CONTACTS 

SUBJECTS
Kaiser Regional Appeals Committee Hearing  Rspond MCRC Letter 071006
UCSF MGBS Notified Kaiser MCRC Appeals Committee Requests Billing In

0704 -
0704 -    ..
0705 - Summary/Objective
0706 -
070601 - Follow up ref SDS 42 0000. ref SDS 41 0000.
070602 -
070603 -
070604 -
070605 -
070606 -
070607 -
070608 -
070609 -
070611 -  ..
0707 -
0708 -
0709 - Progress
0710 -
071001 - Kaiser Used 071002 Letter to CMS to Construct Millie's Appeal
071002 -
071003 - Follow up ref SDS 42 TH8L, ref SDS 41 TH8L.
071004 -
071005 - Tess called.  She is difficult to understand due to an accent,
071006 - possibly Spanish.
071008 -  ..
071009 - She seemed to represent the UCSF group that bills for doctor visits
071010 - described as professional services, which are presented as invoices on
071011 - pink paper, which Millie received on 071006 for services back to
071012 - January. ref SDS 24 PRWW
071014 -  ..
071015 - Tess suggested talking to her boss, Nancy, to facilitate communication
071016 - and expedite the work.
071017 -
071019 -  ..
0711 -
0712 -
0713 - 1349
0714 -
071401 - Talked to Nancy.
071402 -
071403 - She seems to head a group assigned to billings for Medicare patients
071404 - on clinical trials, and for professional services arising from patient
071405 - doctor visits.  This is distinct from charges for doctor visits
071406 - associated with "Facilities Accounting" presented during the meeting
071407 - at UCSF on 070830, ref SDS 14 W06L, and for which interim payment was
071408 - made on 070906, ref SDS 16 EB3P, and further which on 071006 it turned
071409 - out was not the total cost of doctor visits. ref SDS 24 PRWW  On
071410 - 071010 Bob Schwartz in the UCSF accounting department disclosed
071411 - miltiple business units billing Millie for UCSF treatment by Doctor
071412 - Rugo in the Breast Care Clinic. ref SDS 27 OH89
071414 -  ..
071415 - Nancy explained that she has recently been instructed to bill Medicare
071416 - rather than Kaiser for Millie's care in the clinical trial.  She said
071417 - that is why the patient has not previously received invoices for the
071418 - "professional services" part of doctor visits until 071006.  The bills
071419 - have been going to Kaiser, and then being rejected, and it took time
071420 - to finally start sending bills to the patient.  That is why Millie was
071421 - billed the total amount for doctor visits, rather than the amount of
071422 - coinsurance, noted in Millie's letter to UCSF on 071011. ref SDS 29
071423 - K65P
071425 -  ..
071426 - Nancy said the billing process is very complex.  She explained that
071427 - billings for professional services on patient doctor visits go to a
071428 - different department at Medicare, uses different codes and rates from
071429 - billings on the Facilities side for doctor visits.  Nancy is in the
071430 - process of developing new procedures to first send bills to Medicare,
071431 - then get an amount to bill the patient, following similar approach on
071432 - the Facilities side, explained at UCSF during the meeting on 070830.
071433 - ref SDS 14 5W5G
071435 -  ..
071436 - We discussed recent considerations on 071006 for Kaiser to pay for
071437 - costs of the referral, ref SDS 24 TL98, as agreed between Kaiser and
071438 - UCSF on 061230. ref SDS 7 3X6K  Now, this past Tuesday, on 071030
071439 - there was progress toward performing this requirement, working with
071440 - Paula at Kaiser who requested assistance assembling UCSF billing
071441 - information to present for payment at Kaiser. ref SDS 41 TH8L
071443 -  ..
071444 - Today, a letter to Kaiser offering assistance to Paula coordinating
071445 - with UCSF to submit information. ref SDS 43 2U3J
071446 -
071447 -            [On 071128 Kaiser Appeals Committee approved payment for
071448 -            Millie's care on referral to UCSF. ref SDS 45 JZ5R
071450 -  ..
071451 - Paula seems very experienced working with UCSF, reported on 071030.
071452 - ref SDS 41 FM4H
071454 -  ..
071455 - Nancy requested contact information for Paula, so she can coordinate
071456 - directly with Kaiser on this new initiative to expedite payment to
071457 - UCSF, and without further trouble for the patient, as proposed by
071458 - Paula on 071030. ref SDS 41 FN4N
071459 -
071460 -        [On 071105 Paula reports Nancy has not contacted Kaiser to
071461 -        report MGSB billings for Millie's treatment at UCSF.
071462 -        ref SDS 44 K38S
071464 -  ..
071465 - There was discussion that the patient remains a stakeholder in the
071466 - process.
071468 -  ..
071469 - UCSF, Kaiser, and Medicare can communicate directly on payment
071470 - processes.  In the same way that the primary care physician at Kaiser
071471 - and Doctor Rugo at UCSF worked things out on 061230, ref SDS 7 3X6K,
071472 - now, as then, keeping the patient aprised of issues, options and
071473 - determinations provides a record for moving forward in the event
071474 - decisions that are thought to have been agreed upon turn out later to
071475 - become questions of fact.
071477 -  ..
071478 - Nancy appreciates advantages of everyone working together resolving
071479 - complex issues cooperatively.  She will follow up with Paula to work
071480 - out how UCSF billings should be handled at Kaiser and Medicare, per
071481 - Paula's request for assistance yesterday. ref SDS 42 TH8L
071483 -  ..
071484 - Sent a letter to the billing team linked to this record for
071485 - background.
071486 -
071487 -    1.  Subject: B*** Account Kaiser Payment UCSF Documentation
071488 -        Date: Thu, 01 Nov 2007 15:37:01 -0700
071496 -         ..
071497 -    3.  Thanks for your call today, and for explaining background on
071498 -        your groups work to bill for professional services in
071499 -        connection with Millie's doctor visits, as shown in the record
071500 -        of our call today. ref SDS 0 1N3X
071502 -         ..
071503 -    4.  Please let me know if you have any additions or corrections.
071505 -         ..
071506 -    5.  You can contact Paula at Kaiser directly with the above
071507 -        address.  Her telephone number is...************.  She is
071508 -        terrific and seems familiar with UCSF business practices.
071510 -         ..
071511 -    6.  Bob Schwartz has been bird dogging UCSF Facilities Accounts on
071512 -        billings for Millie's treatment, and has already talked to
071513 -        Paula on getting Kaiser involved. [reported on 071030.
071514 -        ref SDS 41 WZ5J]  As you mentioned, this case has become
071515 -        complex and confusing sometimes.  Putting the right people
071516 -        together will hopefully get us on a routine payment track for
071517 -        UCSF.
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0716 -