Guest guest Posted June 4, 2008 Report Share Posted June 4, 2008 Not chart, no minimum clearance level, , though I have seen instances where a private insurance will deny based on creatinine clearance (or BUN or phase of the moon, but what else is new). As long as the pt meets your ctrs criteria w/re: to renal function, you're good to go w/Medicare. J. Aguiar Mayo Clinic Arizona From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Nimmo-, HercyniaSent: Wednesday, June 04, 2008 11:09 AMTo: txfinancialcoordinators Subject: Medicare Hello group, Can someone tell me if there is a Medicare link or rule that will state whether the patient has to have a creatinine clearance of 20 or below in order to have a transplant. I know with UNO’s they will not list a patient but what if I have a patient that as of this time is self pay will have Medicare in November due to disability (according to the wife) and want to have a living donor transplant prior to November. His creatinine clearance is 38. If we transplant will Medicare cover this? is there a chart that Medicare goes by as far as creatinine levels as an approved transplant? Hercynia Nimmo-, MA Transplant Financial Counselor Phone (904)244-9859 Fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 4, 2008 Report Share Posted June 4, 2008 thanks Nimmo- , MA Financial Counselor From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Aguiar, J. Sent: Wednesday, June 04, 2008 2:13 PM To: TxFinancialCoordinators Subject: RE: Medicare Not chart, no minimum clearance level, , though I have seen instances where a private insurance will deny based on creatinine clearance (or BUN or phase of the moon, but what else is new). As long as the pt meets your ctrs criteria w/re: to renal function, you're good to go w/Medicare. J. Aguiar Mayo Clinic Arizona From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Nimmo-, Hercynia Sent: Wednesday, June 04, 2008 11:09 AM To: txfinancialcoordinators Subject: Medicare Hello group, Can someone tell me if there is a Medicare link or rule that will state whether the patient has to have a creatinine clearance of 20 or below in order to have a transplant. I know with UNO’s they will not list a patient but what if I have a patient that as of this time is self pay will have Medicare in November due to disability (according to the wife) and want to have a living donor transplant prior to November. His creatinine clearance is 38. If we transplant will Medicare cover this? is there a chart that Medicare goes by as far as creatinine levels as an approved transplant? Hercynia Nimmo-, MA Transplant Financial Counselor Phone (904)244-9859 Fax (904) 244-9803 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 4, 2008 Report Share Posted June 4, 2008 i don't know where to look for sure, you may want to check your ESRD Network Website but it is <20 to List or transplant and <15 to start dialysis for Medicare to pay Patti Montemayor, RN CCTC Transplant Coordinator and White Hospital 2401 S. 31st Street Temple, TX 76508 254/724-8448 FAX 254/724-8772 >>> hercynia.nimmo-richardson@... 6/4/2008 1:09 PM >>> Hello group, Can someone tell me if there is a Medicare link or rule that will state whether the patient has to have a creatinine clearance of 20 or below in order to have a transplant. I know with UNO's they will not list a patient but what if I have a patient that as of this time is self pay will have Medicare in November due to disability (according to the wife) and want to have a living donor transplant prior to November. His creatinine clearance is 38. If we transplant will Medicare cover this? is there a chart that Medicare goes by as far as creatinine levels as an approved transplant? Hercynia Nimmo-, MA Transplant Financial Counselor Phone (904)244-9859 Fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 4, 2008 Report Share Posted June 4, 2008 thanks Nimmo- , MA Financial Counselor From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Patti Montemayor Sent: Wednesday, June 04, 2008 2:49 PM To: TxFinancialCoordinators Subject: Re: Medicare i don't know where to look for sure, you may want to check your ESRD Network Website but it is <20 to List or transplant and <15 to start dialysis for Medicare to pay Patti Montemayor, RN CCTC Transplant Coordinator and White Hospital 2401 S. 31st Street Temple, TX 76508 254/724-8448 FAX 254/724-8772 >>> hercynia.nimmo-richardson@... 6/4/2008 1:09 PM >>> Hello group, Can someone tell me if there is a Medicare link or rule that will state whether the patient has to have a creatinine clearance of 20 or below in order to have a transplant. I know with UNO's they will not list a patient but what if I have a patient that as of this time is self pay will have Medicare in November due to disability (according to the wife) and want to have a living donor transplant prior to November. His creatinine clearance is 38. If we transplant will Medicare cover this? is there a chart that Medicare goes by as far as creatinine levels as an approved transplant? Hercynia Nimmo-, MA Transplant Financial Counselor Phone (904)244-9859 Fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 4, 2008 Report Share Posted June 4, 2008 If patient is pre-emptive clearance usually has to be less than 15.>>> "Nimmo-, Hercynia" 6/4/2008 2:14 PM >>>thanks Nimmo- , MA Financial CounselorFrom: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Aguiar, J.Sent: Wednesday, June 04, 2008 2:13 PMTo: TxFinancialCoordinators Subject: RE: MedicareNot chart, no minimum clearance level, , though I have seen instances where a private insurance will deny based on creatinine clearance (or BUN or phase of the moon, but what else is new). As long as the pt meets your ctrs criteria w/re: to renal function, you're good to go w/Medicare. J. AguiarMayo Clinic ArizonaFrom: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Nimmo-, HercyniaSent: Wednesday, June 04, 2008 11:09 AMTo: txfinancialcoordinators Subject: MedicareHello group, Can someone tell me if there is a Medicare link or rule that will state whether the patient has to have a creatinine clearance of 20 or below in order to have a transplant. I know with UNO’s they will not list a patient but what if I have a patient that as of this time is self pay will have Medicare in November due to disability (according to the wife) and want to have a living donor transplant prior to November. His creatinine clearance is 38. If we transplant will Medicare cover this? is there a chart that Medicare goes by as far as creatinine levels as an approved transplant?Hercynia Nimmo-, MATransplant Financial CounselorPhone (904)244-9859Fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 4, 2008 Report Share Posted June 4, 2008 I do not think there is a Medicare rule but in the Form 2728, it is required that a physician attest that the patient has End Stage Disease. Also in that form they ask what is the patient creatinine or creatinine clearance. Maybe you should ask your Nephrologist what is the required clearance for them to attest that a patient is meeting the ESRD criteria. Why is the patient in a hurry to have an LRD transplant? They do not start dialysis unless the clearance is below 11 for non diabetics and 15 for diabetics. Austria Specialty Contracting Methodist Health System 1441 North Beckley Avenue Dallas,Texas 75203 Phone: Fax: From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Nimmo-, Hercynia Sent: Wednesday, June 04, 2008 1:09 PM To: txfinancialcoordinators Subject: Medicare Hello group, Can someone tell me if there is a Medicare link or rule that will state whether the patient has to have a creatinine clearance of 20 or below in order to have a transplant. I know with UNO’s they will not list a patient but what if I have a patient that as of this time is self pay will have Medicare in November due to disability (according to the wife) and want to have a living donor transplant prior to November. His creatinine clearance is 38. If we transplant will Medicare cover this? is there a chart that Medicare goes by as far as creatinine levels as an approved transplant? Hercynia Nimmo-, MA Transplant Financial Counselor Phone (904)244-9859 Fax *********************************************************************** This electronic transmission contains information from Methodist Health System and should be considered confidential and privileged. The information contained in the above messages is intended only for the use of the individual(s) and entity(ies) named above. If you are not the intended recipient, be aware that any disclosure, copying, distribution, or use of this information is prohibited. If you receive this transmission in error, please notify the sender immediately by return e-mail. Methodist Health System, its subsidiaries and affiliates hereby claim all applicable privileges related to the transmission of this communication. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 4, 2008 Report Share Posted June 4, 2008 I just found the form I am referring to and it is " The New CMS 2728 Algorithm for GFR at initiation of Renal replacement Therapy " It was sent to me back in 2005 by our ESRD Network 14 of Texas. It does not refer to diabetics in this form but is correct. Patti Montemayor, RN CCTC Transplant Coordinator and White Hospital 2401 S. 31st Street Temple, TX 76508 254/724-8448 FAX 254/724-8772 >>> Austria@... 6/4/2008 2:43 PM >>> I do not think there is a Medicare rule but in the Form 2728, it is required that a physician attest that the patient has End Stage Disease. Also in that form they ask what is the patient creatinine or creatinine clearance. Maybe you should ask your Nephrologist what is the required clearance for them to attest that a patient is meeting the ESRD criteria. Why is the patient in a hurry to have an LRD transplant? They do not start dialysis unless the clearance is below 11 for non diabetics and 15 for diabetics. Austria Specialty Contracting Methodist Health System 1441 North Beckley Avenue Dallas,Texas 75203 Phone: Fax: ________________________________ From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Nimmo-, Hercynia Sent: Wednesday, June 04, 2008 1:09 PM To: txfinancialcoordinators Subject: Medicare Hello group, Can someone tell me if there is a Medicare link or rule that will state whether the patient has to have a creatinine clearance of 20 or below in order to have a transplant. I know with UNO's they will not list a patient but what if I have a patient that as of this time is self pay will have Medicare in November due to disability (according to the wife) and want to have a living donor transplant prior to November. His creatinine clearance is 38. If we transplant will Medicare cover this? is there a chart that Medicare goes by as far as creatinine levels as an approved transplant? Hercynia Nimmo-, MA Transplant Financial Counselor Phone (904)244-9859 Fax *********************************************************************** This electronic transmission contains information from Methodist Health System and should be considered confidential and privileged. The information contained in the above messages is intended only for the use of the individual(s) and entity(ies) named above. If you are not the intended recipient, be aware that any disclosure, copying, distribution, or use of this information is prohibited. If you receive this transmission in error, please notify the sender immediately by return e-mail. Methodist Health System, its subsidiaries and affiliates hereby claim all applicable privileges related to the transmission of this communication. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 4, 2008 Report Share Posted June 4, 2008 It may be dependent on commercial insurance but doesn't comm insurance follow Medicare guidelines in regards to transplant? Medicare will pay for preemtive <20. Patti Montemayor, RN CCTC Transplant Coordinator and White Hospital 2401 S. 31st Street Temple, TX 76508 254/724-8448 FAX 254/724-8772 >>> BALarson@... 6/4/2008 2:02 PM >>> If patient is pre-emptive clearance usually has to be less than 15. >>> " Nimmo-, Hercynia " 6/4/2008 2:14 PM >>> thanks Nimmo- , MA Financial Counselor From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Aguiar, J. Sent: Wednesday, June 04, 2008 2:13 PM To: TxFinancialCoordinators Subject: RE: Medicare Not chart, no minimum clearance level, , though I have seen instances where a private insurance will deny based on creatinine clearance (or BUN or phase of the moon, but what else is new). As long as the pt meets your ctrs criteria w/re: to renal function, you're good to go w/Medicare. J. Aguiar Mayo Clinic Arizona From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Nimmo-, Hercynia Sent: Wednesday, June 04, 2008 11:09 AM To: txfinancialcoordinators Subject: Medicare Hello group, Can someone tell me if there is a Medicare link or rule that will state whether the patient has to have a creatinine clearance of 20 or below in order to have a transplant. I know with UNO’s they will not list a patient but what if I have a patient that as of this time is self pay will have Medicare in November due to disability (according to the wife) and want to have a living donor transplant prior to November. His creatinine clearance is 38. If we transplant will Medicare cover this? is there a chart that Medicare goes by as far as creatinine levels as an approved transplant? Hercynia Nimmo-, MA Transplant Financial Counselor Phone (904)244-9859 Fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 29, 2008 Report Share Posted October 29, 2008 Yes, so right, they cannot sign up for Medicare until have ESRD qualifying Medicare event (transplant or dialysis). The original question involved a patient who had been on dialysis for 2 years -- my response pertained to those patients who are Medicare entitled with dialysis but not yet signed up for Medicare and have a live donor transplant coming up. Sorry for the confusion :>) Daryl Battin, LICSW Financial Coordinator/Social Worker Lahey Clinic Kidney Transplant 41 Mall Road, Burlington, MA 01805 Ph: /FAX: Page: Re: Medicare At the time of transplant. Bev Beverly A. Larson, Transplant Financial Coord. Sentara Norfolk Gen. Hosp. Transplant Department Phone: Fax: email: balarson@ sentara.com >>> " Antoine, Beverly A. " 10/28/2008 4:55 PM >>> I have a patient who has been on dialysis for 2yrs and never signed up for Medicare. He has LGHP and Louisiana Medicaid Purchase Plan. Now he is seeking kidney transplantation. Question: Can he still sign up for Medicare now and not be penalized? Beverly Antoine, LPN Transplant Financial Coordinator LSU-UMC Laffayette, LA bantoi@... See our web page at http://www.lahey.org for a full directory of Lahey sites, staff, services and career opportunities. THIS MESSAGE IS INTENDED FOR THE USE OF THE PERSON TO WHOM IT IS ADDRESSED. IT MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT 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 February 4, 2009 Report Share Posted February 4, 2009 Thanks Pat. I was having one of those minutes when I couldn't remember the answer. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Kreci, Sent: Wednesday, February 04, 2009 11:24 AMTo: TxFinancialCoordinators Subject: RE: MEDICARE Yes they do From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Moseley JoyceSent: Wednesday, February 04, 2009 12:09 PMTo: TxFinancialCoordinators Subject: MEDICAREImportance: High Does Medicare pay for home dialysis???? Thanks ljm Joyce L. Moseley, Sr. PSR Admitting & Transplant Financial Coordinator Kidney, Kidney - Pancreas & Bone Marrow Transplants OU Medical Centers Phone: Fax: E-Mail Leona.Moseleyhcahealthcare Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2009 Report Share Posted February 23, 2009 Thank you, this helps. This is basically what I obtained from Medicare today. Again, thanks for all your help and I will forward to the appropriate people. Tamara From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH Trnsplnt Sent: Monday, February 23, 2009 1:45 PM To: TxFinancialCoordinators Subject: RE: Medicare What our " approval " from the Medical Director of the Fiscal Intermediary really looked like in writing is this (abbreviations are mine): " ...Medicare may neither pre-approve nor otherwise preauth any service or treatment. However the info you submitted regarding Ms X's medical history, and the pertinent literature as well as supportive comments from Medicare consultants indicate such treatment in this pt is medically reasonable and necessary, consistent w/Medicare requirements.... If reimbursement for this tx is denied, please submit the denied claim as a redetermination according to the process... I will approve coverage if the claim comes to me for a redetermination... Sincerely, Dr Z Contractor Medical Director " -----Original Message----- From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of Jelali, Tamara Sent: Monday, February 23, 2009 10:25 AM To: TxFinancialCoordinators Subject: RE: Medicare I am getting conflicting information. I just got off the phone w/ Medicare and they do not pre authorize medications. She basically told me that it would be something that the providers would need to pursue in the event it is not covered-after the fact. Please advise. thank you, From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Mast, Deborah Sent: Monday, February 23, 2009 1:02 PM To: TxFinancialCoordinators Subject: RE: Medicare IVIG, including Retuximab, for desensitization is not a covered benefit under Medicare. You need to contact your FI to request approval based on your protocols. Debbie Mast Manager, Transplant Financial Coordinators Stanford Hospital and Clinics 750 Welch Road, Suite 220 Palo Alto, CA 94304 Trustee, TFCA Heart, Lung, Heart/Lung, Liver, Kidney, Pancreas, Intestinal Transplant Programs Phone: Fax: This email communication and any attachments may contain confidential information for the use of the designated recipients named above. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its contents is prohibited. If you have received this email in error, please notify the sender immediately by calling the phone number above to arrange for destruction of these documents. Thank you. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Jelali, Tamara Sent: Monday, February 23, 2009 10:00 AM To: TxFinancialCoordinators Subject: Medicare I was hoping someone would have an answer about whether Medicare covers Retuximab as a use for IVIG? Please advise. thank you, Tamara L. Jelali Financial Coordinator 3800 Reservoir Rd., NW 2 Main Washington, DC 20007 CONFIDENTIAL: The information contained in this communication, including its attachments may contain confidential information and is intended only for the individual (s) or entity (ies) to whom it is addressed . The information contained in this communication may also be protected by legal privilege , federal law or other applicable law. If you are not the intended recipient of this communication , you are hereby notified that any distribution, dissemination or duplication of this communication is strictly prohibited. If you have received this communication in error please immediately delete and destroy all copies of this message and please immediately notify us of the error by separate communication . Thank you. --_000_2EB31FE41C97274A9218C434734FA82804CC82ABWODEXCH07MEDSTA_-- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2009 Report Share Posted February 23, 2009 ps, the claim was paid without having to request a redetermination! -----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of Jelali, TamaraSent: Monday, February 23, 2009 11:05 AMTo: TxFinancialCoordinators Subject: RE: Medicare Thank you, this helps. This is basically what I obtained from Medicare today. Again, thanks for all your help and I will forward to the appropriate people. Tamara From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH TrnsplntSent: Monday, February 23, 2009 1:45 PMTo: TxFinancialCoordinators Subject: RE: Medicare What our "approval" from the Medical Director of the Fiscal Intermediary really looked like in writing is this (abbreviations are mine): "...Medicare may neither pre-approve nor otherwise preauth any service or treatment. However the info you submitted regarding Ms X's medical history, and the pertinent literature as well as supportive comments from Medicare consultants indicate such treatment in this pt is medically reasonable and necessary, consistent w/Medicare requirements.... If reimbursement for this tx is denied, please submit the denied claim as a redetermination according to the process... I will approve coverage if the claim comes to me for a redetermination... Sincerely, Dr Z Contractor Medical Director" -----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of Jelali, TamaraSent: Monday, February 23, 2009 10:25 AMTo: TxFinancialCoordinators Subject: RE: Medicare I am getting conflicting information. I just got off the phone w/ Medicare and they do not pre authorize medications. She basically told me that it would be something that the providers would need to pursue in the event it is not covered-after the fact. Please advise. thank you, From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Mast, DeborahSent: Monday, February 23, 2009 1:02 PMTo: TxFinancialCoordinators Subject: RE: Medicare IVIG, including Retuximab, for desensitization is not a covered benefit under Medicare. You need to contact your FI to request approval based on your protocols. Debbie Mast Manager, Transplant Financial Coordinators Stanford Hospital and Clinics 750 Welch Road, Suite 220 Palo Alto, CA 94304 Trustee, TFCA Heart, Lung, Heart/Lung, Liver, Kidney, Pancreas, Intestinal Transplant Programs Phone: Fax: This email communication and any attachments may contain confidential information for the use of the designated recipients named above. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its contents is prohibited. If you have received this email in error, please notify the sender immediately by calling the phone number above to arrange for destruction of these documents. Thank you. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Jelali, TamaraSent: Monday, February 23, 2009 10:00 AMTo: TxFinancialCoordinators Subject: Medicare I was hoping someone would have an answer about whether Medicare covers Retuximab as a use for IVIG? Please advise. thank you, Tamara L. Jelali Financial Coordinator 3800 Reservoir Rd., NW 2 Main Washington, DC 20007 CONFIDENTIAL: The information contained in this communication, including its attachments may contain confidential information and is intended only for the individual (s) or entity (ies) to whom it is addressed . The information contained in this communication may also be protected by legal privilege , federal law or other applicable law. If you are not the intended recipient of this communication , you are hereby notified that any distribution, dissemination or duplication of this communication is strictly prohibited. If you have received this communication in error please immediately delete and destroy all copies of this message and please immediately notify us of the error by separate communication . Thank you. --_000_2EB31FE41C97274A9218C434734FA82804CC82ABWODEXCH07MEDSTA_-- Quote Link to comment Share on other sites More sharing options...
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