Medicare Advantage Plan

[Guest guest]

Here is Santana’s email address.

.Santana@...

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Bill Vaughan

Sent: Monday, June 04, 2012 12:14

PM

To: TxFinancialCoordinators

Subject: Re:

Medicare Advantage Plan

Hi

That sounds like a Santana question. Does someone have his

contact information if doesn't have it.

Hope this helps.

Thanks

Bill

Sent from my iPhone

On Jun 4, 2012, at 10:23 AM, " Woodward, L "

wrote:

What happens when you have a MA plan and you bill it for immunos

and it “rejects” telling you to bill to Medicare B. Then you bill to Medicare B

and it “rejects” telling you to bill to MA?????

THIS HAPPENS TO ME DAILY!!! And I can’t seem to get anywhere with

Medicare or the MA plan. No one can tell me what to tell the pharmacy so they

can get the claim to process, so they want my patient to pay full price then

file a paper claim on their own for reimbursement.

HELP!!!!!!

L. Woodward, BS, TFC

Transplant Financial Coordinator

University Hospital

of Arkansas

(501)603-1007 FAX (501)603-1009

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ]

On Behalf Of on, :LPH

Trnsplnt

Sent: Wednesday, May 30, 2012

10:22 AM

To: TxFinancialCoordinators

Subject: RE:

Medicare Advantage Plan

All MA plan booklets have a section

where you’ll find a description of how the plan covers both B and D

drugs. As Ruth says, B drug copays/coinsurance count toward the

annual medical OOP.

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ]

On Behalf Of Ruth.Wilhelm@...

Sent: Wednesday, May 30, 2012 6:54

AM

To: TxFinancialCoordinators

Subject: RE:

Medicare Advantage Plan

But they should have an OOP max and once that is met, they pay

at 100% because it goes under the medical or Part B portion of the

policy. I do have one patient whose plan pays for immunos at 100%

but that is rare indeed.

Ruth

Ruth Wilhelm

Financial

Coordinator

The Virginia

Transplant Center

Henrico Doctors'

Hospital

Henrico, VA

phone

fax

Ruth.Wilhelm@...

Treasurer,

Transplant Financial Coordinators Association

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ]

On Behalf Of Branham, Michele

Sent: Wednesday, May 30, 2012 9:52

AM

To: TxFinancialCoordinators

Subject: RE:

Medicare Advantage Plan

All of the Medicare Advantage plans I have worked with pay 80% and

the patient is responsible for 20% of the cost for immunos.

Michele Branham,

Sr. Transplant Financial Coordinator

Spiritual Ambassador

<image001.jpg>

- Phone; -

Fax

Luke 1:46-47 " My soul Glorifies

the Lord and my Spirit rejoices in God my Savior. "

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ]

On Behalf Of amelliagay

Sent: Wednesday, May 30, 2012 9:48

AM

To: TxFinancialCoordinators

Subject:

Medicare Advantage Plan

I have a

question on how a Medicare Advantage plan pays for the immuno suppressant drugs

post transplant.

I do not work with Advantage plans much.

Do they still pay under medical part B or are they under the Drug portion?

Thank you for your assistance.

Amellia Gay

and White Memorial

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[Guest guest]

If a pt chooses to take a Humana Medicare Advantage Plan, is the kidney transplant considered a Medicare approved transplant (allowing immunos to be covered under medical vs prescription)?

Sara Danner

| Transplant Financial Coordinator | Memorial Medical Center | Springfield, IL

Phone: | Fax: | E-mail:

danner.sara@...

CHOOSE GREAT.

CHOOSE MEMORIAL.

This message (including any attachments) contains confidential information intended for a specific individual and purpose, and is protected by law. If you are not the intended recipient, you should delete this message.

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[Guest guest]

So, none of the Medicare Advantage plans are cost reportable? Is the SAC charge reimbursed by individual contracts with the various MAs? M. Christiansen, BAS, RNTransplant Financial Case Manager DeVos Heart and Lung Transplant Program100 Michigan NEMC 231Grand Rapids, MI 49503Phone: Pager: Fax: lisa.christiansen@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH TrnsplntSent: Wednesday, August 08, 2012 5:23 PMTo: TxFinancialCoordinators Subject: RE: Medicare Advantage Plan Hi all. All MA plans now distinguish between how they cover “B” drugs and how they cover “D” drugs. As we understand it, because the pt is a still a Medicare beneficiary, the transplant is considered “paid by Medicare” (although it’s not cost-reportable) and the MA plan will cover the immunos according to their stated “B” drug benefit. This could range anywhere from 80-100% depending on the pt’s plan - and the OOP should track to the Medical OOP max.As I say this is our understanding. Things do go haywire at the retail pharmacy level from time to time. What are other programs experiencing with this? 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 AguiarSent: Wednesday, August 08, 2012 2:16 PMTo: TFC listservSubject: RE: Medicare Advantage Plan It will be when the pt goes back to regular Medicare. While enrolled in the MA plan, the immunos will have to be gotten thru the MA plan, subject to the plan provisions (check the fine print carefully-there have been instances where the MA plan has reverted to paying only 80% of the immunos just like Medicare B would).For cost reporting purposes, of course, this is not considered a Medicare transplant :-(To: TxFinancialCoordinators From: danner.sara@...Date: Wed, 8 Aug 2012 14:46:37 -0500Subject: Medicare Advantage Plan If a pt chooses to take a Humana Medicare Advantage Plan, is the kidney transplant considered a Medicare approved transplant (allowing immunos to be covered under medical vs prescription)? Sara Danner | Transplant Financial Coordinator | Memorial Medical Center | Springfield, ILPhone: | Fax: | E-mail: danner.sara@... CHOOSE GREAT. CHOOSE MEMORIAL. This message (including any attachments) contains confidential information intended for a specific individual and purpose, and is protected by law. If you are not the intended recipient, you should delete this message. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited.

[Guest guest]

That’s how we do it , the SAC is built in to the contract. 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 lisa.christiansen@...Sent: Wednesday, August 08, 2012 2:34 PMTo: TxFinancialCoordinators Subject: RE: Medicare Advantage Plan So, none of the Medicare Advantage plans are cost reportable? Is the SAC charge reimbursed by individual contracts with the various MAs? M. Christiansen, BAS, RNTransplant Financial Case Manager DeVos Heart and Lung Transplant Program100 Michigan NEMC 231Grand Rapids, MI 49503Phone: Pager: Fax: lisa.christiansen@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH TrnsplntSent: Wednesday, August 08, 2012 5:23 PMTo: TxFinancialCoordinators Subject: RE: Medicare Advantage Plan Hi all. All MA plans now distinguish between how they cover “B” drugs and how they cover “D” drugs. As we understand it, because the pt is a still a Medicare beneficiary, the transplant is considered “paid by Medicare” (although it’s not cost-reportable) and the MA plan will cover the immunos according to their stated “B” drug benefit. This could range anywhere from 80-100% depending on the pt’s plan - and the OOP should track to the Medical OOP max.As I say this is our understanding. Things do go haywire at the retail pharmacy level from time to time. What are other programs experiencing with this? 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 AguiarSent: Wednesday, August 08, 2012 2:16 PMTo: TFC listservSubject: RE: Medicare Advantage Plan It will be when the pt goes back to regular Medicare. While enrolled in the MA plan, the immunos will have to be gotten thru the MA plan, subject to the plan provisions (check the fine print carefully-there have been instances where the MA plan has reverted to paying only 80% of the immunos just like Medicare B would).For cost reporting purposes, of course, this is not considered a Medicare transplant :-(To: TxFinancialCoordinators From: danner.sara@...Date: Wed, 8 Aug 2012 14:46:37 -0500Subject: Medicare Advantage Plan If a pt chooses to take a Humana Medicare Advantage Plan, is the kidney transplant considered a Medicare approved transplant (allowing immunos to be covered under medical vs prescription)? Sara Danner | Transplant Financial Coordinator | Memorial Medical Center | Springfield, ILPhone: | Fax: | E-mail: danner.sara@... CHOOSE GREAT. CHOOSE MEMORIAL. This message (including any attachments) contains confidential information intended for a specific individual and purpose, and is protected by law. If you are not the intended recipient, you should delete this message. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited.

[Guest guest]

Therefore, you enter into a contract with the individual payer just like a commercial payer. I have only had to deal with this one time, just within the last couple weeks. It is a Humana plan but I have not been informed that we need to have a specific contract in place for the transplant to be covered. They said the follow Medicare guidelines. I also called her Rx plan and they are telling me that they will require a Prior Auth for the immunos to be covered under her Part B plan. Am I missing something!?! M. Christiansen, BAS, RNTransplant Financial Case Manager DeVos Heart and Lung Transplant Program100 Michigan NEMC 231Grand Rapids, MI 49503Phone: Pager: Fax: lisa.christiansen@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH TrnsplntSent: Wednesday, August 08, 2012 5:35 PMTo: TxFinancialCoordinators Subject: RE: Medicare Advantage Plan That’s how we do it , the SAC is built in to the contract. 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 lisa.christiansen@...Sent: Wednesday, August 08, 2012 2:34 PMTo: TxFinancialCoordinators Subject: RE: Medicare Advantage Plan So, none of the Medicare Advantage plans are cost reportable? Is the SAC charge reimbursed by individual contracts with the various MAs? M. Christiansen, BAS, RNTransplant Financial Case Manager DeVos Heart and Lung Transplant Program100 Michigan NEMC 231Grand Rapids, MI 49503Phone: Pager: Fax: lisa.christiansen@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH TrnsplntSent: Wednesday, August 08, 2012 5:23 PMTo: TxFinancialCoordinators Subject: RE: Medicare Advantage Plan Hi all. All MA plans now distinguish between how they cover “B” drugs and how they cover “D” drugs. As we understand it, because the pt is a still a Medicare beneficiary, the transplant is considered “paid by Medicare” (although it’s not cost-reportable) and the MA plan will cover the immunos according to their stated “B” drug benefit. This could range anywhere from 80-100% depending on the pt’s plan - and the OOP should track to the Medical OOP max.As I say this is our understanding. Things do go haywire at the retail pharmacy level from time to time. What are other programs experiencing with this? 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 AguiarSent: Wednesday, August 08, 2012 2:16 PMTo: TFC listservSubject: RE: Medicare Advantage Plan It will be when the pt goes back to regular Medicare. While enrolled in the MA plan, the immunos will have to be gotten thru the MA plan, subject to the plan provisions (check the fine print carefully-there have been instances where the MA plan has reverted to paying only 80% of the immunos just like Medicare B would).For cost reporting purposes, of course, this is not considered a Medicare transplant :-(To: TxFinancialCoordinators From: danner.sara@...Date: Wed, 8 Aug 2012 14:46:37 -0500Subject: Medicare Advantage Plan If a pt chooses to take a Humana Medicare Advantage Plan, is the kidney transplant considered a Medicare approved transplant (allowing immunos to be covered under medical vs prescription)? Sara Danner | Transplant Financial Coordinator | Memorial Medical Center | Springfield, ILPhone: | Fax: | E-mail: danner.sara@... CHOOSE GREAT. CHOOSE MEMORIAL. This message (including any attachments) contains confidential information intended for a specific individual and purpose, and is protected by law. If you are not the intended recipient, you should delete this message. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited.

[Guest guest]

Barry Marshall would be so proud!  :-D                          From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of AguiarSent: Wednesday, August 08, 2012 4:16 PMTo: TFC listservSubject: RE: Medicare Advantage Plan Check the fine print of that contract, -if it only says they pay the Medicare DRG & there is no language that specifically address' the organ acquisition fee, you are giving the organ away for free. Remember, Medicare doesn't pay for the organ in the DRG-it's a separate payment thru the Cost Report. Therefore, you need to make sure you have language in these contracts that specifically requires the MA plan to pay for the organ AS WELL making as the DRG payment.I know of at least one program that learned that lesson the hard, & expensive, way to the tune of 8 free kidneys...To: TxFinancialCoordinators From: lisa.christiansen@...Date: Wed, 8 Aug 2012 17:39:58 -0400Subject: RE: Medicare Advantage Plan Therefore, you enter into a contract with the individual payer just like a commercial payer. I have only had to deal with this one time, just within the last couple weeks. It is a Humana plan but I have not been informed that we need to have a specific contract in place for the transplant to be covered. They said the follow Medicare guidelines. I also called her Rx plan and they are telling me that they will require a Prior Auth for the immunos to be covered under her Part B plan. Am I missing something!?! M. Christiansen, BAS, RNTransplant Financial Case Manager DeVos Heart and Lung Transplant Program100 Michigan NEMC 231Grand Rapids, MI 49503Phone: Pager: Fax: lisa.christiansen@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH TrnsplntSent: Wednesday, August 08, 2012 5:35 PMTo: TxFinancialCoordinators Subject: RE: Medicare Advantage Plan That’s how we do it , the SAC is built in to the contract. 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 lisa.christiansen@...Sent: Wednesday, August 08, 2012 2:34 PMTo: TxFinancialCoordinators Subject: RE: Medicare Advantage Plan So, none of the Medicare Advantage plans are cost reportable? Is the SAC charge reimbursed by individual contracts with the various MAs? M. Christiansen, BAS, RNTransplant Financial Case Manager DeVos Heart and Lung Transplant Program100 Michigan NEMC 231Grand Rapids, MI 49503Phone: Pager: Fax: lisa.christiansen@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH TrnsplntSent: Wednesday, August 08, 2012 5:23 PMTo: TxFinancialCoordinators Subject: RE: Medicare Advantage Plan Hi all. All MA plans now distinguish between how they cover “B” drugs and how they cover “D” drugs. As we understand it, because the pt is a still a Medicare beneficiary, the transplant is considered “paid by Medicare” (although it’s not cost-reportable) and the MA plan will cover the immunos according to their stated “B” drug benefit. This could range anywhere from 80-100% depending on the pt’s plan - and the OOP should track to the Medical OOP max.As I say this is our understanding. Things do go haywire at the retail pharmacy level from time to time. What are other programs experiencing with this? 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 AguiarSent: Wednesday, August 08, 2012 2:16 PMTo: TFC listservSubject: RE: Medicare Advantage Plan It will be when the pt goes back to regular Medicare. While enrolled in the MA plan, the immunos will have to be gotten thru the MA plan, subject to the plan provisions (check the fine print carefully-there have been instances where the MA plan has reverted to paying only 80% of the immunos just like Medicare B would).For cost reporting purposes, of course, this is not considered a Medicare transplant :-(To: TxFinancialCoordinators From: danner.sara@...Date: Wed, 8 Aug 2012 14:46:37 -0500Subject: Medicare Advantage Plan If a pt chooses to take a Humana Medicare Advantage Plan, is the kidney transplant considered a Medicare approved transplant (allowing immunos to be covered under medical vs prescription)? Sara Danner | Transplant Financial Coordinator | Memorial Medical Center | Springfield, ILPhone: | Fax: | E-mail: danner.sara@... CHOOSE GREAT. CHOOSE MEMORIAL. This message (including any attachments) contains confidential information intended for a specific individual and purpose, and is protected by law. If you are not the intended recipient, you should delete this message. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited.

[Guest guest]

Wow! Thanks so much for all of the wonderful knowledge out there!!! I will be sure to double check on this right away, before “the point of no return”! J M. Christiansen, BAS, RNTransplant Financial Case Manager DeVos Heart and Lung Transplant Program100 Michigan NEMC 231Grand Rapids, MI 49503Phone: Pager: Fax: lisa.christiansen@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of AguiarSent: Wednesday, August 08, 2012 7:16 PMTo: TFC listservSubject: RE: Medicare Advantage Plan Check the fine print of that contract, -if it only says they pay the Medicare DRG & there is no language that specifically address' the organ acquisition fee, you are giving the organ away for free. Remember, Medicare doesn't pay for the organ in the DRG-it's a separate payment thru the Cost Report. Therefore, you need to make sure you have language in these contracts that specifically requires the MA plan to pay for the organ AS WELL making as the DRG payment.I know of at least one program that learned that lesson the hard, & expensive, way to the tune of 8 free kidneys...To: TxFinancialCoordinators From: lisa.christiansen@...Date: Wed, 8 Aug 2012 17:39:58 -0400Subject: RE: Medicare Advantage Plan Therefore, you enter into a contract with the individual payer just like a commercial payer. I have only had to deal with this one time, just within the last couple weeks. It is a Humana plan but I have not been informed that we need to have a specific contract in place for the transplant to be covered. They said the follow Medicare guidelines. I also called her Rx plan and they are telling me that they will require a Prior Auth for the immunos to be covered under her Part B plan. Am I missing something!?! M. Christiansen, BAS, RNTransplant Financial Case Manager DeVos Heart and Lung Transplant Program100 Michigan NEMC 231Grand Rapids, MI 49503Phone: Pager: Fax: lisa.christiansen@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH TrnsplntSent: Wednesday, August 08, 2012 5:35 PMTo: TxFinancialCoordinators Subject: RE: Medicare Advantage Plan That’s how we do it , the SAC is built in to the contract. 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 lisa.christiansen@...Sent: Wednesday, August 08, 2012 2:34 PMTo: TxFinancialCoordinators Subject: RE: Medicare Advantage Plan So, none of the Medicare Advantage plans are cost reportable? Is the SAC charge reimbursed by individual contracts with the various MAs? M. Christiansen, BAS, RNTransplant Financial Case Manager DeVos Heart and Lung Transplant Program100 Michigan NEMC 231Grand Rapids, MI 49503Phone: Pager: Fax: lisa.christiansen@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH TrnsplntSent: Wednesday, August 08, 2012 5:23 PMTo: TxFinancialCoordinators Subject: RE: Medicare Advantage Plan Hi all. All MA plans now distinguish between how they cover “B” drugs and how they cover “D” drugs. As we understand it, because the pt is a still a Medicare beneficiary, the transplant is considered “paid by Medicare” (although it’s not cost-reportable) and the MA plan will cover the immunos according to their stated “B” drug benefit. This could range anywhere from 80-100% depending on the pt’s plan - and the OOP should track to the Medical OOP max.As I say this is our understanding. Things do go haywire at the retail pharmacy level from time to time. What are other programs experiencing with this? 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 AguiarSent: Wednesday, August 08, 2012 2:16 PMTo: TFC listservSubject: RE: Medicare Advantage Plan It will be when the pt goes back to regular Medicare. While enrolled in the MA plan, the immunos will have to be gotten thru the MA plan, subject to the plan provisions (check the fine print carefully-there have been instances where the MA plan has reverted to paying only 80% of the immunos just like Medicare B would).For cost reporting purposes, of course, this is not considered a Medicare transplant :-(To: TxFinancialCoordinators From: danner.sara@...Date: Wed, 8 Aug 2012 14:46:37 -0500Subject: Medicare Advantage Plan If a pt chooses to take a Humana Medicare Advantage Plan, is the kidney transplant considered a Medicare approved transplant (allowing immunos to be covered under medical vs prescription)? Sara Danner | Transplant Financial Coordinator | Memorial Medical Center | Springfield, ILPhone: | Fax: | E-mail: danner.sara@... CHOOSE GREAT. CHOOSE MEMORIAL. This message (including any attachments) contains confidential information intended for a specific individual and purpose, and is protected by law. If you are not the intended recipient, you should delete this message. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited.