CONTACTS 

SUBJECTS
Kaiser Regional Appeals Committee Hearing  Rspond MCRC Letter 071006

0603 -
0603 -    ..
0604 - Summary/Objective
0605 -
060501 - Follow up ref SDS 58 0000. ref SDS 57 0000.
060502 -
060503 -
060504 -
060505 -
060506 -
060507 -
060509 -  ..
0606 -
0607 -
0608 - Progress
0609 -
060901 - Kaiser Used 071002 Letter to CMS to Construct Millie's Appeal
060902 -
060903 - Follow up ref SDS 58 TH8L, ref SDS 57 TH8L.
060904 -
060905 - Paula asked if I am sitting next the the computer?
060907 -  ..
060908 - I was actually down stairs, but went up to use the "system."
060910 -  ..
060911 - Paula has still not received informaion requested from UCSF on 071030,
060912 - ref SDS 53 FM95, noted in a letter to UCSF also on 071030, ref SDS 53
060913 - JA4S, and acknowledged by UCSF at that time. ref SDS 53 WZ5J  A week
060914 - ago on 071114, she planned to contact UCSF, and letter at that time
060915 - alerted UCSF Kaiser needed support to expedite payment. ref SDS 58
060916 - NE5P She also cannot find patient history in Kaiser's computer, so she
060917 - needs information from the SDS record in order to complete work for
060918 - Kaiser's Appeals Committee to consider payment to UCSF.
060920 -  ..
060921 - Paula explained what she needs, and this was provided from the SDS
060922 - record, per confirming letter shown below. ref SDS 0 DN5H
060923 -
060924 -           [On 071128 Paula advised that the Kaiser Appeals Committee
060925 -           approved payment for Millie's care on referral to UCSF.
060926 -           ref SDS 61 JZ5R
060927 -
060928 -
060960 -  ..
060961 - This letter was sent the next morning, setting out understandings from
060962 - the call today...
060963 -
060964 -    1.  Subject: Buck Account Kaiser Payment UCSF Documentation
060965 -        Date: Tue, 27 Nov 2007 04:01:30 -0800
060974 -         ..
060975 -    2.  Dear Paula,
060977 -         ..
060978 -    3.  This confirms telecon yesterday afternoon 071126 OA 1618,
060979 -        following up the call on 071116, ref SDS 60 6K9G, and
060980 -        previously on 071105 [...reporting UCSF has not submitted
060981 -        documentation to support billings for Millie's treatment on
060982 -        referral. ref SDS 57 P14M and ref SDS 57 K37X
060984 -         ..
060985 -    4.  You received a call from Doctor Rugo's assistant, EJ, who
060986 -        explained that a faulty fax machine has delayed UCSF submitting
060987 -        documentation [supporting charges for] treating Millie on
060988 -        referral from Kaiser. [continuing prior problems reported on
060989 -        071116, ref SDS 60 6K9G, previously on 071114, ref SDS 58 NE5P,
060990 -        and also on 071105. ref SDS 57 K36X
060992 -         ..
060993 -    5.  You further noted today continuing difficulty correlating
060994 -        charges in UCSF billings with the record of work performed,
060995 -        cited previously on 071105. ref SDS 57 K37X [and noted again on
060996 -        071114. ref SDS 58 NE5P, citing billing irregularities listed
060997 -        on 071026. ref SDS 48 X18J; on 071030 Paula reported finding
060998 -        only partial and conflicting records in Kaiser's computer and
060999 -        documentation from UCSF, ref SDS 53 FM6N, leading to plans for
061000 -        Kaiser to obtain information from UCSF. ref SDS 53 FM95
061001 -
061002 -           [On 071128 Paula advised that the Kaiser Appeals Committee
061003 -           approved payment for Millie's care on referral to UCSF.
061004 -           ref SDS 61 JZ5R
061006 -         ..
061007 -    6.  Since Kaiser and UCSF both do excellent medical work, it should
061008 -        be possible to arrange for payments, and to meet and work
061009 -        through issues.  However, this has proved to be difficult for
061010 -        the current team, which requires facilitating communications.
061011 -        [On 071027 patient offers to meet with UCSF single point of
061012 -        contact for explanation of billings, ref SDS 51 CG6H; on 071029
061013 -        UCSF refuses to support charges. ref SDS 52 WR6K]
061015 -         ..
061016 -    7.  Today, you requested a copy of a letter dated 071002, which
061017 -        Kaiser received from CMS as grounds to pay UCSF for Millie's
061018 -        care on referral from Doctor Johnson, as related in your call
061019 -        on 071006. ref SDS 35 Z87L
061021 -         ..
061022 -    8.  You asked why information is hard to manage?
061024 -         ..
061025 -    9.  Finding information in folders, filing cabinets, and on
061026 -        computers is a growing challenge at Kaiser, UCSF, and other
061027 -        institutions, e.g., IBM, Microsoft, Boeing, SRI, etc.  Fax and
061028 -        email compound problems of information density, illustrated by
061029 -        delays getting information from UCSF, and today requesting a
061030 -        letter submitted twice previously to Kaiser.
061032 -         ..
061033 -   10.  While we talked, the letter dated 071002, ref DIP 1 0001, was
061034 -        submitted again for inclusion in your work to pay UCSF.
061035 -        ref SDS 32 KA5J
061037 -         ..
061038 -   11.  Today, you requested documentation of Millie's treatment by
061039 -        UCSF on 070426...
061041 -  ..
061042 - Paula's request for support supplements prior assistance on 071105,
061043 - ref SDS 57 K45W, and implements in part the offer to assist Kaiser
061044 - under the doctor/patient partnership, set out in the letter to Kaiser
061045 - on 071105. ref SDS 57 K44S
061047 -  ..
061048 - Letter to Paula at Kaiser's MCRC unit continues...
061049 -
061050 -   12.  Millie met with Doctor Rugo, Nurse Practitioner
061052 -        and Clinical Trial Research Coordinator
061054 -        The medical team approved Millie for the 4th cycle of 4-weekly
061055 -        treatments with cetuximab.  Results of examination and grounds
061056 -        for approval of treatment are shown in patient history for
061057 -        070426. ref SDS 18 025H
061059 -         ..
061060 -   13.  Later that day on 070426, Millie received treatment in the
061061 -        Infusion Clinic on the 5th floor. ref SDS 19 0001
061063 -         ..
061064 -   14.  You asked about blood tests.  Labs are performed once a month
061065 -        to start each cycle, and so are reported on 070426 starting the
061066 -        4th cycle. ref SDS 19 A64L
061068 -         ..
061069 -   15.  Notice in many cases UCSF units of measure and standards are
061070 -        different from Kaiser.  Lab issues were reviewed with the UCSF
061071 -        accounting department during a meeting on 070830. ref SDS 25
061072 -        T176
061074 -         ..
061075 -   16.  During the call this afternoon, you asked about charges for a
061076 -        blood culture?
061078 -         ..
061079 -   17.  The record on 070419 shows Doctor Rugo ordered a blood culture
061080 -        (see line CU0468) to evaluate inflammation for infection,
061081 -        and/or possible advance of IBC in the area of the port catheter
061082 -        observed during examination. ref SDS 17 S640
061084 -         ..
061085 -   18.  Results were negative.
061087 -         ..
061088 -   19.  You asked about UCSF charges for work on 070524?
061090 -         ..
061091 -   20.  This was another examination by the medical team to approve
061092 -        Millie getting the 5th cycle of 4-weekly treatments.
061093 -        ref SDS 20 0001
061095 -         ..
061096 -   21.  Later that day on 070524, Millie received the 1st treatment for
061097 -        the 5th cycle in the UCSF Infusion Clinic. ref SDS 21 0001
061099 -         ..
061100 -   22.  Notice a complete list of all treatments is shown in each
061101 -        record of patient history, and with links to the record of work
061102 -        performed for each treatment. ref SDS 21 7T3H
061104 -         ..
061105 -   23.  You asked about work on 070607...
061107 -         ..
061108 -   24.  Millie suffered recurrence of cellulitis on her left arm while
061109 -        at UCSF.  Patient history shows this condition is likely
061110 -        associated with removal of lymphatics from treatment for cancer
061111 -        in the left breast.  Initially, home treatment was prescribed.
061112 -        ref SDS 23 8H3I
061114 -         ..
061115 -   25.  However, during treatment in the Infusion Clinic for cancer,
061116 -        Millie's Cellulitis condition worsened, following the pattern
061117 -        of past episodes which required immediate care in Kaiser's ER
061118 -        unit at Walnut Creek.  Doctor Rugo and Doctor Johnson
061119 -        collaborated, and Millie was treated by UCSF until her
061120 -        temperature dropped. ref SDS 23 8J37
061122 -         ..
061123 -   26.  After returning home, Kaiser treated Millie's Cellulitis under
061124 -        Doctor Johnson's care for the next 5 days. ref SDS 23 8L46
061126 -         ..
061127 -   27.  Today, we discussed Doctor Johnson re-submitting authorization
061128 -        for payment of Millie's treatment on referral to UCSF.  During
061129 -        a meeting at Kaiser a week or so ago on 071116 the doctor
061130 -        advised that authorization has been re-submitted. ref SDS 60
061131 -        J65H
061133 -         ..
061134 -   28.  Kaiser's authorization is noted in the Medical Chart.
061135 -        ref SDS 60 U63W
061137 -         ..
061138 -   29.  You indicated that this matter will be reviewed in Oakland
061139 -        today.
061141 -         ..
061142 -   30.  Thanks very much for persistence making sense of a complex
061143 -        case.
061144 -
061145 -           [On 071128 Kaiser Appeals Committee approved payment for
061146 -           Millie's care on referral to UCSF. ref SDS 61 JZ5R
061147 -
061155 -
061156 -
061157 -
061158 -
061159 -
061160 -
061161 -
061162 -
061163 -
061164 -
061165 -
061166 -
061167 -
061168 -
061169 -
0612 -