CONTACTS 

SUBJECTS
Kaiser Regional Appeals Committee Hearing  Rspond MCRC Letter 071006

0603 -
0603 -    ..
0604 - Summary/Objective
0605 -
060501 - Follow up ref SDS 74 0000. ref SDS 73 0000.
060502 -
060503 -
060504 -
060505 -
060506 -
060507 -
060508 -
060510 -  ..
0606 -
0607 -
0608 - Discussion
0609 -
060901 - Kaiser Appeals Committee Approved Payment Millie's Clinical Trial UCSF
060902 -
060903 - Follow up ref SDS 74 TH8L, ref SDS 73 TH8L.
060904 -
060905 - Paula received the letter sent yesterday on 071202 thanking her for
060906 - excellent work resolving Kaiser's dispute with UCSF over payment of
060907 - Millie's care on referral, ref SDS 75 FC5M, and implementing planning
060908 - on 071128 2227 to follow up, ref SDS 74 VN8J, the telecon with Paula
060909 - earlier in the day on 1128 1430. ref SDS 73 TH8L
060911 -  ..
060912 - Paula asked in the call today if her letter sent last Friday on 071130
060913 - has been received confirming Kaiser is paying for Millie's care at
060914 - UCSF?
060916 -  ..
060917 - Advised that Kaiser's letter has not yet been received.
060918 -
060919 -        [On 071204 1517 received letter from Paula confirming that
060920 -        Kaiser will pay for Millie's treatment at UCSF on referral from
060921 -        Kaiser to recover from 4th relapse of cancer. ref SDS 76 TH8L
060923 -  ..
060924 - Paula read through the draft letter on SDS listed on 071128,
060925 - ref SDS 74 JR8O, and cited in the letter to her yesterday. ref SDS 74
060926 - JR8O
060928 -  ..
060929 - Paula feels the Appeals Committee has advised Millie's doctor that the
060930 - only lesson learned by Kaiser is that the doctor erred following
060931 - requirements of EOC section 2 to prescribe clinical trials needed for
060932 - patient care, reviewed on 070927, ref SDS 40 WS6M, because EOC section
060933 - 7 enables Kaiser to avoid paying for patient care using clinical
060934 - trials to advance medical science, reflecting the internal memo
060935 - received from Arlette on 070906, ref SDS 36 WC5S, as discussed when
060936 - Paula called last week on 071128, ref SDS 73 756L,
060938 -  ..
060939 - Paula generally concurs that SDS was helpful resolving the dispute
060940 - between Kaiser and UCSF over payment of Millie's care on referral from
060941 - Kaiser.   She cited support from SDS during her several calls...
060942 -
060943 -    1.  Explain context from patient
060944 -        history............................. 071006, ref SDS 44 9P5J
060946 -         ..
060947 -    2.  Paula asked for more patient history
060948 -        from SDS, because records at Kaiser
060949 -        and UCSF present partial and
060950 -        conflicting information
060951 -        on case management.................. 071030, ref SDS 64 UB4O
060953 -         ..
060954 -    3.  Paula called and requested assistance
060955 -        again getting documentation from UCSF to
060956 -        expedite payment for Millie's
060957 -        treatment at UCSF................... 071031, ref SDS 65 NT3J
060959 -         ..
060960 -    4.  Paula reported finding partial and
060961 -        conflicting information received from
060962 -        UCSF, and in Kaiser's computer on case
060963 -        management needed to evaluate payment
060964 -        of UCSF charges for Millie's
060965 -        treatment........................... 071114, ref SDS 69 NE5P
060967 -         ..
060968 -    5.  Paula reports Kaiser has not received
060969 -        documents requested from UCSF. asks
060970 -        for more assistance assembling
060971 -        Kaiser and UCSF documentation
060972 -        on referral administration
060973 -        for Millie's
060974 -        care................................ 071116, ref SDS 71 6K9G
060976 -         ..
060977 -    6.  Fax machine malfunction Kaiser has still
060978 -        not received documents requested from
060979 -        UCSF to substantiate billing
060980 -        charges for Millie's
060981 -        care................................ 071126, ref SDS 72 H67R
060982 -        Paula called to obtain Kaiser
060983 -        and UCSF case history
060984 -        from the patient.................... 071126, ref SDS 72 OS4N
060986 -         ..
060987 -    7.  Billings from UCSF cannot be reconciled
060988 -        with UCSF records on treatment
060989 -        provided  for Millie's
060990 -        care................................ 071126, ref SDS 72 H67W
060992 -  ..
060993 - Paula was pleased with collaboration the past few months cited in the
060994 - letter to Kaiser yesterday, ref SDS 75 O54W, using Kaiser's
060995 - partnership model that saved time and money for Kaiser case management
060996 - in this transaction.
060998 -  ..
060999 - She has worked with Jeanne Bradley at Kaiser Park Shadelands.
061001 -  ..
061002 - Paula indicated she can only send letters approved by CMS, indicating
061003 - her work is part of Kaiser Senior Advantage.
061005 -  ..
061006 - This is all the more reason to get legal grounding for EOC section 7
061007 - in relation to EOC section 2, shown by 16 issues listed on 070927.
061008 - ref SDS 40 WU6M
061010 -  ..
061011 - On 071002 requested explanation from CMS. ref SDS 41 OY4Q
061012 -
061013 -
061014 -
061015 -
061016 -
061018 -  ..
0611 -
0612 -
0613 - 1010
0614 -
061401 - Called Cheryl
061417 -  ..
061418 - Millie received a copy of a letter from Cheryl to Cris Tanner
061419 - indicating Dave DeCerbo might be able to consult on Millie's dispute
061420 - with Kaiser and UCSF.
061421 -
061423 -  ..
061424 - She has sent a letter to Dave DeCerbo's secretary asking him to
061425 - contact us about this matter.
061427 -  ..
061428 - Cheryl will send a follow up to Dave's secretary saying Millie has not
061429 - heard from Dave, and would like get some help on statutory authority
061430 - for CMS regulation 69.9, reviewed on 070917. ref SDS 38 596Q
061431 -
061433 -  ..
0615 -
0616 -
0617 - 1802
0618 -
061801 - Chris Tanner called.
061802 -
061803 - She seemed to have received a letter from Cheryl objecting to being
061804 - contacted to follow up on getting support for Millie.
061805 -
061806 -
061807 -
061808 -
061809 -
061810 -
061811 -
061812 -
0619 -