billing differences in organ procurement

[Guest guest]

Hi!!

I'm wondering if I can get some information on the difference(s) (if there are

any) in billing for organ procurement on a live donor when the recipient is in

another location? If so, what are they?

I'm trying to understand both sides. For example, the donor being at our

facility and the organ then being sent to the recipient in at organization; and

also an organ being procured from a live donor at another organization and the

recipient of that organ being at my organization.

Thank you in advance, and I appreciate your comments. I'm not a TFC but

instead am in reimbursement working on the cost report. I am just " a BIT "

confused by this.

Lavery

[Guest guest]

Useful and important info for us at Tampa General as well. We appreciate your input Bill.Have a great weekend. From: Bill Vaughan Sent: Saturday, June 30, 2012 09:53 AMTo: TxFinancialCoordinators <TxFinancialCoordinators >Subject: Re: billing differences in organ procurement Hi ,A donor is a donor. When the pair is in the same transplant center, the evaluation of the donor is the responsibility of the transplanting center. No insurance is to be billed for evaluation. Physician evaluation consultations are the responsibilityof the transplanting center and are not billed to any insurance company.At the time of donation the inpatient stay for the donor is written off to the transplant center for inclusion on the Cost Report and is not billed to any insurance. The Physicians and Surgeons that provide services to the Donor are billed to and paidby the recipients insurance unless the transplant is a global and then the Physicians and Surgeons are paid by the transplanting center and those fees are NOT put on the Cost Report.When the donor is in one transplant center and the recipient is in another, the donor is evaluated and the evaluation services are covered by the donor center and not billed to any insurance just like above.At the time of donation the inpatient stay for the donor is written off to the transplant center for inclusion on the Cost Report and is not billed to any insurance. The donor bill (charges) are then reduced to cost utilizing Medicare Cost ReportingData reported on the D-4 Part I. A copy of the charges, the D-4 Part I and the computation of the cost are sent to the recipient center, the recipient center pays the cost of the recovery at the donor center. The amount received from the recipient centeris offset on the line on D-4, Part III, Revenue for Organs Sold, the organ is counted as a live donor organ recovered and is counted as a medicare organ in the numerator and denominator. The Physicians and Surgeons that provide services to the Donor are billed to and paid by the recipients insurance unless the transplant is a global and then the Physicians and Surgeons are paid by the transplanting center and those fees are NOT put onthe Cost Report. The financial coordinator at the donor and recipient center work together to make sure that the donor physicians and surgeons are paid for their services. If Medicare is the primary payer, the recipient center provides the donor center withthe recipients medicare information. IF there is a global contract, with the NKR, there is an agreed upon amount that is paid by the recipient center, the financial coordinators provide billing information to the physicians and surgeons. If the recipienthas another group insurance, the financial coordinators obtain necessary information and permissions from the payer to assure that the recovery physicians and surgeons get paid. If there is no mechanism for the recovery docs go get paid, then generally, thecase should not proceed.If you have any questions, please let me know.Thanks,BillReply-To: <TxFinancialCoordinators >Date: Friday, June 29, 2012 3:33 PMTo: <TxFinancialCoordinators >Subject: billing differences in organ procurement Hi!!I'm wondering if I can get some information on the difference(s) (if there are any) in billing for organ procurement on a live donor when the recipient is in another location? If so, what are they?I'm trying to understand both sides. For example, the donor being at our facility and the organ then being sent to the recipient in at organization; and also an organ being procured from a live donor at another organization and the recipient of that organ beingat my organization. Thank you in advance, and I appreciate your comments. I'm not a TFC but instead am in reimbursement working on the cost report. I am just " a BIT " confused by this. Lavery