Re: Donor Complications Billing

April 18, 2012

Hi Julius,

I believe you should bill

whatever insurance is primary for the recipient, whether it be commercial or

Medicare. If commercial is primary and denies, Medicare B is the safety net

and can be billed secondary. This applies to both facility and physician

services, according to the attached policy.

Maddox

Transplant Financial Coordinator

Via Christi Hospital

Transplant Institute

929 N St Francis,

Suite M157

Wichita KS 67214

PH

FX

shannon.maddox@...

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1 of 1 File(s)

Donor Complication Billing.pdf

April 18, 2012

Hi Julius,Physician fees to the recipients payer Medicare or not. For the first 90 days the KACC from then on the primary payer for Technical Services.Hope this helps,Thanks,BillReply-To: <TxFinancialCoordinators >Date: Wednesday, April 18, 2012 12:05 PMTo: "'TxFinancialCoordinators '" <TxFinancialCoordinators >Subject: Donor Complications Billing

Guys just for clarification. If a donor had complications under the new guidelines and the recipient's primary insurance is an insurer other than Medicare. When billing services do we bill the recipient's primary carrier or do we bill Medicare? Julius EasonTransplant Financial CoordinatorMulti-Organ Transplant DepartmentBeaumont Health Systemjeason@...(P) (F)

April 19, 2012

Hi Bill,

I am a little confused and

need clarification on your response to Julius. The question was in regards to

donor complications and the new CMS policy released on 10/28/11 says the

following:

Regarding donor complications:

Expenses incurred for complications that arise with

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

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

discharge will be billed under the recipient’s health insurance claim

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

donor complications will be reviewed.

In all of these situations, the donor is not responsible

for co-insurance or deductible.

In addition, CR7523 is adding language to

Section 90.1.3 of Chapter 3 of the “Medicare Claims Processing

Manual” to provide clarifications as follows:

Expenses incurred for complications that arise with

respect to the donor are covered and separately billable only if they are

directly attributable to the donation surgery.

All covered services (both institutional and

professional) for complications from a Medicare covered transplant that arise

after the date of the donor’s transplant discharge will be billed under

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

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

According to this donor

complications, after discharge from the donation event itself, should be billed

to the recipient’s insurance. It states it is true of both institutional

and professional charges. Am I misunderstanding something?

As always, thank you for

your help!