RE: Part B coverage for immunos after return to dialysis

[Guest guest]

Hi ,

I have a patient that is back on dialysis, re-listed for transplant, and still getting prograf covered by part B at his pharmacy. I believe they use Walgreens.

Did the pharmacy actually submit the claim and get a rejection?

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 on, :LPH Trnsplnt

Sent: Friday, July 20, 2012 4:59 PM

To: TxFinancialCoordinators

Subject: Part B coverage for immunos after return to dialysis

I love a new question after 8 years of this! Who is responsible for covering immunos when a patient returns to dialysis?

Pt’s pharmacy says

Part B will reject their claim b/c kidney is no longer functioning, and her Part D will say

she must now get her immunos through her dialysis unit who will be reimbursed as part of their bundled payment. Any guidance much appreciated.

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@...

" The finding

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— but one in which everything interesting, like ourselves, results from flaws or breaks in that symmetry. " - Dennis Overbye, NYT

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[Guest guest]

,

When a patient whose primary payer is Medicare (or secondary if Part B is billed for immunos) returns to dialysis, the dialysis unit would assume responsible

for providing the patients immunos as these drugs fall under the new CMS ESRD bundled payment guidelines. See link

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ESRDpayment/index.html

Tammy Zukowski

Specialty Pharmacy Program Manager

University of Michigan

300 N. Ingalls 3D06

Ann Arbor, MI 48109

Fax

tammyz@...

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]

On Behalf Of on, :LPH Trnsplnt

Sent: Friday, July 20, 2012 4:59 PM

To: TxFinancialCoordinators

Subject: Part B coverage for immunos after return to dialysis

I love a new question after 8 years of this! Who is responsible for covering immunos when a patient returns to dialysis?

Pt’s pharmacy says

Part B will reject their claim b/c kidney is no longer functioning, and her Part D will say

she must now get her immunos through her dialysis unit who will be reimbursed as part of their bundled payment. Any guidance much appreciated.

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@...

" The finding

of the Higgs boson affirms a grand view of a universe described by simple and elegant and symmetrical laws

— but one in which everything interesting, like ourselves, results from flaws or breaks in that symmetry. " - Dennis Overbye, NYT

**********************************************************

Electronic Mail is not secure, may not be read every day, and should not be used for urgent or sensitive issues

[Guest guest]

Thanks very much for the link Tammy! I had to take the “s” off “https” in the address line but that might just be a glitch in my hospital’s system.  From the MLNMatters newsletter link on the website, here is the heart of it: Effective January 1, 2011, section 153b of the MIPPA requires that all ESRD-related drugs and biologicals are included in the ESRD PPS and must be billed by the renal dialysis facility. 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 Zukowski, TammySent: Monday, July 23, 2012 7:12 AMTo: TxFinancialCoordinators Subject: RE: Part B coverage for immunos after return to dialysis , When a patient whose primary payer is Medicare (or secondary if Part B is billed for immunos) returns to dialysis, the dialysis unit would assume responsible for providing the patients immunos as these drugs fall under the new CMS ESRD bundled payment guidelines. See link https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ESRDpayment/index.html Tammy Zukowski Specialty Pharmacy Program ManagerUniversity of Michigan 300 N. Ingalls 3D06Ann Arbor, MI 48109Fax tammyz@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH TrnsplntSent: Friday, July 20, 2012 4:59 PMTo: TxFinancialCoordinators Subject: Part B coverage for immunos after return to dialysis I love a new question after 8 years of this! Who is responsible for covering immunos when a patient returns to dialysis? Pt’s pharmacy says Part B will reject their claim b/c kidney is no longer functioning, and her Part D will say she must now get her immunos through her dialysis unit who will be reimbursed as part of their bundled payment. Any guidance much appreciated. onTransplant Financial CoordinatorLegacy Good Samaritan HospitalLegacy Transplant Services1040 NW 22nd Ave Ste 480Portland OR 97210 direct main office toll-free faxlmorriso@... " The finding of the Higgs boson affirms a grand view of a universe described by simple and elegant and symmetrical laws — but one in which everything interesting, like ourselves, results from flaws or breaks in that symmetry. " - Dennis Overbye, NYT**********************************************************Electronic Mail is not secure, may not be read every day, and should not be used for urgent or sensitive issues