THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net


S U M M A R Y


DIARY: October 29, 2007 00:57 AM Monday; Rod Welch

Planning resolve billing dispute Kaiser UCSF Medicare.

1...Summary/Objective
2...Kaiser Referral Appeal Commitee Schedule Hearing Begin Preparations
3...Appeal Representation Page 2 Missing from Kaise'r Records
4...UCSF Coordination Meeting Explain Billings Single Point of Contact
5...Precise Explanation Total Doctor Visit Billings Only Facilities
6...Misrepresentation Patient Accused Avoiding Payment Owed to UCSF
7...Stringing Out Payment to UCSF Billing Representative Emotional
8...UCSF Representative Emotional Miscommunications Accuse Patient Bad Faith
........Loss Credibility and Confidence Change UCSF Account Rep
........Coordination Referral Clinical Trial Meeting Explain Procedures
........Meeting Schedule Coordination on Referral UCSF Clinical Trial
........Single Point of Contact UCSF Referral Coordination Meeting
........UCSF Referral Coordination Meeting Requested Single Point of Contact
9...Coinsurance Only Applies Patient Self-referrals Not Doctor Referrals
10...Clinical Trials No Coinsurance Medicare Physician Referrals
11...HMO Pays Costs of Physician Referrals for Clinical Trials
12...Medicare Requirements Managed Care Pay for Referrals Clinical Trials


..............
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CONTACTS 

SUBJECTS
Kaiser Regional Appeals Committee Hearing  Rspond MCRC Letter 071006

0603 -
0603 -    ..
0604 - Summary/Objective
0605 -
060501 - Follow up ref SDS 37 0000. ref SDS 36 0000.
060502 -
060503 -
060504 -
060505 -
060506 -
060507 -
060509 -  ..
0606 -
0607 -
0608 - Progress
0609 -
060901 - Pending actions required...
060902 -
060903 -    1.  Call Geoffrey White...
060904 -
060905 -        Letter to Geoffrey on 071027. ref SDS 37 5M7N  Ask about 3
060906 -        issues. ref SDS 37 TH8L
060908 -         ..
060909 -        Statutory requirement for Medicare pay clincial trials, and
060910 -        patient pays coinsurance.  Does this prevent Kaiser from
060911 -        prescribing treatments? ref SDS 37 FA36
060912 -
060914 -  ..
0610 -
0611 -
0612 - 0905
0613 -
061301 - Left message for Geoffry to call back on the letter to him.
061302 -
061303 -
061305 -  ..
0614 -
0615 -
0616 - 0936
061701 -  ..
061702 - Kaiser Referral Appeal Commitee Schedule Hearing Begin Preparations
061703 -
061704 -
061705 -    2.  Called Kaiser MCRC Paula, follow up...
061706 -
061707 -        a.  Millie's letter on 071025 received. ref SDS 34 AM3K
061709 -             ..
061710 -        b.  Appeals Committee meeting...
061711 -
061712 -            1)  Date of hearing.
061714 -                 ..
061715 -            2)  Issue to be decided, see background in Kaiser letter on
061716 -                071010. ref SDS 27 TH8L
061718 -                 ..
061719 -            3)  "Determination" being appealed, cited in review of
061720 -                letter on 071010? ref SDS 27 813X
061722 -                 ..
061723 -            4)  Procedures listed on 071010. ref SDS 27 4V7H
061725 -             ..
061726 -        c.  Continue explanation of case begun with Paula's call on
061727 -            071006. ref SDS 23 KA5J
061729 -  ..
061730 - Turns out the number we have for Paula is incorrect.  Sent an email
061731 - asking for a call back.  After sending the email, found the correct
061732 - number for Paula, and called and left a message for her.
061733 -
061734 -
061736 -  ..
0618 -
0619 -
0620 - 1547
0621 -
062101 - Appeal Representation Page 2 Missing from Kaise'r Records
062102 -
062103 - Called Paula again.  She answered and said authorization Millie sent
062104 - by mail on 071025, ref SDS 34 AM3K, and confirmed in email the next
062105 - day on 071026, ref SDS 36 TH8L, was missing page 2 with signatures.
062107 -  ..
062108 - Paula said to send the letter and authorization again.  She said
062109 - Millie could submit the documents via fax using the number in Kaiser's
062110 - letter dated 071006, received on 071010. ref SDS 27 816V
062112 -  ..
062113 - Millie took the copy of the authorization letter to a local store and
062114 - tried to send the authorization via fax, as Paula requested.
062115 -
062117 -  ..
0622 -
0623 -
0624 - 1622
0625 -
062501 - Millie called and said the fax number in Kaiser's letter dated 071006
062502 - and received on 071010 is evidently incorrect. ref SDS 27 816V  Fax
062503 - transmission fails using that number.
062505 -  ..
062506 - Called Paula.  Got voice mail.  Left message explaining problem, and
062507 - asking for corrected fax telephone number.
062508 -
062510 -  ..
0626 -
0627 -
0628 - 1643
0629 -
062901 - Paula called back.  She gave the correct fax number for her office...
062902 -
062903 -                   925 924 5165
062905 -  ..
062906 - Thanked Paula for timely response.  This corrects Paula's letter shown
062907 - on 071010. ref SDS 27 816V
062909 -  ..
062910 - She said to call Kaiser tomorrow at 0930 to follow up on preparing for
062911 - the Kaiser hearing planned in Kaiser's letter on 071006, received on
062912 - 071010. ref SDS 27 TH8L
062914 -  ..
062915 - Called Millie on the cell.  She was still at the copy and fax store
062916 - (Kinkos??).
062918 -  ..
062919 - Gave her corrected fax number for Paula.
062921 -  ..
062922 - She will try again to send a fax, and also put a copy in the US mail.
062923 -
062925 -  ..
0630 -
0631 -
0632 - 1704
0633 -
063301 - Millie returned.  Fax was sent successfully to corrected number.
063302 -
063303 - Millie feels certain she included the 2nd page in the original
063304 - mailing; concerned Kaiser lost the document in the mailroom.
063306 -  ..
063307 - Feels better with electronic confirmation of transmission.
063308 -
063309 -
063311 -  ..
0634 -
0635 -
0636 - 0820
063701 -  ..
063702 - UCSF Coordination Meeting Explain Billings Single Point of Contact
063703 -
063704 -
063705 -    3.  Called UCSF.
063706 -
063707 -        a.  Referral coordination meeting schedule presented in letter
063708 -            to UCSF on 071027, ref SDS 38 MA8P, because Kaiser has "cut
063709 -            loose" Millie from contract management support by Kaiser.
063710 -            ref SDS 38 MA5Q
063712 -             ..
063713 -        b.  Single point of contact represent UCSF. ref SDS 38 MA8S
063715 -             ..
063716 -        c.  Billing issues to resolve listed on 071026, including
063717 -            determine interim payment. ref SDS 35 UW5J
063719 -  ..
0638 -
0639 -
0640 - 0821
0641 -
064101 - Precise Explanation Total Doctor Visit Billings Only Facilities
064102 - Misrepresentation Patient Accused Avoiding Payment Owed to UCSF
064103 - Stringing Out Payment to UCSF Billing Representative Emotional
064104 - UCSF Representative Emotional Miscommunications Accuse Patient Bad Faith
064105 -
064106 - Bob was very emotional this morning, angry and hurt.  He feels UCSF
064107 - has met its duty of disclosure explaining billings with complete and
064108 - clear information, required by UCSF Bill of Rights, noted on 070830.
064109 - ref SDS 14 WU5N   The UCSF billing team believes irregularities in
064110 - billings listed on 071026, ref SDS 35 X18J, are exaggerated for the
064111 - purpose of delaying payment with calls for unnecessary substantiation
064112 - of charges - he complained that UCSF is suffering damages from Kaiser
064113 - improperly "stringing out" payments owed on the referral, and
064114 - indicated that since Kaiser has not paid, the patient should pay, and
064115 - in that case, UCSF has no duty to support charges beyond telling the
064116 - patient to contact Medicare, cited in UCSF's letter on 071010.
064117 - ref SDS 26 OH7R
064119 -             ..
064120 -            [On 071031 Millie receives notice dated 071026 UCSF plans
064121 -            referral to collection agency for payment of $202.65 on
064122 -            Kaiser referral account 12493370, ref SDS 40 KK4I, revised
064123 -            070830, ref SDS 14 4P8K, and revised again on 070917,
064124 -            ref SDS 17 MK4H; no indication of UCSF collection efforts
064125 -            against Kaiser; separate notice dated 071027 and also
064126 -            received 071031 UCSF says Millie's treatment for cancer
064127 -            ordered by Kaiser will be terminated if UCSF does not
064128 -            receive payment of $202.65. ref SDS 40 KM8J
064130 -             ..
064131 -            [On 071105 notified Kaiser of UCSF concern about delay that
064132 -            "strings out" payments. ref SDS 41 K36X and ref SDS 41 K38X
064134 -  ..
064135 - Bob refused to discuss issues in the letter on 071027, per above.
064136 - ref SDS 0 P73O  Bob indicated patient concern about UCSF failure to
064137 - submit total costs during the meeting on 070830, and getting
064138 - additional duplicate billings on 071006, ref SDS 23 PRWW, set out in
064139 - the letter to UCSF on 071027, ref SDS 38 MA3V, was a personal attack
064140 - on his integrity, similar to his letter on 071026 questioning the
064141 - "word" of the patient side, citing correspondence on 071010,
064142 - ref SDS 35 SU53, and ignoring notice to UCSF the next day on 071011
064143 - that UCSF misled the patient about charges, possibly inadvertently.
064144 - ref SDS 28 K69X
064146 -  ..
064147 - Bob recalls this morning that he was very precise explaining billings
064148 - he presented on 070830, ref SDS 14 WP5I, responding to patient request
064149 - on 070823 for the total UCSF claim, ref SDS 13 PQRY, was only for
064150 - something called "Facility Accounts."   He feels the patient knew or
064151 - reasonably should have known payment for clinical trial services at
064152 - UCSF require billings from multiple business units, because he recalls
064153 - being precise describing charges only for "Facility Accounts."
064155 -  ..
064156 - Review shows the spreadsheet Bob submitted on 070830 has a heading for
064157 - "UCSF Facility Billing." ref SDS 14 WP5I  This was not meaningful as
064158 - presenting only a partial claim, because the document summarizes
064159 - invoices and statements that do not convey partial billing.  They all
064160 - say...
064161 -
064162 -          Hospital Itimized Statement                 HOSP NO.
064163 -          UCSF Medical Center                         050454
064164 -          Patient Financial Services
064165 -          Box 0810
064166 -          San Francisco, Ca  94145-0810
064167 -          FEI # 94-3281657
064168 -
064169 - ...or...
064170 -
064171 -          Hospital Statement
064172 -          UCSF Medical Center
064173 -          Patient Financial Services
064174 -          Box 0810
064175 -          San Francisco, Ca  94145-0810
064176 -          FEI # 94-3281657
064178 -  ..
064179 - There is nothing evident about UCSF invoices and statements indicating
064180 - these are not all UCSF charges for services in Millie's case.  There
064181 - is no other documentation or record of discussion, procedures etc.,
064182 - that indicates UCSF bills from separate business units, nor that
064183 - billings for work in January would be received in October, reported on
064184 - 071006. ref SDS 23 PRWW
064186 -  ..
064187 - This morning Bob would not discuss patient lack of familiarity working
064188 - with UCSF can be corrected with a referral coordination meeting for
064189 - UCSF to explain billing procedures, requested in the letter to UCSF on
064190 - 071027. ref SDS 38 MA8P
064192 -  ..
064193 - Bob refused to discuss anything, and said he is writing another letter
064194 - to prove that UCSF did not mislead the patient.  He would not consider
064195 - the possibility that misunderstanding and miscommunication occurs from
064196 - lack of familiarity with work practices and procedures, and lack of
064197 - disclosure by UCSF of billing practices.
064198 -
064199 -            [On 071031 Millie receives notice dated 071026 UCSF plans
064200 -            referral to collection agency for payment of $202.65 on
064201 -            Kaiser referral account 12493370, ref SDS 40 KK4I, revised
064202 -            070830, ref SDS 14 4P8K, and revised again on 070917,
064203 -            ref SDS 17 MK4H; no indication of UCSF collection efforts
064204 -            against Kaiser; separate notice dated 071027 and also
064205 -            received 071031 UCSF says Millie's treatment for cancer
064206 -            ordered by Kaiser will be terminated if UCSF does not
064207 -            receive payment of $202.65. ref SDS 40 KM8J
064209 -  ..
064210 - Asked to talk to Bob's supervisor.
064212 -  ..
064213 - Bob transferred the call to a voice mail.  Left a message for Robin
064214 - Hanson to call about assigning someone else to handle Millie's
064215 - account, based on...
064216 -
064217 -        1.  Difficulty working with Bob on issues of integrity noted
064218 -            this morning. ref SDS 0 WR8M
064220 -             ..
064221 -        2.  UCSF challege to Millie's integrity in Bob's letter on
064222 -            071026. ref SDS 35 SU53
064224 -             ..
064225 -        3.  Billing irregularities that require good faith review,
064226 -            listed on 071027. ref SDS 35 X18J
064228 -             ..
064229 -        4.  Need for effective representation to develop business
064230 -            relationship going forward with a single point of contact
064231 -            at UCSF. ref SDS 38 CG6H
064233 -  ..
064234 - Sent a letter to Robin Hanson asking to facilitate a meeting to
064235 - explain billings and payments.
064236 -
064237 -    1.  Subject: Referral Coordination Meeting Single Point of Contact
064238 -        Date: Mon, 29 Oct 2007 09:15:15 -0700
064249 -         ..
064250 -    2.  Bob S******* in your office sent a letter on October 26th
064251 -        demanding payment in 1 week of balances UCSF shows outstanding
064252 -        in connection with Millie's treatment by Doctor Rugo in the
064253 -        Breast Care Clinic. ref SDS 35 SU5V
064255 -         ..
064256 -    3.  It has turned out in the past few weeks that Millie is being
064257 -        billed by multiple business units. [reported on 071006,
064258 -        ref SDS 23 PRWW]  Millie needs the total UCSF claim to date, in
064259 -        order to determine what to pay, she needs to know the basis of
064260 -        billings, the same as if UCSF was being paid by Kaiser, all as
064261 -        explained in the letter to UCSF on October 27. ref SDS 38 MH6U
064262 -        A copy of the letter was sent to your email address, so you may
064263 -        be familiar with this matter.
064265 -         ..
064266 -    4.  When I called this morning, Bob seems angry, insisting Millie's
064267 -        proposal to make an interim payment on 071010 should be honored
064268 -        {...that Millie did not keep her "word," ref SDS 0 WR8M},
064269 -        despite subsequent information that she is being billed by
064270 -        multiple business units, has not been notified of UCSF's total
064271 -        claim, nor the basis of payments.  Normally, when a new project
064272 -        starts, if the parties do not have an ongoing business
064273 -        relationship, as here, there is a launch meeting to explain
064274 -        terms, conditions, and procedures.  This work started in
064275 -        January, and because we thought Kaiser was paying for the
064276 -        referral, there was no meeting to set parameters for billings
064277 -        and payments.
064278 -
064280 -         ..
064281 -        Loss Credibility and Confidence Change UCSF Account Rep
064282 -
064283 -
064284 -    5.  Accordingly, this is needed now, since at no time has UCSF
064285 -        explained terms and conditions of the work. [explained in the
064286 -        letter to UCSF on 071027, ref SDS 38 CG6H]  I met with Bob in
064287 -        your offices on 070830, and understood he was presenting UCSF's
064288 -        total claim, ref SDS 14 S69H, because that was requested in a
064289 -        call with him on 070823. ref SDS 13 JP50  We now know that is
064290 -        not true.  Bob indicated this morning he said something about
064291 -        this was only UCSF billings for facility accounts.  Since
064292 -        Millie was not aware there were other charges, and since we
064293 -        were expecting to get the total picture there was evidently
064294 -        miscommunication.  This morning Bob feels I am not being honest
064295 -        because he recalls not representing this that and other.   He
064296 -        was uncomfortable discussing issues, and insisted on writing
064297 -        another letter, etc.  When we get to this point, it is time to
064298 -        get others involved.
064299 -
064300 -            [On 071030 UCSF not honoring request for new account
064301 -            representative; UCSF Kaiser called to get billing
064302 -            information; UCSF tells Millie to disregard prior demands
064303 -            for immediate payment. ref SDS 39 WZ5J
064305 -             ..
064306 -            [On 071031 Millie receives notice dated 071026 UCSF plans
064307 -            referral to collection agency for payment of $202.65 on
064308 -            Kaiser referral account 12493370, ref SDS 40 KK4I, revised
064309 -            070830, ref SDS 14 4P8K, and revised again on 070917,
064310 -            ref SDS 17 MK4H; no indication of UCSF collection efforts
064311 -            against Kaiser; separate notice dated 071027 and also
064312 -            received 071031 UCSF says Millie's treatment for cancer
064313 -            ordered by Kaiser will be terminated if UCSF does not
064314 -            receive payment of $202.65. ref SDS 40 KM8J
064315 -
064316 -
064318 -         ..
064319 -        Coordination Referral Clinical Trial Meeting Explain Procedures
064320 -        Meeting Schedule Coordination on Referral UCSF Clinical Trial
064321 -        Single Point of Contact UCSF Referral Coordination Meeting
064322 -        UCSF Referral Coordination Meeting Requested Single Point of Contact
064323 -
064325 -         ..
064326 -    6.  Since we don't know UCSF's total claim, and we don't know the
064327 -        basis of charges, setting aside who has responsibility for
064328 -        payment, Millie feels her obligation is the standard copayments
064329 -        at Kaiser, less any costs paid by the clinical trial.  We have
064330 -        not yet seen what is paid by the clinical trial.  Could you
064331 -        arrange a meeting with a person at UCSF who can be our single
064332 -        point of contact on billings, so we find out procedures, terms
064333 -        and conditions. [requested in the letter to UCSF on 071027.
064334 -        ref SDS 38 MA8P
064336 -         ..
064337 -    7.  Thanks for consideration.
064338 -
064339 -
064340 -
064341 -
064343 -  ..
0644 -
0645 -
0646 - 1009
0647 -
064701 - Coinsurance Only Applies Patient Self-referrals Not Doctor Referrals
064702 - Clinical Trials No Coinsurance Medicare Physician Referrals
064703 - HMO Pays Costs of Physician Referrals for Clinical Trials
064704 - Medicare Requirements Managed Care Pay for Referrals Clinical Trials
064705 -
064706 -
064707 -    8.  Call CMS regarding 16 issues on 070927. ref SDS 19 WU6M
064708 -
064709 -        a.  James Mayhew follow up on letter 071004. ref SDS 22 KA5J
064710 -
064711 -            Left message for James.
064712 -
064713 -                  410 786 9244
064715 -            ..
064716 -           42CFR 422.109 c4
064717 -
064718 -
064720 -  ..
0648 -
0649 -
0650 - 1347
0651 -
065101 - Jim called back.
065102 -
065103 - He had not received the letter submitted on 071004. ref SDS 22 KA5J
065105 -  ..
065106 - Jim said CMS is having trouble with the email system.  Some
065107 - correspondence is filted out which should be received.  He asked to
065108 - send the letter again.
065110 -  ..
065111 - Did that; forwarded the letter on 071004 to Jim via email.
065113 -  ..
065114 - While we talked, Jim received the letter, ref DIP 1 0001, originally
065115 - sent on 071004, ref SDS 22 KA5J, and confirming discussions with Jim
065116 - the day before on 071003. ref SDS 21 0E4K
065118 -  ..
065119 - Jim said the Cathy works for him, so he will let her know that he is
065120 - handling the matter, and she does not need to return the call to Cathy
065121 - per below. ref SDS 0 013F
065123 -  ..
065124 - James asked for an explanation of issues.
065126 -  ..
065127 - Explained we need citation and language in the statute that guides CMS
065128 - regulations on physician referral distinguished from patient
065129 - self-referral.
065131 -  ..
065132 - Sent Jim another letter with 16 issues listed on 070927 that flow from
065133 - self-referral in clinical trials. ref SDS 19 8G5N
065135 -  ..
065136 - Jim will assign this for research and let me know follow up.
065138 -  ..
065139 - Jim asked when the Kaiser hearing is scheduled and whether Millie is
065140 - represented by counsel?
065142 -  ..
065143 - Advised that Kaiser has not yet scheduled the hearing.  There is a
065144 - call today on scheduling the hearing, but Kaiser has not called back,
065145 - per above. ref SDS 0 02GF
065147 -  ..
065148 - Jim said there are many public service law firms who can represent
065149 - seniors in Medicare issues.  Customers do not have to be destitute to
065150 - qualify for this support.
065152 -  ..
065153 - Advised that at this time, Millie has not retained counsel; there have
065154 - been informal discussions, per above. ref SDS 0 TH8L  On 071015 HICAP
065155 - offered to provide representation if Kaiser refuses to pay for
065156 - Millie's care. ref SDS 30 IJ7F
065157 -
065158 -
065160 -  ..
0652 -
0653 -
0654 - 1403
0655 -
065501 - After the call, submitted letter to confirm understandings...
065502 -
065503 -    1.  Subject: Clinical Trials Managed Care Provider Makes Referral
065504 -        Date: Mon, 29 Oct 2007 14:10:52 -0700
065505 -        From: Rod Welch
065506 -        To: james.mayhew@cms.hhs.gov
065508 -         ..
065509 -    2.  Jim,
065511 -         ..
065512 -    3.  Thanks for calling today.
065514 -         ..
065515 -    4.  There are 16 issues reviewed on 070927, which seem to arise
065516 -        from Medicare support for clinical trials. ref SDS 19 8G5N [and
065517 -        supplement the letter to you at CMS on 071004. ref SDS 22 KA5J]
065519 -         ..
065520 -    5.  Appreciate your good offices directing review at CMS.  Please
065521 -        keep me posted.
065523 -         ..
065524 -    6.  I sent you separately a BCC showing Jullin Kwok, who evidently
065525 -        manages the Kaiser Medicare contract for Senior Advantage in
065526 -        your San Francisco office, and showing plans to submit a
065527 -        written response to some of these issues.
065528 -
065529 -            [...see below correspondence with Jullin. ref SDS 0 4V6K
065530 -
065531 -
065532 -
065534 -  ..
0656 -
0657 -
0658 - 1011
0659 -
065901 - Called for Cathy...
065903 -             ..
065904 -        b.  Catherine Windfield-Jones follow up on whether Kaiser can
065905 -            avoid payment for patient care by prescribing treatment in
065906 -            clinical trials, follow up contact on 071003. ref SDS 21
065907 -            KA5J
065909 -             ..
065910 -            Left message for Cathy following up the record on 070927.
065911 -            ref SDS 19 KA71
065913 -  ..
065914 - During the call with Jim above, he indicated that Cathy works for him.
065915 - He will let her know she need not return the call, since he is
065916 - following up, per above. ref SDS 0 0132
065917 -
065918 -
065919 -
065921 -  ..
0660 -
0661 -
0662 - 1015
0663 -
066301 - Called CMS in San Francisco...
066303 -             ..
066304 -        c.  Jullin follow up call on 071009 when Jullin submitted
066305 -            question in letter on 071002, ref SDS 20 OY4Q, for
066306 -            research. ref SDS 25 R66K
066308 -  ..
066309 - Talked to Lee.  She remembered the letter dated 071002 on Millie's
066310 - case, and recalled sending it to Jullin, who manages the Kaiser
066311 - account.
066313 -  ..
066314 - Lee will send Jullin a letter this morning with a copy to the patient
066315 - rep saying the patient followed up on Jullin's call on 071009 saying
066316 - CMS was researching the issue, ref SDS 25 R66K, in the letter on
066317 - whether Kaiser can transfer costs of patient care by prescribing
066318 - treatment in clinical trials for oncology patients, ref SDS 20 OY4Q,
066319 - as set out in 16 issues listed on 070927. ref SDS 19 WU6M
066321 -  ..
066322 - Lee transferred the call to Jullin.  Left voice mail asking about
066323 - progress on Jullin's research submitted on 071009? ref SDS 25 R66K
066324 -
066325 -
066327 -  ..
0664 -
0665 -
0666 - 1147
0667 -
066701 - Received letter from Jullin responding to discussion with Lee, per
066702 - above, ref SDS 0 547T, and saying...
066703 -
066704 -    1.  Subject: your call
066705 -        Date: Mon, 29 Oct 2007 14:19:44 -0400
066709 -         ..
066710 -    2.  Hi Rod
066711 -
066712 -        Just wanted to let you know that we received your phone
066713 -        message.  Please give us your mailing address so that we can
066714 -        send you a written response thanks!  [...to the letter to CMS
066715 -        on 071002 asking for legal authority on coinsurance for
066716 -        self-referral to clinical trials and difference from payment
066717 -        requirements for physician referral as occurred in this case.
066718 -        ref SDS 20 OY4Q, and per telecon with Jullin on 071009.
066719 -        ref SDS 25 R66K
066720 -
066722 -  ..
0668 -
0669 -
0670 - 1154
0671 -
067101 - Submitted response to Jullin saying...
067102 -
067103 -    1.  Subject: Millie **** SS *********** UCSF MRN ******** Kaiser ********
067104 -        Date: Mon, 29 Oct 2007 12:06:06 -0700
067111 -         ..
067112 -    3.  Thanks for timely response with your letter this morning, shown
067113 -        below, to our call to Lee at CMS this morning.. ref SDS 0 547T
067115 -         ..
067116 -    4.  We would like to get an email written response [per Jullin's
067117 -        letter this morning planning response, ref SDS 0 VO6F, to the
067118 -        letter to CMS on 071002, ref SDS 20 OY4Q], so we don't have to
067119 -        type it all over for case management, and can integrate this
067120 -        writing with other relevant patient history.  No problem
067121 -        sending printed writings for the record, but need a rendering
067122 -        via email for efficient case management.
067124 -         ..
067125 -    5.  Could you call me to discuss.  ************.
067127 -         ..
067128 -    6.  Thanks very much.
067129 -
067130 -
067132 -  ..
0672 -
0673 -
0674 - 1225
0675 -
067501 - Received letter from Jullin following up on the letter to CMS on
067502 - 071002, and request for email response, per above. ref SDS 0 W85X
067503 -
067504 -    1.  Subject: Millie **** SS *********** UCSF MRN ******** Kaiser ********
067505 -        Date: Mon, 29 Oct 2007 15:48:42 -0400
067509 -         ..
067510 -    2.  Please give us the mailing address...we'll be happy to attach
067511 -        the letter via email as well.  Thanks!
067512 -
067514 -  ..
0676 -
0677 -
0678 - 1256
0679 -
067901 - Submitted response to Jullin's letter, per above, and with copy to Jim
067902 - so that his review team will be aware of parallel efforts, and can
067903 - consider collaboration. ref SDS 0 4U8M
067904 -
067905 -    1.  Subject: Millie **** SS *********** UCSF MRN ******** Kaiser ********
067906 -        Date: Mon, 29 Oct 2007 14:00:56 -0700
067911 -         ..
067912 -    2.  Jullin,
067914 -         ..
067915 -    3.  Sorry, should have sent the address earlier...
067923 -         ..
067924 -    5.  Can you call me today or tomorrow (925 680 8947) to discuss
067925 -        this, as noted in my letter earlier today?
067927 -         ..
067928 -    6.  Thanks for timely follow up.
067929 -
067930 -           [...see above notified Jim about parallel efforts by Jullin
067931 -           in San Francisco. ref SDS 0 4U8M
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0680 -