This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 3, 2012 Report Share Posted July 3, 2012 I have a questions that relates to this thread – Our donor had complications and was seen at their local emergency room and then transferred to our facility via ambulance. Do I pay the technical charges for the ED visit at the local hospital and then give them the recipient insurance info to bill the professional fees? How would the ambulance fees be considered – professional or technical? Thanks, Deidra Deidra M. Simano Transplant Operations Analyst Department of Transplant Surgery Dartmouth-Hitchcock Lebanon Phone: (603) 653.3689 / Fax: (603) 676.4287 Transplant Secretary (603) 653.3931 Dartmouth-Hitchcock.org From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Thursday, June 28, 2012 4:29 PM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi Mckenzie, First if the Donor was readmitted within 90 days, the technical services go to the Cost Report, if the admission was after 90 days the hospital bill goes to the recipients payer. In both cases, the physicians bills go to the recipients payer. Second, regardless of the recipients payer, the inpatient stay for the actual donor surgery goes to the Cost Report, they do NOT go to the Recipients Insurance. Physician fees for the donor actual surgery go to the recipients payer, regardless of payer. Hope this helps, Thanks, Bill From: MakenzieS Reply-To: <TxFinancialCoordinators > Date: Thursday, June 28, 2012 11:44 AM To: <TxFinancialCoordinators > Subject: Donor Complications I think I might be a little confused on how these are supposed to be paid/billed. I have two seperate circumstances. The First, the recipient has Medicare primary. Donor was re-admitted for complications. Is this something that goes on the Cost Report, or is it billed to the recipient's Medicare? The second, the recipient has BCBS primary. Charges are for the actual surgery. They should be billed to the recipient's BCBS plan, right? Just need some clarification. Your help is so appreciated. Makenzie IMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE: This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 3, 2012 Report Share Posted July 3, 2012 Hi Deidra,If the complication was in the first 90 days after the transplant, the transplant center pays the technical fees and gives the physicians billing information for the recipient. If the complication was after 90 days, the transplant center gives the hospital and physicians billing information for the recipient.Hope this helps,Thanks,BillReply-To: <TxFinancialCoordinators >Date: Tuesday, July 3, 2012 10:42 AMTo: "TxFinancialCoordinators " <TxFinancialCoordinators >Subject: RE: Donor Complications I have a questions that relates to this thread – Our donor had complications and was seen at their local emergency room and then transferred to our facility via ambulance. Do I pay the technical charges for the ED visit at the local hospital and then give them the recipient insurance info to bill the professional fees? How would the ambulance fees be considered – professional or technical? Thanks, Deidra Deidra M. SimanoTransplant Operations AnalystDepartment of Transplant SurgeryDartmouth-Hitchcock LebanonPhone: (603) 653.3689 / Fax: (603) 676.4287Transplant Secretary (603) 653.3931Dartmouth-Hitchcock.org From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Thursday, June 28, 2012 4:29 PMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi Mckenzie, First if the Donor was readmitted within 90 days, the technical services go to the Cost Report, if the admission was after 90 days the hospital bill goes to the recipients payer. In both cases, the physicians bills go to the recipients payer. Second, regardless of the recipients payer, the inpatient stay for the actual donor surgery goes to the Cost Report, they do NOT go to the Recipients Insurance. Physician fees for the donor actual surgery go to the recipients payer, regardless of payer. Hope this helps,Thanks,Bill From: MakenzieS Reply-To: <TxFinancialCoordinators >Date: Thursday, June 28, 2012 11:44 AMTo: <TxFinancialCoordinators >Subject: Donor Complications I think I might be a little confused on how these are supposed to be paid/billed. I have two seperate circumstances. The First, the recipient has Medicare primary. Donor was re-admitted for complications. Is this something that goes on the Cost Report, or is it billed to the recipient's Medicare? The second, the recipient has BCBS primary. Charges are for the actual surgery. They should be billed to the recipient's BCBS plan, right? Just need some clarification. Your help is so appreciated. Makenzie IMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE: This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 3, 2012 Report Share Posted July 3, 2012 It does, thank you very much. Deidra Deidra M. Simano Transplant Operations Analyst Department of Transplant Surgery Dartmouth-Hitchcock Lebanon Phone: (603) 653.3689 / Fax: (603) 676.4287 Transplant Secretary (603) 653.3931 Dartmouth-Hitchcock.org From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Tuesday, July 03, 2012 11:00 AM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi Deidra, If the complication was in the first 90 days after the transplant, the transplant center pays the technical fees and gives the physicians billing information for the recipient. If the complication was after 90 days, the transplant center gives the hospital and physicians billing information for the recipient. Hope this helps, Thanks, Bill From: " Deidra M. Simano " Reply-To: <TxFinancialCoordinators > Date: Tuesday, July 3, 2012 10:42 AM To: " TxFinancialCoordinators " <TxFinancialCoordinators > Subject: RE: Donor Complications I have a questions that relates to this thread – Our donor had complications and was seen at their local emergency room and then transferred to our facility via ambulance. Do I pay the technical charges for the ED visit at the local hospital and then give them the recipient insurance info to bill the professional fees? How would the ambulance fees be considered – professional or technical? Thanks, Deidra Deidra M. Simano Transplant Operations Analyst Department of Transplant Surgery Dartmouth-Hitchcock Lebanon Phone: (603) 653.3689 / Fax: (603) 676.4287 Transplant Secretary (603) 653.3931 Dartmouth-Hitchcock.org From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Thursday, June 28, 2012 4:29 PM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi Mckenzie, First if the Donor was readmitted within 90 days, the technical services go to the Cost Report, if the admission was after 90 days the hospital bill goes to the recipients payer. In both cases, the physicians bills go to the recipients payer. Second, regardless of the recipients payer, the inpatient stay for the actual donor surgery goes to the Cost Report, they do NOT go to the Recipients Insurance. Physician fees for the donor actual surgery go to the recipients payer, regardless of payer. Hope this helps, Thanks, Bill From: MakenzieS Reply-To: <TxFinancialCoordinators > Date: Thursday, June 28, 2012 11:44 AM To: <TxFinancialCoordinators > Subject: Donor Complications I think I might be a little confused on how these are supposed to be paid/billed. I have two seperate circumstances. The First, the recipient has Medicare primary. Donor was re-admitted for complications. Is this something that goes on the Cost Report, or is it billed to the recipient's Medicare? The second, the recipient has BCBS primary. Charges are for the actual surgery. They should be billed to the recipient's BCBS plan, right? Just need some clarification. Your help is so appreciated. Makenzie IMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE: This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. IMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE: This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 3, 2012 Report Share Posted July 3, 2012 It does, thank you very much. Deidra Deidra M. Simano Transplant Operations Analyst Department of Transplant Surgery Dartmouth-Hitchcock Lebanon Phone: (603) 653.3689 / Fax: (603) 676.4287 Transplant Secretary (603) 653.3931 Dartmouth-Hitchcock.org From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Tuesday, July 03, 2012 11:00 AM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi Deidra, If the complication was in the first 90 days after the transplant, the transplant center pays the technical fees and gives the physicians billing information for the recipient. If the complication was after 90 days, the transplant center gives the hospital and physicians billing information for the recipient. Hope this helps, Thanks, Bill From: " Deidra M. Simano " Reply-To: <TxFinancialCoordinators > Date: Tuesday, July 3, 2012 10:42 AM To: " TxFinancialCoordinators " <TxFinancialCoordinators > Subject: RE: Donor Complications I have a questions that relates to this thread – Our donor had complications and was seen at their local emergency room and then transferred to our facility via ambulance. Do I pay the technical charges for the ED visit at the local hospital and then give them the recipient insurance info to bill the professional fees? How would the ambulance fees be considered – professional or technical? Thanks, Deidra Deidra M. Simano Transplant Operations Analyst Department of Transplant Surgery Dartmouth-Hitchcock Lebanon Phone: (603) 653.3689 / Fax: (603) 676.4287 Transplant Secretary (603) 653.3931 Dartmouth-Hitchcock.org From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Thursday, June 28, 2012 4:29 PM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi Mckenzie, First if the Donor was readmitted within 90 days, the technical services go to the Cost Report, if the admission was after 90 days the hospital bill goes to the recipients payer. In both cases, the physicians bills go to the recipients payer. Second, regardless of the recipients payer, the inpatient stay for the actual donor surgery goes to the Cost Report, they do NOT go to the Recipients Insurance. Physician fees for the donor actual surgery go to the recipients payer, regardless of payer. Hope this helps, Thanks, Bill From: MakenzieS Reply-To: <TxFinancialCoordinators > Date: Thursday, June 28, 2012 11:44 AM To: <TxFinancialCoordinators > Subject: Donor Complications I think I might be a little confused on how these are supposed to be paid/billed. I have two seperate circumstances. The First, the recipient has Medicare primary. Donor was re-admitted for complications. Is this something that goes on the Cost Report, or is it billed to the recipient's Medicare? The second, the recipient has BCBS primary. Charges are for the actual surgery. They should be billed to the recipient's BCBS plan, right? Just need some clarification. Your help is so appreciated. Makenzie IMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE: This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. IMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE: This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 11, 2012 Report Share Posted July 11, 2012 Hello Bill if you are out there! I’m busy overthinking things again – could you offer some direction? Donor to a Medicare beneficiary seen at 5.5 months post op by her PCP to “monitor for possible complications.” Claim sent to us for office visit plus labs. Do I direct them to bill technical and profees to Medicare, or technical to us, profee to Medicare? Many thanks for your input – I am getting thrown by “follow-up examinations may be covered for up to 6 months after the donation to monitor for possible complications” on the same page as instructions to limit routine follow-up to 90 days. on Transplant Financial Coordinator Legacy Good Samaritan Hospital Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 direct main office toll-free fax lmorriso@... ü Please consider the environment - think before you print! From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Tuesday, July 03, 2012 8:00 AMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi Deidra,If the complication was in the first 90 days after the transplant, the transplant center pays the technical fees and gives the physicians billing information for the recipient. If the complication was after 90 days, the transplant center gives the hospital and physicians billing information for the recipient. Hope this helps,Thanks,Bill Reply-To: <TxFinancialCoordinators >Date: Tuesday, July 3, 2012 10:42 AMTo: " TxFinancialCoordinators " <TxFinancialCoordinators >Subject: RE: Donor Complications I have a questions that relates to this thread – Our donor had complications and was seen at their local emergency room and then transferred to our facility via ambulance. Do I pay the technical charges for the ED visit at the local hospital and then give them the recipient insurance info to bill the professional fees? How would the ambulance fees be considered – professional or technical? Thanks, Deidra Deidra M. SimanoTransplant Operations AnalystDepartment of Transplant SurgeryDartmouth-Hitchcock LebanonPhone: (603) 653.3689 / Fax: (603) 676.4287Transplant Secretary (603) 653.3931Dartmouth-Hitchcock.org From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Thursday, June 28, 2012 4:29 PMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi Mckenzie, First if the Donor was readmitted within 90 days, the technical services go to the Cost Report, if the admission was after 90 days the hospital bill goes to the recipients payer. In both cases, the physicians bills go to the recipients payer. Second, regardless of the recipients payer, the inpatient stay for the actual donor surgery goes to the Cost Report, they do NOT go to the Recipients Insurance. Physician fees for the donor actual surgery go to the recipients payer, regardless of payer. Hope this helps,Thanks,Bill Reply-To: <TxFinancialCoordinators >Date: Thursday, June 28, 2012 11:44 AMTo: <TxFinancialCoordinators >Subject: Donor Complications I think I might be a little confused on how these are supposed to be paid/billed. I have two seperate circumstances. The First, the recipient has Medicare primary. Donor was re-admitted for complications. Is this something that goes on the Cost Report, or is it billed to the recipient's Medicare?The second, the recipient has BCBS primary. Charges are for the actual surgery. They should be billed to the recipient's BCBS plan, right?Just need some clarification. Your help is so appreciated. :)MakenzieIMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE:This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 11, 2012 Report Share Posted July 11, 2012 Hi ,Routine well baby visits, to make sure that there are no problems are billed to the transplant center and paid at 100% of Medicare just like an evaluation. That is step one.Step 2, if there is a complication in the first 90 days, the transplant center is responsible for technical services and the physician fees are billed to the recipients payer.Step 3, after 90 days both technical and professional fees are billed to the recipients primary payer.Hope this helps,Thanks,BillReply-To: <TxFinancialCoordinators >Date: Wednesday, July 11, 2012 4:12 PMTo: <TxFinancialCoordinators >Subject: RE: Donor Complications Hello Bill if you are out there! I’m busy overthinking things again – could you offer some direction? Donor to a Medicare beneficiary seen at 5.5 months post op by her PCP to “monitor for possible complications.” Claim sent to us for office visit plus labs. Do I direct them to bill technical and profees to Medicare, or technical to us, profee to Medicare? Many thanks for your input – I am getting thrown by “follow-up examinations may be covered for up to 6 months after the donation to monitor for possible complications” on the same page as instructions to limit routine follow-up to 90 days. on Transplant Financial Coordinator Legacy Good Samaritan Hospital Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 direct main office toll-free fax lmorriso@... ü Please consider the environment - think before you print! From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Tuesday, July 03, 2012 8:00 AMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi Deidra,If the complication was in the first 90 days after the transplant, the transplant center pays the technical fees and gives the physicians billing information for the recipient. If the complication was after 90 days, the transplant center gives the hospital and physicians billing information for the recipient. Hope this helps,Thanks,Bill Reply-To: <TxFinancialCoordinators >Date: Tuesday, July 3, 2012 10:42 AMTo: "TxFinancialCoordinators " <TxFinancialCoordinators >Subject: RE: Donor Complications I have a questions that relates to this thread – Our donor had complications and was seen at their local emergency room and then transferred to our facility via ambulance. Do I pay the technical charges for the ED visit at the local hospital and then give them the recipient insurance info to bill the professional fees? How would the ambulance fees be considered – professional or technical? Thanks, Deidra Deidra M. SimanoTransplant Operations AnalystDepartment of Transplant SurgeryDartmouth-Hitchcock LebanonPhone: (603) 653.3689 / Fax: (603) 676.4287Transplant Secretary (603) 653.3931Dartmouth-Hitchcock.org From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Thursday, June 28, 2012 4:29 PMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi Mckenzie, First if the Donor was readmitted within 90 days, the technical services go to the Cost Report, if the admission was after 90 days the hospital bill goes to the recipients payer. In both cases, the physicians bills go to the recipients payer. Second, regardless of the recipients payer, the inpatient stay for the actual donor surgery goes to the Cost Report, they do NOT go to the Recipients Insurance. Physician fees for the donor actual surgery go to the recipients payer, regardless of payer. Hope this helps,Thanks,Bill Reply-To: <TxFinancialCoordinators >Date: Thursday, June 28, 2012 11:44 AMTo: <TxFinancialCoordinators >Subject: Donor Complications I think I might be a little confused on how these are supposed to be paid/billed. I have two seperate circumstances. The First, the recipient has Medicare primary. Donor was re-admitted for complications. Is this something that goes on the Cost Report, or is it billed to the recipient's Medicare?The second, the recipient has BCBS primary. Charges are for the actual surgery. They should be billed to the recipient's BCBS plan, right?Just need some clarification. Your help is so appreciated. :)MakenzieIMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE:This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 11, 2012 Report Share Posted July 11, 2012 Thanks Bill, very much. Well baby – is the rule of thumb, ok up to pay 180 days post? From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Wednesday, July 11, 2012 1:32 PMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi , Routine well baby visits, to make sure that there are no problems are billed to the transplant center and paid at 100% of Medicare just like an evaluation. That is step one. Step 2, if there is a complication in the first 90 days, the transplant center is responsible for technical services and the physician fees are billed to the recipients payer. Step 3, after 90 days both technical and professional fees are billed to the recipients primary payer. Hope this helps,Thanks,Bill Reply-To: <TxFinancialCoordinators >Date: Wednesday, July 11, 2012 4:12 PMTo: <TxFinancialCoordinators >Subject: RE: Donor Complications Hello Bill if you are out there! I’m busy overthinking things again – could you offer some direction? Donor to a Medicare beneficiary seen at 5.5 months post op by her PCP to “monitor for possible complications.” Claim sent to us for office visit plus labs. Do I direct them to bill technical and profees to Medicare, or technical to us, profee to Medicare? Many thanks for your input – I am getting thrown by “follow-up examinations may be covered for up to 6 months after the donation to monitor for possible complications” on the same page as instructions to limit routine follow-up to 90 days. on Transplant Financial Coordinator Legacy Good Samaritan Hospital Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 direct main office toll-free fax lmorriso@... ü Please consider the environment - think before you print! From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Tuesday, July 03, 2012 8:00 AMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi Deidra,If the complication was in the first 90 days after the transplant, the transplant center pays the technical fees and gives the physicians billing information for the recipient. If the complication was after 90 days, the transplant center gives the hospital and physicians billing information for the recipient. Hope this helps,Thanks,Bill Reply-To: <TxFinancialCoordinators >Date: Tuesday, July 3, 2012 10:42 AMTo: " TxFinancialCoordinators " <TxFinancialCoordinators >Subject: RE: Donor Complications I have a questions that relates to this thread – Our donor had complications and was seen at their local emergency room and then transferred to our facility via ambulance. Do I pay the technical charges for the ED visit at the local hospital and then give them the recipient insurance info to bill the professional fees? How would the ambulance fees be considered – professional or technical? Thanks, Deidra Deidra M. SimanoTransplant Operations AnalystDepartment of Transplant SurgeryDartmouth-Hitchcock LebanonPhone: (603) 653.3689 / Fax: (603) 676.4287Transplant Secretary (603) 653.3931Dartmouth-Hitchcock.org From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Thursday, June 28, 2012 4:29 PMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi Mckenzie, First if the Donor was readmitted within 90 days, the technical services go to the Cost Report, if the admission was after 90 days the hospital bill goes to the recipients payer. In both cases, the physicians bills go to the recipients payer. Second, regardless of the recipients payer, the inpatient stay for the actual donor surgery goes to the Cost Report, they do NOT go to the Recipients Insurance. Physician fees for the donor actual surgery go to the recipients payer, regardless of payer. Hope this helps,Thanks,Bill Reply-To: <TxFinancialCoordinators >Date: Thursday, June 28, 2012 11:44 AMTo: <TxFinancialCoordinators >Subject: Donor Complications I think I might be a little confused on how these are supposed to be paid/billed. I have two seperate circumstances. The First, the recipient has Medicare primary. Donor was re-admitted for complications. Is this something that goes on the Cost Report, or is it billed to the recipient's Medicare?The second, the recipient has BCBS primary. Charges are for the actual surgery. They should be billed to the recipient's BCBS plan, right?Just need some clarification. Your help is so appreciated. :)MakenzieIMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE:This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 12, 2012 Report Share Posted July 12, 2012 More than 180 days, it is until.Reply-To: <TxFinancialCoordinators >Date: Wednesday, July 11, 2012 5:09 PMTo: <TxFinancialCoordinators >Subject: RE: Donor Complications Thanks Bill, very much. Well baby – is the rule of thumb, ok up to pay 180 days post? From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Wednesday, July 11, 2012 1:32 PMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi , Routine well baby visits, to make sure that there are no problems are billed to the transplant center and paid at 100% of Medicare just like an evaluation. That is step one. Step 2, if there is a complication in the first 90 days, the transplant center is responsible for technical services and the physician fees are billed to the recipients payer. Step 3, after 90 days both technical and professional fees are billed to the recipients primary payer. Hope this helps,Thanks,Bill Reply-To: <TxFinancialCoordinators >Date: Wednesday, July 11, 2012 4:12 PMTo: <TxFinancialCoordinators >Subject: RE: Donor Complications Hello Bill if you are out there! I’m busy overthinking things again – could you offer some direction? Donor to a Medicare beneficiary seen at 5.5 months post op by her PCP to “monitor for possible complications.” Claim sent to us for office visit plus labs. Do I direct them to bill technical and profees to Medicare, or technical to us, profee to Medicare? Many thanks for your input – I am getting thrown by “follow-up examinations may be covered for up to 6 months after the donation to monitor for possible complications” on the same page as instructions to limit routine follow-up to 90 days. on Transplant Financial Coordinator Legacy Good Samaritan Hospital Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 direct main office toll-free fax lmorriso@... ü Please consider the environment - think before you print! From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Tuesday, July 03, 2012 8:00 AMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi Deidra,If the complication was in the first 90 days after the transplant, the transplant center pays the technical fees and gives the physicians billing information for the recipient. If the complication was after 90 days, the transplant center gives the hospital and physicians billing information for the recipient. Hope this helps,Thanks,Bill Reply-To: <TxFinancialCoordinators >Date: Tuesday, July 3, 2012 10:42 AMTo: "TxFinancialCoordinators " <TxFinancialCoordinators >Subject: RE: Donor Complications I have a questions that relates to this thread – Our donor had complications and was seen at their local emergency room and then transferred to our facility via ambulance. Do I pay the technical charges for the ED visit at the local hospital and then give them the recipient insurance info to bill the professional fees? How would the ambulance fees be considered – professional or technical? Thanks, Deidra Deidra M. SimanoTransplant Operations AnalystDepartment of Transplant SurgeryDartmouth-Hitchcock LebanonPhone: (603) 653.3689 / Fax: (603) 676.4287Transplant Secretary (603) 653.3931Dartmouth-Hitchcock.org From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Thursday, June 28, 2012 4:29 PMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi Mckenzie, First if the Donor was readmitted within 90 days, the technical services go to the Cost Report, if the admission was after 90 days the hospital bill goes to the recipients payer. In both cases, the physicians bills go to the recipients payer. Second, regardless of the recipients payer, the inpatient stay for the actual donor surgery goes to the Cost Report, they do NOT go to the Recipients Insurance. Physician fees for the donor actual surgery go to the recipients payer, regardless of payer. Hope this helps,Thanks,Bill Reply-To: <TxFinancialCoordinators >Date: Thursday, June 28, 2012 11:44 AMTo: <TxFinancialCoordinators >Subject: Donor Complications I think I might be a little confused on how these are supposed to be paid/billed. I have two seperate circumstances. The First, the recipient has Medicare primary. Donor was re-admitted for complications. Is this something that goes on the Cost Report, or is it billed to the recipient's Medicare?The second, the recipient has BCBS primary. Charges are for the actual surgery. They should be billed to the recipient's BCBS plan, right?Just need some clarification. Your help is so appreciated. :)MakenzieIMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE:This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 12, 2012 Report Share Posted July 12, 2012 Are we channeling Yoda today or what? Translation: ok to bill program’s KACC for routine donor follow up until 180 post op. Thanks Bill! From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Wednesday, July 11, 2012 4:12 PMTo: TxFinancialCoordinators Subject: Re: Donor Complications More than 180 days, it is until. Reply-To: <TxFinancialCoordinators >Date: Wednesday, July 11, 2012 5:09 PMTo: <TxFinancialCoordinators >Subject: RE: Donor Complications Thanks Bill, very much. Well baby – is the rule of thumb, ok up to pay 180 days post? From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Wednesday, July 11, 2012 1:32 PMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi , Routine well baby visits, to make sure that there are no problems are billed to the transplant center and paid at 100% of Medicare just like an evaluation. That is step one. Step 2, if there is a complication in the first 90 days, the transplant center is responsible for technical services and the physician fees are billed to the recipients payer. Step 3, after 90 days both technical and professional fees are billed to the recipients primary payer. Hope this helps,Thanks,Bill Reply-To: <TxFinancialCoordinators >Date: Wednesday, July 11, 2012 4:12 PMTo: <TxFinancialCoordinators >Subject: RE: Donor Complications Hello Bill if you are out there! I’m busy overthinking things again – could you offer some direction? Donor to a Medicare beneficiary seen at 5.5 months post op by her PCP to “monitor for possible complications.” Claim sent to us for office visit plus labs. Do I direct them to bill technical and profees to Medicare, or technical to us, profee to Medicare? Many thanks for your input – I am getting thrown by “follow-up examinations may be covered for up to 6 months after the donation to monitor for possible complications” on the same page as instructions to limit routine follow-up to 90 days. on Transplant Financial Coordinator Legacy Good Samaritan Hospital Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 direct main office toll-free fax lmorriso@... ü Please consider the environment - think before you print! From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Tuesday, July 03, 2012 8:00 AMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi Deidra,If the complication was in the first 90 days after the transplant, the transplant center pays the technical fees and gives the physicians billing information for the recipient. If the complication was after 90 days, the transplant center gives the hospital and physicians billing information for the recipient. Hope this helps,Thanks,Bill Reply-To: <TxFinancialCoordinators >Date: Tuesday, July 3, 2012 10:42 AMTo: " TxFinancialCoordinators " <TxFinancialCoordinators >Subject: RE: Donor Complications I have a questions that relates to this thread – Our donor had complications and was seen at their local emergency room and then transferred to our facility via ambulance. Do I pay the technical charges for the ED visit at the local hospital and then give them the recipient insurance info to bill the professional fees? How would the ambulance fees be considered – professional or technical? Thanks, Deidra Deidra M. SimanoTransplant Operations AnalystDepartment of Transplant SurgeryDartmouth-Hitchcock LebanonPhone: (603) 653.3689 / Fax: (603) 676.4287Transplant Secretary (603) 653.3931Dartmouth-Hitchcock.org From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Thursday, June 28, 2012 4:29 PMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi Mckenzie, First if the Donor was readmitted within 90 days, the technical services go to the Cost Report, if the admission was after 90 days the hospital bill goes to the recipients payer. In both cases, the physicians bills go to the recipients payer. Second, regardless of the recipients payer, the inpatient stay for the actual donor surgery goes to the Cost Report, they do NOT go to the Recipients Insurance. Physician fees for the donor actual surgery go to the recipients payer, regardless of payer. Hope this helps,Thanks,Bill Reply-To: <TxFinancialCoordinators >Date: Thursday, June 28, 2012 11:44 AMTo: <TxFinancialCoordinators >Subject: Donor Complications I think I might be a little confused on how these are supposed to be paid/billed. I have two seperate circumstances. The First, the recipient has Medicare primary. Donor was re-admitted for complications. Is this something that goes on the Cost Report, or is it billed to the recipient's Medicare?The second, the recipient has BCBS primary. Charges are for the actual surgery. They should be billed to the recipient's BCBS plan, right?Just need some clarification. Your help is so appreciated. :)MakenzieIMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE:This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 12, 2012 Report Share Posted July 12, 2012 Sorry – meant throw ( too early!) JoAnne Cannone Administrative Assistant to: C. Mendez, MD Barbara A. Pisani, DO Co-Medical Directors of The Advanced Heart Failure, Heart Transplant & Mechanical Circulatory Support Program at Rush 1725 West on Street, Professional Building III - Suite 1159 Chicago, Illinois 60612 Office: Fax: J. March, MD Associate Professor of Surgery Department of Cardiovascular-Thoracic Surgery 1725 West on Street, Professional Building III - Suite 1156 Chicago, Illinois 60612 Office: Fax: From: Joanne Cannone Sent: Thursday, July 12, 2012 8:18 AM To: 'TxFinancialCoordinators ' Subject: RE: Donor Complications To through a small wrench in the question – will this same process apply to the “Pair Donor Exchange Program” in which donors are coming from out-of-state and may not be covered under the recipient’s insurance – in the post 90 days scenario (step 3)? JoAnne Cannone Administrative Assistant to: C. Mendez, MD Barbara A. Pisani, DO Co-Medical Directors of The Advanced Heart Failure, Heart Transplant & Mechanical Circulatory Support Program at Rush 1725 West on Street, Professional Building III - Suite 1159 Chicago, Illinois 60612 Office: Fax: J. March, MD Associate Professor of Surgery Department of Cardiovascular-Thoracic Surgery 1725 West on Street, Professional Building III - Suite 1156 Chicago, Illinois 60612 Office: Fax: From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Wednesday, July 11, 2012 3:32 PM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi , Routine well baby visits, to make sure that there are no problems are billed to the transplant center and paid at 100% of Medicare just like an evaluation. That is step one. Step 2, if there is a complication in the first 90 days, the transplant center is responsible for technical services and the physician fees are billed to the recipients payer. Step 3, after 90 days both technical and professional fees are billed to the recipients primary payer. Hope this helps, Thanks, Bill From: " on, :LPH Trnsplnt " Reply-To: <TxFinancialCoordinators > Date: Wednesday, July 11, 2012 4:12 PM To: <TxFinancialCoordinators > Subject: RE: Donor Complications Hello Bill if you are out there! I’m busy overthinking things again – could you offer some direction? Donor to a Medicare beneficiary seen at 5.5 months post op by her PCP to “monitor for possible complications.” Claim sent to us for office visit plus labs. Do I direct them to bill technical and profees to Medicare, or technical to us, profee to Medicare? Many thanks for your input – I am getting thrown by “follow-up examinations may be covered for up to 6 months after the donation to monitor for possible complications” on the same page as instructions to limit routine follow-up to 90 days. on Transplant Financial Coordinator Legacy Good Samaritan Hospital Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 direct main office toll-free fax lmorriso@... ü Please consider the environment - think before you print! From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Tuesday, July 03, 2012 8:00 AM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi Deidra, If the complication was in the first 90 days after the transplant, the transplant center pays the technical fees and gives the physicians billing information for the recipient. If the complication was after 90 days, the transplant center gives the hospital and physicians billing information for the recipient. Hope this helps, Thanks, Bill Reply-To: <TxFinancialCoordinators > Date: Tuesday, July 3, 2012 10:42 AM To: " TxFinancialCoordinators " <TxFinancialCoordinators > Subject: RE: Donor Complications I have a questions that relates to this thread – Our donor had complications and was seen at their local emergency room and then transferred to our facility via ambulance. Do I pay the technical charges for the ED visit at the local hospital and then give them the recipient insurance info to bill the professional fees? How would the ambulance fees be considered – professional or technical? Thanks, Deidra Deidra M. Simano Transplant Operations Analyst Department of Transplant Surgery Dartmouth-Hitchcock Lebanon Phone: (603) 653.3689 / Fax: (603) 676.4287 Transplant Secretary (603) 653.3931 Dartmouth-Hitchcock.org From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Thursday, June 28, 2012 4:29 PM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi Mckenzie, First if the Donor was readmitted within 90 days, the technical services go to the Cost Report, if the admission was after 90 days the hospital bill goes to the recipients payer. In both cases, the physicians bills go to the recipients payer. Second, regardless of the recipients payer, the inpatient stay for the actual donor surgery goes to the Cost Report, they do NOT go to the Recipients Insurance. Physician fees for the donor actual surgery go to the recipients payer, regardless of payer. Hope this helps, Thanks, Bill Reply-To: <TxFinancialCoordinators > Date: Thursday, June 28, 2012 11:44 AM To: <TxFinancialCoordinators > Subject: Donor Complications I think I might be a little confused on how these are supposed to be paid/billed. I have two seperate circumstances. The First, the recipient has Medicare primary. Donor was re-admitted for complications. Is this something that goes on the Cost Report, or is it billed to the recipient's Medicare? The second, the recipient has BCBS primary. Charges are for the actual surgery. They should be billed to the recipient's BCBS plan, right? Just need some clarification. Your help is so appreciated. Makenzie IMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE: This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 12, 2012 Report Share Posted July 12, 2012 To through a small wrench in the question – will this same process apply to the “Pair Donor Exchange Program” in which donors are coming from out-of-state and may not be covered under the recipient’s insurance – in the post 90 days scenario (step 3)? JoAnne Cannone Administrative Assistant to: C. Mendez, MD Barbara A. Pisani, DO Co-Medical Directors of The Advanced Heart Failure, Heart Transplant & Mechanical Circulatory Support Program at Rush 1725 West on Street, Professional Building III - Suite 1159 Chicago, Illinois 60612 Office: Fax: J. March, MD Associate Professor of Surgery Department of Cardiovascular-Thoracic Surgery 1725 West on Street, Professional Building III - Suite 1156 Chicago, Illinois 60612 Office: Fax: From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Wednesday, July 11, 2012 3:32 PM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi , Routine well baby visits, to make sure that there are no problems are billed to the transplant center and paid at 100% of Medicare just like an evaluation. That is step one. Step 2, if there is a complication in the first 90 days, the transplant center is responsible for technical services and the physician fees are billed to the recipients payer. Step 3, after 90 days both technical and professional fees are billed to the recipients primary payer. Hope this helps, Thanks, Bill From: " on, :LPH Trnsplnt " Reply-To: <TxFinancialCoordinators > Date: Wednesday, July 11, 2012 4:12 PM To: <TxFinancialCoordinators > Subject: RE: Donor Complications Hello Bill if you are out there! I’m busy overthinking things again – could you offer some direction? Donor to a Medicare beneficiary seen at 5.5 months post op by her PCP to “monitor for possible complications.” Claim sent to us for office visit plus labs. Do I direct them to bill technical and profees to Medicare, or technical to us, profee to Medicare? Many thanks for your input – I am getting thrown by “follow-up examinations may be covered for up to 6 months after the donation to monitor for possible complications” on the same page as instructions to limit routine follow-up to 90 days. on Transplant Financial Coordinator Legacy Good Samaritan Hospital Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 direct main office toll-free fax lmorriso@... ü Please consider the environment - think before you print! From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Tuesday, July 03, 2012 8:00 AM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi Deidra, If the complication was in the first 90 days after the transplant, the transplant center pays the technical fees and gives the physicians billing information for the recipient. If the complication was after 90 days, the transplant center gives the hospital and physicians billing information for the recipient. Hope this helps, Thanks, Bill Reply-To: <TxFinancialCoordinators > Date: Tuesday, July 3, 2012 10:42 AM To: " TxFinancialCoordinators " <TxFinancialCoordinators > Subject: RE: Donor Complications I have a questions that relates to this thread – Our donor had complications and was seen at their local emergency room and then transferred to our facility via ambulance. Do I pay the technical charges for the ED visit at the local hospital and then give them the recipient insurance info to bill the professional fees? How would the ambulance fees be considered – professional or technical? Thanks, Deidra Deidra M. Simano Transplant Operations Analyst Department of Transplant Surgery Dartmouth-Hitchcock Lebanon Phone: (603) 653.3689 / Fax: (603) 676.4287 Transplant Secretary (603) 653.3931 Dartmouth-Hitchcock.org From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Thursday, June 28, 2012 4:29 PM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi Mckenzie, First if the Donor was readmitted within 90 days, the technical services go to the Cost Report, if the admission was after 90 days the hospital bill goes to the recipients payer. In both cases, the physicians bills go to the recipients payer. Second, regardless of the recipients payer, the inpatient stay for the actual donor surgery goes to the Cost Report, they do NOT go to the Recipients Insurance. Physician fees for the donor actual surgery go to the recipients payer, regardless of payer. Hope this helps, Thanks, Bill Reply-To: <TxFinancialCoordinators > Date: Thursday, June 28, 2012 11:44 AM To: <TxFinancialCoordinators > Subject: Donor Complications I think I might be a little confused on how these are supposed to be paid/billed. I have two seperate circumstances. The First, the recipient has Medicare primary. Donor was re-admitted for complications. Is this something that goes on the Cost Report, or is it billed to the recipient's Medicare? The second, the recipient has BCBS primary. Charges are for the actual surgery. They should be billed to the recipient's BCBS plan, right? Just need some clarification. Your help is so appreciated. Makenzie IMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE: This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 12, 2012 Report Share Posted July 12, 2012 THANKS!!! JoAnne Cannone Administrative Assistant to: C. Mendez, MD Barbara A. Pisani, DO Co-Medical Directors of The Advanced Heart Failure, Heart Transplant & Mechanical Circulatory Support Program at Rush 1725 West on Street, Professional Building III - Suite 1159 Chicago, Illinois 60612 Office: Fax: J. March, MD Associate Professor of Surgery Department of Cardiovascular-Thoracic Surgery 1725 West on Street, Professional Building III - Suite 1156 Chicago, Illinois 60612 Office: Fax: From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Thursday, July 12, 2012 8:22 AM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi Joanne, Yes it will, it is incumbent on the transplant centers that they contract donor complication care with payers. The routine follow up is the responsibility of the transplanting center. Hope this helps, Thanks, Bill From: Joanne Cannone Reply-To: <TxFinancialCoordinators > Date: Thursday, July 12, 2012 9:18 AM To: " TxFinancialCoordinators " <TxFinancialCoordinators > Subject: RE: Donor Complications To through a small wrench in the question – will this same process apply to the “Pair Donor Exchange Program” in which donors are coming from out-of-state and may not be covered under the recipient’s insurance – in the post 90 days scenario (step 3)? JoAnne Cannone Administrative Assistant to: C. Mendez, MD Barbara A. Pisani, DO Co-Medical Directors of The Advanced Heart Failure, Heart Transplant & Mechanical Circulatory Support Program at Rush 1725 West on Street, Professional Building III - Suite 1159 Chicago, Illinois 60612 Office: Fax: J. March, MD Associate Professor of Surgery Department of Cardiovascular-Thoracic Surgery 1725 West on Street, Professional Building III - Suite 1156 Chicago, Illinois 60612 Office: Fax: From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Wednesday, July 11, 2012 3:32 PM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi , Routine well baby visits, to make sure that there are no problems are billed to the transplant center and paid at 100% of Medicare just like an evaluation. That is step one. Step 2, if there is a complication in the first 90 days, the transplant center is responsible for technical services and the physician fees are billed to the recipients payer. Step 3, after 90 days both technical and professional fees are billed to the recipients primary payer. Hope this helps, Thanks, Bill Reply-To: <TxFinancialCoordinators > Date: Wednesday, July 11, 2012 4:12 PM To: <TxFinancialCoordinators > Subject: RE: Donor Complications Hello Bill if you are out there! I’m busy overthinking things again – could you offer some direction? Donor to a Medicare beneficiary seen at 5.5 months post op by her PCP to “monitor for possible complications.” Claim sent to us for office visit plus labs. Do I direct them to bill technical and profees to Medicare, or technical to us, profee to Medicare? Many thanks for your input – I am getting thrown by “follow-up examinations may be covered for up to 6 months after the donation to monitor for possible complications” on the same page as instructions to limit routine follow-up to 90 days. on Transplant Financial Coordinator Legacy Good Samaritan Hospital Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 direct main office toll-free fax lmorriso@... üPlease consider the environment - think before you print! From:TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Tuesday, July 03, 2012 8:00 AM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi Deidra, If the complication was in the first 90 days after the transplant, the transplant center pays the technical fees and gives the physicians billing information for the recipient. If the complication was after 90 days, the transplant center gives the hospital and physicians billing information for the recipient. Hope this helps, Thanks, Bill Reply-To: <TxFinancialCoordinators > Date: Tuesday, July 3, 2012 10:42 AM To: " TxFinancialCoordinators " <TxFinancialCoordinators > Subject: RE: Donor Complications I have a questions that relates to this thread – Our donor had complications and was seen at their local emergency room and then transferred to our facility via ambulance. Do I pay the technical charges for the ED visit at the local hospital and then give them the recipient insurance info to bill the professional fees? How would the ambulance fees be considered – professional or technical? Thanks, Deidra Deidra M. Simano Transplant Operations Analyst Department of Transplant Surgery Dartmouth-Hitchcock Lebanon Phone: (603) 653.3689 / Fax: (603) 676.4287 Transplant Secretary (603) 653.3931 Dartmouth-Hitchcock.org From:TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Thursday, June 28, 2012 4:29 PM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi Mckenzie, First if the Donor was readmitted within 90 days, the technical services go to the Cost Report, if the admission was after 90 days the hospital bill goes to the recipients payer. In both cases, the physicians bills go to the recipients payer. Second, regardless of the recipients payer, the inpatient stay for the actual donor surgery goes to the Cost Report, they do NOT go to the Recipients Insurance. Physician fees for the donor actual surgery go to the recipients payer, regardless of payer. Hope this helps, Thanks, Bill Reply-To: <TxFinancialCoordinators > Date: Thursday, June 28, 2012 11:44 AM To: <TxFinancialCoordinators > Subject: Donor Complications I think I might be a little confused on how these are supposed to be paid/billed. I have two seperate circumstances. The First, the recipient has Medicare primary. Donor was re-admitted for complications. Is this something that goes on the Cost Report, or is it billed to the recipient's Medicare? The second, the recipient has BCBS primary. Charges are for the actual surgery. They should be billed to the recipient's BCBS plan, right? Just need some clarification. Your help is so appreciated. Makenzie IMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE: This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 12, 2012 Report Share Posted July 12, 2012 Hi Joanne,Yes it will, it is incumbent on the transplant centers that they contract donor complication care with payers. The routine follow up is the responsibility of the transplanting center.Hope this helps,Thanks,BillReply-To: <TxFinancialCoordinators >Date: Thursday, July 12, 2012 9:18 AMTo: "TxFinancialCoordinators " <TxFinancialCoordinators >Subject: RE: Donor Complications To through a small wrench in the question – will this same process apply to the “Pair Donor Exchange Program” in which donors are coming from out-of-state and may not be covered under the recipient’s insurance – in the post 90 days scenario (step 3)? JoAnne CannoneAdministrative Assistant to: C. Mendez, MDBarbara A. Pisani, DOCo-Medical Directors of The Advanced Heart Failure,Heart Transplant & Mechanical Circulatory Support Program at Rush1725 West on Street, Professional Building III - Suite 1159Chicago, Illinois 60612Office: Fax: J. March, MDAssociate Professor of SurgeryDepartment of Cardiovascular-Thoracic Surgery1725 West on Street, Professional Building III - Suite 1156Chicago, Illinois 60612Office: Fax: From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Wednesday, July 11, 2012 3:32 PMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi , Routine well baby visits, to make sure that there are no problems are billed to the transplant center and paid at 100% of Medicare just like an evaluation. That is step one. Step 2, if there is a complication in the first 90 days, the transplant center is responsible for technical services and the physician fees are billed to the recipients payer. Step 3, after 90 days both technical and professional fees are billed to the recipients primary payer. Hope this helps,Thanks,Bill From: "on, :LPH Trnsplnt" Reply-To: <TxFinancialCoordinators >Date: Wednesday, July 11, 2012 4:12 PMTo: <TxFinancialCoordinators >Subject: RE: Donor Complications Hello Bill if you are out there! I’m busy overthinking things again – could you offer some direction? Donor to a Medicare beneficiary seen at 5.5 months post op by her PCP to “monitor for possible complications.” Claim sent to us for office visit plus labs. Do I direct them to bill technical and profees to Medicare, or technical to us, profee to Medicare? Many thanks for your input – I am getting thrown by “follow-up examinations may be covered for up to 6 months after the donation to monitor for possible complications” on the same page as instructions to limit routine follow-up to 90 days. onTransplant Financial CoordinatorLegacy Good Samaritan HospitalLegacy Transplant Services1040 NW 22nd Ave Ste 480Portland OR 97210 direct main office toll-free faxlmorriso@...üPlease consider the environment - think before you print! From:TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Tuesday, July 03, 2012 8:00 AMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi Deidra, If the complication was in the first 90 days after the transplant, the transplant center pays the technical fees and gives the physicians billing information for the recipient. If the complication was after 90 days, the transplant center gives the hospital and physicians billing information for the recipient. Hope this helps, Thanks, Bill Reply-To: <TxFinancialCoordinators >Date: Tuesday, July 3, 2012 10:42 AMTo: "TxFinancialCoordinators " <TxFinancialCoordinators >Subject: RE: Donor Complications I have a questions that relates to this thread – Our donor had complications and was seen at their local emergency room and then transferred to our facility via ambulance. Do I pay the technical charges for the ED visit at the local hospital and then give them the recipient insurance info to bill the professional fees? How would the ambulance fees be considered – professional or technical? Thanks, Deidra Deidra M. SimanoTransplant Operations AnalystDepartment of Transplant SurgeryDartmouth-Hitchcock LebanonPhone: (603) 653.3689 / Fax: (603) 676.4287Transplant Secretary (603) 653.3931Dartmouth-Hitchcock.org From:TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Thursday, June 28, 2012 4:29 PMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi Mckenzie, First if the Donor was readmitted within 90 days, the technical services go to the Cost Report, if the admission was after 90 days the hospital bill goes to the recipients payer. In both cases, the physicians bills go to the recipients payer. Second, regardless of the recipients payer, the inpatient stay for the actual donor surgery goes to the Cost Report, they do NOT go to the Recipients Insurance. Physician fees for the donor actual surgery go to the recipients payer, regardless of payer. Hope this helps, Thanks, Bill Reply-To: <TxFinancialCoordinators >Date: Thursday, June 28, 2012 11:44 AMTo: <TxFinancialCoordinators >Subject: Donor Complications I think I might be a little confused on how these are supposed to be paid/billed. I have two seperate circumstances. The First, the recipient has Medicare primary. Donor was re-admitted for complications. Is this something that goes on the Cost Report, or is it billed to the recipient's Medicare? The second, the recipient has BCBS primary. Charges are for the actual surgery. They should be billed to the recipient's BCBS plan, right? Just need some clarification. Your help is so appreciated. Makenzie IMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE: This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 12, 2012 Report Share Posted July 12, 2012 Bill, in an Medicare Learning Network memo regrding Billing for donor Post-Kidney Tranpslant Complication Services it tries to break down this information. Unless I'm misunderstanding what I am reading I think itis saying something different than you. It states under the heading of 'Regarding Donor Complicatins'- " Expenses incurred for complications that arise with rspect 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 health insurance claim number. This is true of both facility cost and physician services. " I'm I mis-interpeting to believe that all donor complications post discharge date should go under the recipient's claim number, both facility and physicians? I can fax you a copy of this memo for your review. Julius Eason Transplant Financial Coordinator Multi-Organ Transplant Department Beaumont Health System jeason@... (P) (F) From: TxFinancialCoordinators [TxFinancialCoordinators ] on behalf of Bill Vaughan [Vaughan@...] Sent: Thursday, July 12, 2012 9:21 AM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi Joanne, Yes it will, it is incumbent on the transplant centers that they contract donor complication care with payers. The routine follow up is the responsibility of the transplanting center. Hope this helps, Thanks, Bill Reply-To: <TxFinancialCoordinators > Date: Thursday, July 12, 2012 9:18 AM To: " TxFinancialCoordinators " <TxFinancialCoordinators > Subject: RE: Donor Complications To through a small wrench in the question – will this same process apply to the “Pair Donor Exchange Program” in which donors are coming from out-of-state and may not be covered under the recipient’s insurance – in the post 90 days scenario (step 3)? JoAnne Cannone Administrative Assistant to: C. Mendez, MD Barbara A. Pisani, DO Co-Medical Directors of The Advanced Heart Failure, Heart Transplant & Mechanical Circulatory Support Program at Rush 1725 West on Street, Professional Building III - Suite 1159 Chicago, Illinois 60612 Office: Fax: J. March, MD Associate Professor of Surgery Department of Cardiovascular-Thoracic Surgery 1725 West on Street, Professional Building III - Suite 1156 Chicago, Illinois 60612 Office: Fax: From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Wednesday, July 11, 2012 3:32 PM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi , Routine well baby visits, to make sure that there are no problems are billed to the transplant center and paid at 100% of Medicare just like an evaluation. That is step one. Step 2, if there is a complication in the first 90 days, the transplant center is responsible for technical services and the physician fees are billed to the recipients payer. Step 3, after 90 days both technical and professional fees are billed to the recipients primary payer. Hope this helps, Thanks, Bill From: " on, :LPH Trnsplnt " Reply-To: <TxFinancialCoordinators > Date: Wednesday, July 11, 2012 4:12 PM To: <TxFinancialCoordinators > Subject: RE: Donor Complications Hello Bill if you are out there! I’m busy overthinking things again – could you offer some direction? Donor to a Medicare beneficiary seen at 5.5 months post op by her PCP to “monitor for possible complications.” Claim sent to us for office visit plus labs. Do I direct them to bill technical and profees to Medicare, or technical to us, profee to Medicare? Many thanks for your input – I am getting thrown by “follow-up examinations may be covered for up to 6 months after the donation to monitor for possible complications” on the same page as instructions to limit routine follow-up to 90 days. on Transplant Financial Coordinator Legacy Good Samaritan Hospital Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 direct main office toll-free fax lmorriso@... üPlease consider the environment - think before you print! From:TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Tuesday, July 03, 2012 8:00 AM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi Deidra, If the complication was in the first 90 days after the transplant, the transplant center pays the technical fees and gives the physicians billing information for the recipient. If the complication was after 90 days, the transplant center gives the hospital and physicians billing information for the recipient. Hope this helps, Thanks, Bill From: " Deidra M. Simano " Reply-To: <TxFinancialCoordinators > Date: Tuesday, July 3, 2012 10:42 AM To: " TxFinancialCoordinators " <TxFinancialCoordinators > Subject: RE: Donor Complications I have a questions that relates to this thread – Our donor had complications and was seen at their local emergency room and then transferred to our facility via ambulance. Do I pay the technical charges for the ED visit at the local hospital and then give them the recipient insurance info to bill the professional fees? How would the ambulance fees be considered – professional or technical? Thanks, Deidra Deidra M. Simano Transplant Operations Analyst Department of Transplant Surgery Dartmouth-Hitchcock Lebanon Phone: (603) 653.3689 / Fax: (603) 676.4287 Transplant Secretary (603) 653.3931 Dartmouth-Hitchcock.org From:TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Thursday, June 28, 2012 4:29 PM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi Mckenzie, First if the Donor was readmitted within 90 days, the technical services go to the Cost Report, if the admission was after 90 days the hospital bill goes to the recipients payer. In both cases, the physicians bills go to the recipients payer. Second, regardless of the recipients payer, the inpatient stay for the actual donor surgery goes to the Cost Report, they do NOT go to the Recipients Insurance. Physician fees for the donor actual surgery go to the recipients payer, regardless of payer. Hope this helps, Thanks, Bill From: MakenzieS Reply-To: <TxFinancialCoordinators > Date: Thursday, June 28, 2012 11:44 AM To: <TxFinancialCoordinators > Subject: Donor Complications I think I might be a little confused on how these are supposed to be paid/billed. I have two seperate circumstances. The First, the recipient has Medicare primary. Donor was re-admitted for complications. Is this something that goes on the Cost Report, or is it billed to the recipient's Medicare? The second, the recipient has BCBS primary. Charges are for the actual surgery. They should be billed to the recipient's BCBS plan, right? Just need some clarification. Your help is so appreciated. Makenzie IMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE: This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. To report this email as SPAM, please forward it to spam@.... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 12, 2012 Report Share Posted July 12, 2012 HI Julius,Please send me a copy. My read is that if the complication is identified in the first 90 days the technical cost goes to the cost report and the physician portion goes to the payer for the recipient. After 90 days it all goes to the payer. I am willing to change my opinion. I will look to see if I can find the CMS pronouncement and share it.The part I like best is that well baby coverage is now a part of the cost report for both technical and professional services.Hope this helps,Thanks,BillReply-To: <TxFinancialCoordinators >Date: Thursday, July 12, 2012 10:01 AMTo: "TxFinancialCoordinators " <TxFinancialCoordinators >Subject: RE: Donor Complications Bill, in an Medicare Learning Network memo regrding Billing for donor Post-Kidney Tranpslant Complication Services it tries to break down this information. Unless I'm misunderstanding what I am reading I think itis saying something different than you. It states under the heading of 'Regarding Donor Complicatins'- "Expenses incurred for complications that arise with rspect 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 health insurance claim number. This is true of both facility cost and physician services." I'm I mis-interpeting to believe that all donor complications post discharge date should go under the recipient's claim number, both facility and physicians? I can fax you a copy of this memo for your review. Julius EasonTransplant Financial CoordinatorMulti-Organ Transplant DepartmentBeaumont Health Systemjeason@...(P) (F) From: TxFinancialCoordinators [TxFinancialCoordinators ] on behalf of Bill Vaughan [Vaughan@...]Sent: Thursday, July 12, 2012 9:21 AMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi Joanne,Yes it will, it is incumbent on the transplant centers that they contract donor complication care with payers. The routine follow up is the responsibility of the transplanting center.Hope this helps,Thanks,BillReply-To: <TxFinancialCoordinators >Date: Thursday, July 12, 2012 9:18 AMTo: "TxFinancialCoordinators " <TxFinancialCoordinators >Subject: RE: Donor Complications To through a small wrench in the question – will this same process apply to the “Pair Donor Exchange Program” in which donors are coming from out-of-state and may not be covered under the recipient’s insurance – in the post 90 days scenario (step 3)? JoAnne CannoneAdministrative Assistant to: C. Mendez, MDBarbara A. Pisani, DOCo-Medical Directors of The Advanced Heart Failure,Heart Transplant & Mechanical Circulatory Support Program at Rush1725 West on Street, Professional Building III - Suite 1159Chicago, Illinois 60612Office: Fax: J. March, MDAssociate Professor of SurgeryDepartment of Cardiovascular-Thoracic Surgery1725 West on Street, Professional Building III - Suite 1156Chicago, Illinois 60612Office: Fax: From:TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Wednesday, July 11, 2012 3:32 PMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi , Routine well baby visits, to make sure that there are no problems are billed to the transplant center and paid at 100% of Medicare just like an evaluation. That is step one. Step 2, if there is a complication in the first 90 days, the transplant center is responsible for technical services and the physician fees are billed to the recipients payer. Step 3, after 90 days both technical and professional fees are billed to the recipients primary payer. Hope this helps,Thanks,Bill Reply-To: <TxFinancialCoordinators >Date: Wednesday, July 11, 2012 4:12 PMTo: <TxFinancialCoordinators >Subject: RE: Donor Complications Hello Bill if you are out there! I’m busy overthinking things again – could you offer some direction? Donor to a Medicare beneficiary seen at 5.5 months post op by her PCP to “monitor for possible complications.” Claim sent to us for office visit plus labs. Do I direct them to bill technical and profees to Medicare, or technical to us, profee to Medicare? Many thanks for your input – I am getting thrown by “follow-up examinations may be covered for up to 6 months after the donation to monitor for possible complications” on the same page as instructions to limit routine follow-up to 90 days. onTransplant Financial CoordinatorLegacy Good Samaritan HospitalLegacy Transplant Services1040 NW 22nd Ave Ste 480Portland OR 97210 direct main office toll-free faxlmorriso@...üPlease consider the environment - think before you print! From:TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Tuesday, July 03, 2012 8:00 AMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi Deidra,If the complication was in the first 90 days after the transplant, the transplant center pays the technical fees and gives the physicians billing information for the recipient. If the complication was after 90 days, the transplant center gives the hospital and physicians billing information for the recipient. Hope this helps,Thanks,Bill From: "Deidra M. Simano" Reply-To: <TxFinancialCoordinators >Date: Tuesday, July 3, 2012 10:42 AMTo: "TxFinancialCoordinators " <TxFinancialCoordinators >Subject: RE: Donor Complications I have a questions that relates to this thread – Our donor had complications and was seen at their local emergency room and then transferred to our facility via ambulance. Do I pay the technical charges for the ED visit at the local hospital and then give them the recipient insurance info to bill the professional fees? How would the ambulance fees be considered – professional or technical? Thanks, Deidra Deidra M. SimanoTransplant Operations AnalystDepartment of Transplant SurgeryDartmouth-Hitchcock LebanonPhone: (603) 653.3689 / Fax: (603) 676.4287Transplant Secretary (603) 653.3931Dartmouth-Hitchcock.org From:TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Thursday, June 28, 2012 4:29 PMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi Mckenzie, First if the Donor was readmitted within 90 days, the technical services go to the Cost Report, if the admission was after 90 days the hospital bill goes to the recipients payer. In both cases, the physicians bills go to the recipients payer. Second, regardless of the recipients payer, the inpatient stay for the actual donor surgery goes to the Cost Report, they do NOT go to the Recipients Insurance. Physician fees for the donor actual surgery go to the recipients payer, regardless of payer. Hope this helps,Thanks,Bill From: MakenzieS Reply-To: <TxFinancialCoordinators >Date: Thursday, June 28, 2012 11:44 AMTo: <TxFinancialCoordinators >Subject: Donor Complications I think I might be a little confused on how these are supposed to be paid/billed. I have two seperate circumstances. The First, the recipient has Medicare primary. Donor was re-admitted for complications. Is this something that goes on the Cost Report, or is it billed to the recipient's Medicare? The second, the recipient has BCBS primary. Charges are for the actual surgery. They should be billed to the recipient's BCBS plan, right? Just need some clarification. Your help is so appreciated. Makenzie IMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE: This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. To report this email as SPAM, please forward it to spam@.... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 12, 2012 Report Share Posted July 12, 2012 Bill, what is your fax number? Julius Eason Transplant Financial Coordinator Multi-Organ Transplant Department Beaumont Health System jeason@... (P) (F) From: TxFinancialCoordinators [TxFinancialCoordinators ] on behalf of Bill Vaughan [Vaughan@...] Sent: Thursday, July 12, 2012 10:45 AM To: TxFinancialCoordinators Subject: Re: Donor Complications HI Julius, Please send me a copy. My read is that if the complication is identified in the first 90 days the technical cost goes to the cost report and the physician portion goes to the payer for the recipient. After 90 days it all goes to the payer. I am willing to change my opinion. I will look to see if I can find the CMS pronouncement and share it. The part I like best is that well baby coverage is now a part of the cost report for both technical and professional services. Hope this helps, Thanks, Bill Reply-To: <TxFinancialCoordinators > Date: Thursday, July 12, 2012 10:01 AM To: " TxFinancialCoordinators " <TxFinancialCoordinators > Subject: RE: Donor Complications Bill, in an Medicare Learning Network memo regrding Billing for donor Post-Kidney Tranpslant Complication Services it tries to break down this information. Unless I'm misunderstanding what I am reading I think itis saying something different than you. It states under the heading of 'Regarding Donor Complicatins'- " Expenses incurred for complications that arise with rspect 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 health insurance claim number. This is true of both facility cost and physician services. " I'm I mis-interpeting to believe that all donor complications post discharge date should go under the recipient's claim number, both facility and physicians? I can fax you a copy of this memo for your review. Julius Eason Transplant Financial Coordinator Multi-Organ Transplant Department Beaumont Health System jeason@... (P) (F) From: TxFinancialCoordinators [TxFinancialCoordinators ] on behalf of Bill Vaughan [Vaughan@...] Sent: Thursday, July 12, 2012 9:21 AM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi Joanne, Yes it will, it is incumbent on the transplant centers that they contract donor complication care with payers. The routine follow up is the responsibility of the transplanting center. Hope this helps, Thanks, Bill Reply-To: <TxFinancialCoordinators > Date: Thursday, July 12, 2012 9:18 AM To: " TxFinancialCoordinators " <TxFinancialCoordinators > Subject: RE: Donor Complications To through a small wrench in the question – will this same process apply to the “Pair Donor Exchange Program” in which donors are coming from out-of-state and may not be covered under the recipient’s insurance – in the post 90 days scenario (step 3)? JoAnne Cannone Administrative Assistant to: C. Mendez, MD Barbara A. Pisani, DO Co-Medical Directors of The Advanced Heart Failure, Heart Transplant & Mechanical Circulatory Support Program at Rush 1725 West on Street, Professional Building III - Suite 1159 Chicago, Illinois 60612 Office: Fax: J. March, MD Associate Professor of Surgery Department of Cardiovascular-Thoracic Surgery 1725 West on Street, Professional Building III - Suite 1156 Chicago, Illinois 60612 Office: Fax: From:TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Wednesday, July 11, 2012 3:32 PM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi , Routine well baby visits, to make sure that there are no problems are billed to the transplant center and paid at 100% of Medicare just like an evaluation. That is step one. Step 2, if there is a complication in the first 90 days, the transplant center is responsible for technical services and the physician fees are billed to the recipients payer. Step 3, after 90 days both technical and professional fees are billed to the recipients primary payer. Hope this helps, Thanks, Bill From: " on, :LPH Trnsplnt " Reply-To: <TxFinancialCoordinators > Date: Wednesday, July 11, 2012 4:12 PM To: <TxFinancialCoordinators > Subject: RE: Donor Complications Hello Bill if you are out there! I’m busy overthinking things again – could you offer some direction? Donor to a Medicare beneficiary seen at 5.5 months post op by her PCP to “monitor for possible complications.” Claim sent to us for office visit plus labs. Do I direct them to bill technical and profees to Medicare, or technical to us, profee to Medicare? Many thanks for your input – I am getting thrown by “follow-up examinations may be covered for up to 6 months after the donation to monitor for possible complications” on the same page as instructions to limit routine follow-up to 90 days. on Transplant Financial Coordinator Legacy Good Samaritan Hospital Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 direct main office toll-free fax lmorriso@... üPlease consider the environment - think before you print! From:TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Tuesday, July 03, 2012 8:00 AM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi Deidra, If the complication was in the first 90 days after the transplant, the transplant center pays the technical fees and gives the physicians billing information for the recipient. If the complication was after 90 days, the transplant center gives the hospital and physicians billing information for the recipient. Hope this helps, Thanks, Bill From: " Deidra M. Simano " Reply-To: <TxFinancialCoordinators > Date: Tuesday, July 3, 2012 10:42 AM To: " TxFinancialCoordinators " <TxFinancialCoordinators > Subject: RE: Donor Complications I have a questions that relates to this thread – Our donor had complications and was seen at their local emergency room and then transferred to our facility via ambulance. Do I pay the technical charges for the ED visit at the local hospital and then give them the recipient insurance info to bill the professional fees? How would the ambulance fees be considered – professional or technical? Thanks, Deidra Deidra M. Simano Transplant Operations Analyst Department of Transplant Surgery Dartmouth-Hitchcock Lebanon Phone: (603) 653.3689 / Fax: (603) 676.4287 Transplant Secretary (603) 653.3931 Dartmouth-Hitchcock.org From:TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Thursday, June 28, 2012 4:29 PM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi Mckenzie, First if the Donor was readmitted within 90 days, the technical services go to the Cost Report, if the admission was after 90 days the hospital bill goes to the recipients payer. In both cases, the physicians bills go to the recipients payer. Second, regardless of the recipients payer, the inpatient stay for the actual donor surgery goes to the Cost Report, they do NOT go to the Recipients Insurance. Physician fees for the donor actual surgery go to the recipients payer, regardless of payer. Hope this helps, Thanks, Bill From: MakenzieS Reply-To: <TxFinancialCoordinators > Date: Thursday, June 28, 2012 11:44 AM To: <TxFinancialCoordinators > Subject: Donor Complications I think I might be a little confused on how these are supposed to be paid/billed. I have two seperate circumstances. The First, the recipient has Medicare primary. Donor was re-admitted for complications. Is this something that goes on the Cost Report, or is it billed to the recipient's Medicare? The second, the recipient has BCBS primary. Charges are for the actual surgery. They should be billed to the recipient's BCBS plan, right? Just need some clarification. Your help is so appreciated. Makenzie IMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE: This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. To report this email as SPAM, please forward it to spam@.... To report this email as SPAM, please forward it to spam@.... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 12, 2012 Report Share Posted July 12, 2012 8138378471Reply-To: <TxFinancialCoordinators >Date: Thursday, July 12, 2012 11:40 AMTo: "TxFinancialCoordinators " <TxFinancialCoordinators >Subject: RE: Donor Complications Bill, what is your fax number? Julius EasonTransplant Financial CoordinatorMulti-Organ Transplant DepartmentBeaumont Health Systemjeason@...(P) (F) From: TxFinancialCoordinators [TxFinancialCoordinators ] on behalf of Bill Vaughan [Vaughan@...]Sent: Thursday, July 12, 2012 10:45 AMTo: TxFinancialCoordinators Subject: Re: Donor Complications HI Julius,Please send me a copy. My read is that if the complication is identified in the first 90 days the technical cost goes to the cost report and the physician portion goes to the payer for the recipient. After 90 days it all goes to the payer. I am willing to change my opinion. I will look to see if I can find the CMS pronouncement and share it.The part I like best is that well baby coverage is now a part of the cost report for both technical and professional services.Hope this helps,Thanks,BillReply-To: <TxFinancialCoordinators >Date: Thursday, July 12, 2012 10:01 AMTo: "TxFinancialCoordinators " <TxFinancialCoordinators >Subject: RE: Donor Complications Bill, in an Medicare Learning Network memo regrding Billing for donor Post-Kidney Tranpslant Complication Services it tries to break down this information. Unless I'm misunderstanding what I am reading I think itis saying something different than you. It states under the heading of 'Regarding Donor Complicatins'- "Expenses incurred for complications that arise with rspect 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 health insurance claim number. This is true of both facility cost and physician services." I'm I mis-interpeting to believe that all donor complications post discharge date should go under the recipient's claim number, both facility and physicians? I can fax you a copy of this memo for your review. Julius EasonTransplant Financial CoordinatorMulti-Organ Transplant DepartmentBeaumont Health Systemjeason@...(P) (F) From:TxFinancialCoordinators [TxFinancialCoordinators ] on behalf of Bill Vaughan [Vaughan@...]Sent: Thursday, July 12, 2012 9:21 AMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi Joanne,Yes it will, it is incumbent on the transplant centers that they contract donor complication care with payers. The routine follow up is the responsibility of the transplanting center.Hope this helps,Thanks,BillReply-To: <TxFinancialCoordinators >Date: Thursday, July 12, 2012 9:18 AMTo: "TxFinancialCoordinators " <TxFinancialCoordinators >Subject: RE: Donor Complications To through a small wrench in the question – will this same process apply to the “Pair Donor Exchange Program” in which donors are coming from out-of-state and may not be covered under the recipient’s insurance – in the post 90 days scenario (step 3)? JoAnne CannoneAdministrative Assistant to: C. Mendez, MDBarbara A. Pisani, DOCo-Medical Directors of The Advanced Heart Failure,Heart Transplant & Mechanical Circulatory Support Program at Rush1725 West on Street, Professional Building III - Suite 1159Chicago, Illinois 60612Office: Fax: J. March, MDAssociate Professor of SurgeryDepartment of Cardiovascular-Thoracic Surgery1725 West on Street, Professional Building III - Suite 1156Chicago, Illinois 60612Office: Fax: From:TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Wednesday, July 11, 2012 3:32 PMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi , Routine well baby visits, to make sure that there are no problems are billed to the transplant center and paid at 100% of Medicare just like an evaluation. That is step one. Step 2, if there is a complication in the first 90 days, the transplant center is responsible for technical services and the physician fees are billed to the recipients payer. Step 3, after 90 days both technical and professional fees are billed to the recipients primary payer. Hope this helps,Thanks,Bill Reply-To: <TxFinancialCoordinators >Date: Wednesday, July 11, 2012 4:12 PMTo: <TxFinancialCoordinators >Subject: RE: Donor Complications Hello Bill if you are out there! I’m busy overthinking things again – could you offer some direction? Donor to a Medicare beneficiary seen at 5.5 months post op by her PCP to “monitor for possible complications.” Claim sent to us for office visit plus labs. Do I direct them to bill technical and profees to Medicare, or technical to us, profee to Medicare? Many thanks for your input – I am getting thrown by “follow-up examinations may be covered for up to 6 months after the donation to monitor for possible complications” on the same page as instructions to limit routine follow-up to 90 days. onTransplant Financial CoordinatorLegacy Good Samaritan HospitalLegacy Transplant Services1040 NW 22nd Ave Ste 480Portland OR 97210 direct main office toll-free faxlmorriso@...üPlease consider the environment - think before you print! From:TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Tuesday, July 03, 2012 8:00 AMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi Deidra,If the complication was in the first 90 days after the transplant, the transplant center pays the technical fees and gives the physicians billing information for the recipient. If the complication was after 90 days, the transplant center gives the hospital and physicians billing information for the recipient. Hope this helps,Thanks,Bill From: "Deidra M. Simano" Reply-To: <TxFinancialCoordinators >Date: Tuesday, July 3, 2012 10:42 AMTo: "TxFinancialCoordinators " <TxFinancialCoordinators >Subject: RE: Donor Complications I have a questions that relates to this thread – Our donor had complications and was seen at their local emergency room and then transferred to our facility via ambulance. Do I pay the technical charges for the ED visit at the local hospital and then give them the recipient insurance info to bill the professional fees? How would the ambulance fees be considered – professional or technical? Thanks, Deidra Deidra M. SimanoTransplant Operations AnalystDepartment of Transplant SurgeryDartmouth-Hitchcock LebanonPhone: (603) 653.3689 / Fax: (603) 676.4287Transplant Secretary (603) 653.3931Dartmouth-Hitchcock.org From:TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Thursday, June 28, 2012 4:29 PMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi Mckenzie, First if the Donor was readmitted within 90 days, the technical services go to the Cost Report, if the admission was after 90 days the hospital bill goes to the recipients payer. In both cases, the physicians bills go to the recipients payer. Second, regardless of the recipients payer, the inpatient stay for the actual donor surgery goes to the Cost Report, they do NOT go to the Recipients Insurance. Physician fees for the donor actual surgery go to the recipients payer, regardless of payer. Hope this helps,Thanks,Bill From: MakenzieS Reply-To: <TxFinancialCoordinators >Date: Thursday, June 28, 2012 11:44 AMTo: <TxFinancialCoordinators >Subject: Donor Complications I think I might be a little confused on how these are supposed to be paid/billed. I have two seperate circumstances. The First, the recipient has Medicare primary. Donor was re-admitted for complications. Is this something that goes on the Cost Report, or is it billed to the recipient's Medicare? The second, the recipient has BCBS primary. Charges are for the actual surgery. They should be billed to the recipient's BCBS plan, right? Just need some clarification. Your help is so appreciated. Makenzie IMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE: This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. To report this email as SPAM, please forward it to spam@.... To report this email as SPAM, please forward it to spam@.... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 12, 2012 Report Share Posted July 12, 2012 Hi Julius and Bill: Julius, That is my interpretation as well. M. Sr. Administrative Associate Cedars-Sinai Medical Center Comprehensive Transplant Center 8635 W 3rd Street, Suite 590 W Los Angeles, CA 90048 -Office -FAX From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Thursday, July 12, 2012 7:45 AM To: TxFinancialCoordinators Subject: Re: Donor Complications HI Julius, Please send me a copy. My read is that if the complication is identified in the first 90 days the technical cost goes to the cost report and the physician portion goes to the payer for the recipient. After 90 days it all goes to the payer. I am willing to change my opinion. I will look to see if I can find the CMS pronouncement and share it. The part I like best is that well baby coverage is now a part of the cost report for both technical and professional services. Hope this helps, Thanks, Bill From: Julius Eason Reply-To: <TxFinancialCoordinators > Date: Thursday, July 12, 2012 10:01 AM To: " TxFinancialCoordinators " <TxFinancialCoordinators > Subject: RE: Donor Complications Bill, in an Medicare Learning Network memo regrding Billing for donor Post-Kidney Tranpslant Complication Services it tries to break down this information. Unless I'm misunderstanding what I am reading I think itis saying something different than you. It states under the heading of 'Regarding Donor Complicatins'- " Expenses incurred for complications that arise with rspect 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 health insurance claim number. This is true of both facility cost and physician services. " I'm I mis-interpeting to believe that all donor complications post discharge date should go under the recipient's claim number, both facility and physicians? I can fax you a copy of this memo for your review. Julius Eason Transplant Financial Coordinator Multi-Organ Transplant Department Beaumont Health System jeason@... (P) (F) From: TxFinancialCoordinators [TxFinancialCoordinators ] on behalf of Bill Vaughan [Vaughan@...] Sent: Thursday, July 12, 2012 9:21 AM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi Joanne, Yes it will, it is incumbent on the transplant centers that they contract donor complication care with payers. The routine follow up is the responsibility of the transplanting center. Hope this helps, Thanks, Bill From: Joanne Cannone Reply-To: <TxFinancialCoordinators > Date: Thursday, July 12, 2012 9:18 AM To: " TxFinancialCoordinators " <TxFinancialCoordinators > Subject: RE: Donor Complications To through a small wrench in the question – will this same process apply to the “Pair Donor Exchange Program” in which donors are coming from out-of-state and may not be covered under the recipient’s insurance – in the post 90 days scenario (step 3)? JoAnne Cannone Administrative Assistant to: C. Mendez, MD Barbara A. Pisani, DO Co-Medical Directors of The Advanced Heart Failure, Heart Transplant & Mechanical Circulatory Support Program at Rush 1725 West on Street, Professional Building III - Suite 1159 Chicago, Illinois 60612 Office: Fax: J. March, MD Associate Professor of Surgery Department of Cardiovascular-Thoracic Surgery 1725 West on Street, Professional Building III - Suite 1156 Chicago, Illinois 60612 Office: Fax: From:TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Wednesday, July 11, 2012 3:32 PM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi , Routine well baby visits, to make sure that there are no problems are billed to the transplant center and paid at 100% of Medicare just like an evaluation. That is step one. Step 2, if there is a complication in the first 90 days, the transplant center is responsible for technical services and the physician fees are billed to the recipients payer. Step 3, after 90 days both technical and professional fees are billed to the recipients primary payer. Hope this helps, Thanks, Bill From: " on, :LPH Trnsplnt " Reply-To: <TxFinancialCoordinators > Date: Wednesday, July 11, 2012 4:12 PM To: <TxFinancialCoordinators > Subject: RE: Donor Complications Hello Bill if you are out there! I’m busy overthinking things again – could you offer some direction? Donor to a Medicare beneficiary seen at 5.5 months post op by her PCP to “monitor for possible complications.” Claim sent to us for office visit plus labs. Do I direct them to bill technical and profees to Medicare, or technical to us, profee to Medicare? Many thanks for your input – I am getting thrown by “follow-up examinations may be covered for up to 6 months after the donation to monitor for possible complications” on the same page as instructions to limit routine follow-up to 90 days. on Transplant Financial Coordinator Legacy Good Samaritan Hospital Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 direct main office toll-free fax lmorriso@... üPlease consider the environment - think before you print! From:TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Tuesday, July 03, 2012 8:00 AM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi Deidra, If the complication was in the first 90 days after the transplant, the transplant center pays the technical fees and gives the physicians billing information for the recipient. If the complication was after 90 days, the transplant center gives the hospital and physicians billing information for the recipient. Hope this helps, Thanks, Bill From: " Deidra M. Simano " Reply-To: <TxFinancialCoordinators > Date: Tuesday, July 3, 2012 10:42 AM To: " TxFinancialCoordinators " <TxFinancialCoordinators > Subject: RE: Donor Complications I have a questions that relates to this thread – Our donor had complications and was seen at their local emergency room and then transferred to our facility via ambulance. Do I pay the technical charges for the ED visit at the local hospital and then give them the recipient insurance info to bill the professional fees? How would the ambulance fees be considered – professional or technical? Thanks, Deidra Deidra M. Simano Transplant Operations Analyst Department of Transplant Surgery Dartmouth-Hitchcock Lebanon Phone: (603) 653.3689 / Fax: (603) 676.4287 Transplant Secretary (603) 653.3931 Dartmouth-Hitchcock.org From:TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Thursday, June 28, 2012 4:29 PM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi Mckenzie, First if the Donor was readmitted within 90 days, the technical services go to the Cost Report, if the admission was after 90 days the hospital bill goes to the recipients payer. In both cases, the physicians bills go to the recipients payer. Second, regardless of the recipients payer, the inpatient stay for the actual donor surgery goes to the Cost Report, they do NOT go to the Recipients Insurance. Physician fees for the donor actual surgery go to the recipients payer, regardless of payer. Hope this helps, Thanks, Bill From: MakenzieS Reply-To: <TxFinancialCoordinators > Date: Thursday, June 28, 2012 11:44 AM To: <TxFinancialCoordinators > Subject: Donor Complications I think I might be a little confused on how these are supposed to be paid/billed. I have two seperate circumstances. The First, the recipient has Medicare primary. Donor was re-admitted for complications. Is this something that goes on the Cost Report, or is it billed to the recipient's Medicare? The second, the recipient has BCBS primary. Charges are for the actual surgery. They should be billed to the recipient's BCBS plan, right? Just need some clarification. Your help is so appreciated. Makenzie IMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE: This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. To report this email as SPAM, please forward it to spam@.... IMPORTANT WARNING: This message is intended for the use of the person or entity to which it is addressed and may contain information that is privileged and confidential, the disclosure of which is governed by applicable law. If the reader of this message is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this information is STRICTLY PROHIBITED. If you have received this message in error, please notify us immediately by calling and destroy the related message. Thank You for your cooperation. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 12, 2012 Report Share Posted July 12, 2012 Allow me to muddy the waters further! This was my interpretation of the MLN bulletin from April 2012 For Routine follow-up:1) Facility charges (through 180 days post) go to Organ Acquisition 2) Surgeon's pro fee is included in the 90 day global 3) Surgeon's pro fee after 90 days is billable directly to Part B under the recipient's HICN (billing will be reviewed)4) Pro fees for follow up through 90 days post by MDs other than the surgeon are billable directly to Part B For Complications after discharge that are directly attributable to donation: 1) Facility costs and pro fees are directly billable to Medicare under the recipient's HICN (billing will be reviewed) on Transplant Financial Coordinator Legacy Good Samaritan Hospital Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 direct main office toll-free fax lmorriso@... ü Please consider the environment - think before you print! From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of , Sent: Thursday, July 12, 2012 9:48 AMTo: TxFinancialCoordinators Subject: RE: Donor Complications Hi Julius and Bill: Julius, That is my interpretation as well. M. Sr. Administrative AssociateCedars-Sinai Medical CenterComprehensive Transplant Center 8635 W 3rd Street, Suite 590 WLos Angeles, CA 90048-Office-FAX From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Thursday, July 12, 2012 7:45 AMTo: TxFinancialCoordinators Subject: Re: Donor Complications HI Julius,Please send me a copy. My read is that if the complication is identified in the first 90 days the technical cost goes to the cost report and the physician portion goes to the payer for the recipient. After 90 days it all goes to the payer. I am willing to change my opinion. I will look to see if I can find the CMS pronouncement and share it. The part I like best is that well baby coverage is now a part of the cost report for both technical and professional services. Hope this helps,Thanks,Bill Reply-To: <TxFinancialCoordinators >Date: Thursday, July 12, 2012 10:01 AMTo: " TxFinancialCoordinators " <TxFinancialCoordinators >Subject: RE: Donor Complications Bill, in an Medicare Learning Network memo regrding Billing for donor Post-Kidney Tranpslant Complication Services it tries to break down this information. Unless I'm misunderstanding what I am reading I think itis saying something different than you. It states under the heading of 'Regarding Donor Complicatins'- " Expenses incurred for complications that arise with rspect 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 health insurance claim number. This is true of both facility cost and physician services. " I'm I mis-interpeting to believe that all donor complications post discharge date should go under the recipient's claim number, both facility and physicians? I can fax you a copy of this memo for your review. Julius EasonTransplant Financial CoordinatorMulti-Organ Transplant DepartmentBeaumont Health Systemjeason@...(P) (F) From: TxFinancialCoordinators [TxFinancialCoordinators ] on behalf of Bill Vaughan [Vaughan@...]Sent: Thursday, July 12, 2012 9:21 AMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi Joanne,Yes it will, it is incumbent on the transplant centers that they contract donor complication care with payers. The routine follow up is the responsibility of the transplanting center. Hope this helps,Thanks,Bill Reply-To: <TxFinancialCoordinators >Date: Thursday, July 12, 2012 9:18 AMTo: " TxFinancialCoordinators " <TxFinancialCoordinators >Subject: RE: Donor Complications To through a small wrench in the question – will this same process apply to the “Pair Donor Exchange Program” in which donors are coming from out-of-state and may not be covered under the recipient’s insurance – in the post 90 days scenario (step 3)? JoAnne CannoneAdministrative Assistant to: C. Mendez, MDBarbara A. Pisani, DOCo-Medical Directors of The Advanced Heart Failure,Heart Transplant & Mechanical Circulatory Support Program at Rush1725 West on Street, Professional Building III - Suite 1159Chicago, Illinois 60612Office: Fax: J. March, MDAssociate Professor of SurgeryDepartment of Cardiovascular-Thoracic Surgery1725 West on Street, Professional Building III - Suite 1156Chicago, Illinois 60612Office: Fax: From:TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Wednesday, July 11, 2012 3:32 PMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi , Routine well baby visits, to make sure that there are no problems are billed to the transplant center and paid at 100% of Medicare just like an evaluation. That is step one. Step 2, if there is a complication in the first 90 days, the transplant center is responsible for technical services and the physician fees are billed to the recipients payer. Step 3, after 90 days both technical and professional fees are billed to the recipients primary payer. Hope this helps,Thanks,Bill Reply-To: <TxFinancialCoordinators >Date: Wednesday, July 11, 2012 4:12 PMTo: <TxFinancialCoordinators >Subject: RE: Donor Complications Hello Bill if you are out there! I’m busy overthinking things again – could you offer some direction? Donor to a Medicare beneficiary seen at 5.5 months post op by her PCP to “monitor for possible complications.” Claim sent to us for office visit plus labs. Do I direct them to bill technical and profees to Medicare, or technical to us, profee to Medicare? Many thanks for your input – I am getting thrown by “follow-up examinations may be covered for up to 6 months after the donation to monitor for possible complications” on the same page as instructions to limit routine follow-up to 90 days. onTransplant Financial CoordinatorLegacy Good Samaritan HospitalLegacy Transplant Services1040 NW 22nd Ave Ste 480Portland OR 97210 direct main office toll-free faxlmorriso@...üPlease consider the environment - think before you print! From:TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Tuesday, July 03, 2012 8:00 AMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi Deidra,If the complication was in the first 90 days after the transplant, the transplant center pays the technical fees and gives the physicians billing information for the recipient. If the complication was after 90 days, the transplant center gives the hospital and physicians billing information for the recipient. Hope this helps,Thanks,Bill Reply-To: <TxFinancialCoordinators >Date: Tuesday, July 3, 2012 10:42 AMTo: " TxFinancialCoordinators " <TxFinancialCoordinators >Subject: RE: Donor Complications I have a questions that relates to this thread – Our donor had complications and was seen at their local emergency room and then transferred to our facility via ambulance. Do I pay the technical charges for the ED visit at the local hospital and then give them the recipient insurance info to bill the professional fees? How would the ambulance fees be considered – professional or technical? Thanks, Deidra Deidra M. SimanoTransplant Operations AnalystDepartment of Transplant SurgeryDartmouth-Hitchcock LebanonPhone: (603) 653.3689 / Fax: (603) 676.4287Transplant Secretary (603) 653.3931Dartmouth-Hitchcock.org From:TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill VaughanSent: Thursday, June 28, 2012 4:29 PMTo: TxFinancialCoordinators Subject: Re: Donor Complications Hi Mckenzie, First if the Donor was readmitted within 90 days, the technical services go to the Cost Report, if the admission was after 90 days the hospital bill goes to the recipients payer. In both cases, the physicians bills go to the recipients payer. Second, regardless of the recipients payer, the inpatient stay for the actual donor surgery goes to the Cost Report, they do NOT go to the Recipients Insurance. Physician fees for the donor actual surgery go to the recipients payer, regardless of payer. Hope this helps,Thanks,Bill Reply-To: <TxFinancialCoordinators >Date: Thursday, June 28, 2012 11:44 AMTo: <TxFinancialCoordinators >Subject: Donor Complications I think I might be a little confused on how these are supposed to be paid/billed. I have two seperate circumstances. The First, the recipient has Medicare primary. Donor was re-admitted for complications. Is this something that goes on the Cost Report, or is it billed to the recipient's Medicare?The second, the recipient has BCBS primary. Charges are for the actual surgery. They should be billed to the recipient's BCBS plan, right?Just need some clarification. Your help is so appreciated. :)MakenzieIMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE:This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. To report this email as SPAM, please forward it to spam@.... IMPORTANT WARNING: This message is intended for the use of the person or entity to which it is addressed and may contain information that is privileged and confidential, the disclosure of which is governed by applicable law. If the reader of this message is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this information is STRICTLY PROHIBITED. If you have received this message in error, please notify us immediately by calling and destroy the related message. Thank You for your cooperation. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 12, 2012 Report Share Posted July 12, 2012 Bill and I will be reviewing these in more detail moving forward and will be presenting at the conference in September. Debbie Mast Database Administrator/Financial Manager Solid Organ Transplant/VAD Program Stanford Hospital and Clinics 750 Welch Road, Suite 220 Palo Alto, CA 94304 Heart, Lung, Heart/Lung, Liver, Kidney, Pancreas, Intestinal Transplant Programs Trustee, TFCA Phone: Fax: www.donateLIFEcalifornia.org/stanfordmed From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of , Sent: Thursday, July 12, 2012 9:48 AM To: TxFinancialCoordinators Subject: RE: Donor Complications Hi Julius and Bill: Julius, That is my interpretation as well. M. Sr. Administrative Associate Cedars-Sinai Medical Center Comprehensive Transplant Center 8635 W 3rd Street, Suite 590 W Los Angeles, CA 90048 (310) 423-3170-Office (310) 248-8160-FAX From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Thursday, July 12, 2012 7:45 AM To: TxFinancialCoordinators Subject: Re: Donor Complications HI Julius, Please send me a copy. My read is that if the complication is identified in the first 90 days the technical cost goes to the cost report and the physician portion goes to the payer for the recipient. After 90 days it all goes to the payer. I am willing to change my opinion. I will look to see if I can find the CMS pronouncement and share it. The part I like best is that well baby coverage is now a part of the cost report for both technical and professional services. Hope this helps, Thanks, Bill Reply-To: <TxFinancialCoordinators > Date: Thursday, July 12, 2012 10:01 AM To: " TxFinancialCoordinators " <TxFinancialCoordinators > Subject: RE: Donor Complications Bill, in an Medicare Learning Network memo regrding Billing for donor Post-Kidney Tranpslant Complication Services it tries to break down this information. Unless I'm misunderstanding what I am reading I think itis saying something different than you. It states under the heading of 'Regarding Donor Complicatins'- " Expenses incurred for complications that arise with rspect 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 health insurance claim number. This is true of both facility cost and physician services. " I'm I mis-interpeting to believe that all donor complications post discharge date should go under the recipient's claim number, both facility and physicians? I can fax you a copy of this memo for your review. Julius Eason Transplant Financial Coordinator Multi-Organ Transplant Department Beaumont Health System jeason@... (P) 248 551 0077 (F) From: TxFinancialCoordinators [TxFinancialCoordinators ] on behalf of Bill Vaughan [Vaughan@...] Sent: Thursday, July 12, 2012 9:21 AM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi Joanne, Yes it will, it is incumbent on the transplant centers that they contract donor complication care with payers. The routine follow up is the responsibility of the transplanting center. Hope this helps, Thanks, Bill Reply-To: <TxFinancialCoordinators > Date: Thursday, July 12, 2012 9:18 AM To: " TxFinancialCoordinators " <TxFinancialCoordinators > Subject: RE: Donor Complications To through a small wrench in the question – will this same process apply to the “Pair Donor Exchange Program” in which donors are coming from out-of-state and may not be covered under the recipient’s insurance – in the post 90 days scenario (step 3)? JoAnne Cannone Administrative Assistant to: C. Mendez, MD Barbara A. Pisani, DO Co-Medical Directors of The Advanced Heart Failure, Heart Transplant & Mechanical Circulatory Support Program at Rush 1725 West on Street, Professional Building III - Suite 1159 Chicago, Illinois 60612 Office: Fax: J. March, MD Associate Professor of Surgery Department of Cardiovascular-Thoracic Surgery 1725 West on Street, Professional Building III - Suite 1156 Chicago, Illinois 60612 Office: Fax: From:TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Wednesday, July 11, 2012 3:32 PM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi , Routine well baby visits, to make sure that there are no problems are billed to the transplant center and paid at 100% of Medicare just like an evaluation. That is step one. Step 2, if there is a complication in the first 90 days, the transplant center is responsible for technical services and the physician fees are billed to the recipients payer. Step 3, after 90 days both technical and professional fees are billed to the recipients primary payer. Hope this helps, Thanks, Bill From: " on, :LPH Trnsplnt " Reply-To: <TxFinancialCoordinators > Date: Wednesday, July 11, 2012 4:12 PM To: <TxFinancialCoordinators > Subject: RE: Donor Complications Hello Bill if you are out there! I’m busy overthinking things again – could you offer some direction? Donor to a Medicare beneficiary seen at 5.5 months post op by her PCP to “monitor for possible complications.” Claim sent to us for office visit plus labs. Do I direct them to bill technical and profees to Medicare, or technical to us, profee to Medicare? Many thanks for your input – I am getting thrown by “follow-up examinations may be covered for up to 6 months after the donation to monitor for possible complications” on the same page as instructions to limit routine follow-up to 90 days. on Transplant Financial Coordinator Legacy Good Samaritan Hospital Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 direct main office toll-free fax lmorriso@... üPlease consider the environment - think before you print! From:TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Tuesday, July 03, 2012 8:00 AM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi Deidra, If the complication was in the first 90 days after the transplant, the transplant center pays the technical fees and gives the physicians billing information for the recipient. If the complication was after 90 days, the transplant center gives the hospital and physicians billing information for the recipient. Hope this helps, Thanks, Bill Reply-To: <TxFinancialCoordinators > Date: Tuesday, July 3, 2012 10:42 AM To: " TxFinancialCoordinators " <TxFinancialCoordinators > Subject: RE: Donor Complications I have a questions that relates to this thread – Our donor had complications and was seen at their local emergency room and then transferred to our facility via ambulance. Do I pay the technical charges for the ED visit at the local hospital and then give them the recipient insurance info to bill the professional fees? How would the ambulance fees be considered – professional or technical? Thanks, Deidra Deidra M. Simano Transplant Operations Analyst Department of Transplant Surgery Dartmouth-Hitchcock Lebanon Phone: (603) 653.3689 / Fax: (603) 676.4287 Transplant Secretary (603) 653.3931 Dartmouth-Hitchcock.org From:TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan Sent: Thursday, June 28, 2012 4:29 PM To: TxFinancialCoordinators Subject: Re: Donor Complications Hi Mckenzie, First if the Donor was readmitted within 90 days, the technical services go to the Cost Report, if the admission was after 90 days the hospital bill goes to the recipients payer. In both cases, the physicians bills go to the recipients payer. Second, regardless of the recipients payer, the inpatient stay for the actual donor surgery goes to the Cost Report, they do NOT go to the Recipients Insurance. Physician fees for the donor actual surgery go to the recipients payer, regardless of payer. Hope this helps, Thanks, Bill Reply-To: <TxFinancialCoordinators > Date: Thursday, June 28, 2012 11:44 AM To: <TxFinancialCoordinators > Subject: Donor Complications I think I might be a little confused on how these are supposed to be paid/billed. I have two seperate circumstances. The First, the recipient has Medicare primary. Donor was re-admitted for complications. Is this something that goes on the Cost Report, or is it billed to the recipient's Medicare? The second, the recipient has BCBS primary. Charges are for the actual surgery. They should be billed to the recipient's BCBS plan, right? Just need some clarification. Your help is so appreciated. Makenzie IMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE: This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. To report this email as SPAM, please forward it to spam@.... IMPORTANT WARNING: This message is intended for the use of the person or entity to which it is addressed and may contain information that is privileged and confidential, the disclosure of which is governed by applicable law. If the reader of this message is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this information is STRICTLY PROHIBITED. If you have received this message in error, please notify us immediately by calling and destroy the related message. Thank You for your cooperation. Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.