CONTACTS 

SUBJECTS
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0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 11 0000. ref SDS 9 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Submitted a letter to Bob, who has been communicating for the
040902 - accounting department on UCSF's claim to recover charges for Millie's
040903 - care at UCSF which is the responsibility of Kaiser.  Bob's letter on
040904 - 070912 received in the record on 070917 said to contact Bob about
040905 - billing and payment issues. ref SDS 4 H47I  This was confirmed in
040906 - Bob's letter 070924. ref SDS 5 N45S
040907 -
040908 -    1.  Subject: Payment on Account
040909 -        Date: Wed, 24 Oct 2007 00:56:40 -0700
040915 -         ..
040916 -    2.  Dear Bob,
040918 -         ..
040919 -        Kaiser has notified Millie they will take up the coinsurance
040920 -        issue, possibly in a hearing next month, shown by telecon with
040921 -        Paula McPhail on 071006. ref SDS 7 0001
040922 -
040923 -            [On 071006 UCSF responds, ref SDS 16 K49J, and demands
040924 -            payment of its claim against Millie within 1 week.
040925 -            ref SDS 16 SU5V
040927 -         ..
040928 -    3.  On 071010 Millie received a letter from Paula confirming Kaiser
040929 -        proposes MCRC Appeals Committee review. ref SDS 12 TH8L
040931 -         ..
040932 -    4.  Whether Kaiser pays UCSF or Millie pays, UCSF will have to show
040933 -        the basis for charges.  Millie requested this information in a
040934 -        letter to UCSF dated 071010. ref SDS 11 HZ9X  Your letter later
040935 -        in the day on the 10th, explained further charges were
040936 -        incurred, ref SDS 11 4R3I, following submission of a
040937 -        spreadsheet you submitted with a letter dated 070912. [received
040938 -        on 070917. ref SDS 4 595U]  Millie recognizes UCSF entitlement
040939 -        to payment for ongoing services, and holds Kaiser is
040940 -        responsible to pay for treatment prescribed on 070105 under the
040941 -        EOC for Senior Advantage reviewed on 070927. ref SDS 6 WU6M
040942 -
040943 -            [On 071006 UCSF refuses to explain billings to Millie in
040944 -            relation to charges for medical services. ref SDS 16 SU6R
040946 -         ..
040947 -    5.  Your letter on O71010 also said that questions about the amount
040948 -        of UCSF charges to Millie should be addressed to Medicare.
040949 -        ref SDS 11 OH7R  Does this mean that people UCSF works with at
040950 -        Kaiser's Medicare unit refuse to submit the basis of payments
040951 -        to UCSF and proposed charges to Millie?  The [payer] at least
040952 -        should be able to spot check long complicated invoices for
040953 -        compliance with requirements.
040955 -         ..
040956 -    6.  Your letter on 071010 further reported that MBGS is assembling
040957 -        additional charges. ref SDS 11 OH89  How many business units
040958 -        are charging Millie? [repeats question in Millie's letter to
040959 -        UCSF on 071011, ref SDS 13 K64T, asking if there are other
040960 -        colored invoices pending, and asking for clarify on what is
040961 -        claimed by UCSF. ref SDS 13 K65S
040962 -
040963 -           [On 071101 Nancy Baird with MGBS called to request
040964 -           assistance with billing for professional services; she
040965 -           plans to contact Paula about facilitating UCSF billings for
040966 -           referral from Kaiser. ref SDS 18 5R5H
040968 -         ..
040969 -    7.  UCSF was asked in a call on 070823 to submit all charges to
040970 -        date so that Millie would know the total being claimed.
040971 -        ref SDS 2 JP50  This was reviewed in your office on 070830 as
040972 -        UCSF's total claim against Millie. ref SDS 3 S69H ...which
040973 -        seemed to be an additional $10K above her annual insurance paid
040974 -        to Kaiser of $1K.  [ref SDS 3 W05N]  Your letter on 070912
040975 -        reduced UCSF's claim by about $8K. ref SDS 4 595U  Millie
040976 -        wanted to make interim payment pending review by Kaiser.
040977 -        [letter to UCSF on 071010, ref SDS 11 HZ7W]  On 071006 Millie
040978 -        received additional UCSF billings adding $2.2K for work from
040979 -        January to April, suggesting twice that amount is owed for
040980 -        services after April. ref SDS 7 PRWW  Since these new (pink)
040981 -        invoices describe level 4 and 5 services, which are explained
040982 -        in your letter on 071010 as covering services in the white
040983 -        invoices for the same period, there is concern about
040984 -        duplication. ref SDS 11 OH83  Millie therefore deferred payment
040985 -        [reported in a letter to UCSF on 071011, ref SDS 13 K64Q, while
040986 -        you complete review of the account, as stated in your letter on
040987 -        071010. ref SDS 11 OH89
040989 -         ..
040990 -    8.  Please submit a spreadsheet updating the UCSF claim on 070912,
040991 -        and showing the total claimed to date by UCSF for all business
040992 -        units. [received on 070917, ref SDS 4 WP5I]  You indicated
040993 -        coinsurance charges Millie 20%. ref SDS 11 OH7W  Please show
040994 -        how this was applied to calculate UCSF's claim for account
040995 -        #12593370 described as services on 070301.  This is
040996 -        representative of other invoices, so understanding how one
040997 -        invoice is calculated, will save time reconciling other
040998 -        invoices.
040999 -
041000 -            [On 071026 UCSF submits a listing of prior billings,
041001 -            ref SDS 16 SU4Q, and says another business unit is still
041002 -            assembling additional charges that seem to duplicate
041003 -            amounts already paid. ref SDS 16 SU6U
041005 -         ..
041006 -    9.  Additionally, Millie has worried that because invoices (white)
041007 -        she receives contain statements that Medicare denied payment of
041008 -        laboratory tests, UCSF may be charging her for this work.  Your
041009 -        letter on 071010 seems to state that UCSF is not charging
041010 -        Millie for costs of blood tests (labs). ref SDS 11 OH7W  Please
041011 -        clarify this issue.  As a result of confusion in billings,
041012 -        Millie had blood work done at Kaiser last week.  This caused
041013 -        confusion [reported on 071017, ref SDS 14 PRPX, and delay in
041014 -        treatment [on 071018, ref SDS 15 HL7O], as we discussed on
041015 -        070830. ref SDS 3 L94G  She would like to avoid these problems
041016 -        by having the work done at UCSF, provided this does not cause
041017 -        payment problems of extra charges.  Assistance on this is
041018 -        appreciated.
041020 -         ..
041021 -   10.  Millie would like to make payment on account pending review by
041022 -        Kaiser and determination by appropriate authority.  Payment of
041023 -        UCSF claimed amount can be construed as accepting Kaiser's
041024 -        failure to perform.  Can UCSF suggest a procedure for payment
041025 -        on account while dispute resolution continues?  One approach
041026 -        would be to pay UCSF copayment amounts that would be made if
041027 -        the work were done at Kaiser, which seems originally
041028 -        contemplated between UCSF and Kaiser on 061230. ref SDS 1 3X6K
041029 -
041030 -            [On 071026 UCSF responds, ref SDS 16 K49J, and demands
041031 -            payment of its claim against Millie within 1 week.
041032 -            ref SDS 16 SU5V
041034 -         ..
041035 -   11.  If it would help to meet again on these matters, just let me
041036 -        know.
041038 -  ..
041039 - This would update and correct billing irregularities from the meeting
041040 - with UCSF on 070830, ref SDS 3 0001, which are listed on 071006.
041041 - ref SDS 7 454M
041042 -
041043 -            [On 071026 UCSF billing irregularities reviewed.
041044 -            ref SDS 16 X18J
041046 -             ..
041047 -            [On 071026 UCSF responds, ref SDS 16 K49J, and demands
041048 -            payment of its claim against Millie within 1 week, and does
041049 -            not agree to meet on its claim. ref SDS 16 SU5V
041051 -             ..
041052 -            [On 071027 letter to UCSF requests meeting with single
041053 -            point of contact so that UCSF can present total billings to
041054 -            date and explain billing procedures. ref SDS 17 CG6H
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0411 -