Changes in Medicare rules for donor complications

[Donna Luebke]

CMS recently issued clarification regarding the billing of post donor complications.   The language is modified in the Medicare Benefit Policy Manual (100-02), Chapter 11, Section 140.9. One item of note is the treatment of post discharge donor complications. 

"Complications that arise after the date of the donor’s discharge will be billed under the recipient’s health insurance claim number. This is true of both facility cost and physician services. Billings for donor complications will be reviewed."

In the past, transplant facilities have included the facility charges for post discharge donor complications within organ acquisition on the cost report. Effective November 28, 2011, these should be billed under the recipient's Medicare number and no longer claimed as organ acquisition.

https://www.cms.gov/transmittals/downloads/R2334CP.pdf

Potential donors need to be sure that the recipient has Medicare either as primary or secondary so their complicatoins get covered by Medicare.  Per Mark Horney from CMS, Medicare will pay even years out from the donation for a donor complication.  We need to be sure this includes care at any hospital the donor choses.  Donors should not have to return to the transplant center to get care unless they want.  An issue to follow. 

[Donna Luebke]

Noticed my typo which 'wherever the donor chooses.'.  Since Bill Freeman and Vicky Young are on the OPTN Living Donor Committee, perhaps they can be our voice to address insurance coverage for donors.  Not billing donors or requiring donors to submit their insurance information. There is no reason to see the donor's insurance info unless to verify they have coverage or bill the donors.  We are a treatment for someone else.  If the recipient does not have Medicare, be sure to read carefully the terms of coverage for the private policy.  Not all provide the same level of coverage.  Regardless, for any surgery there is a global period which covers 90 days postop.  If you have a complication, the insurance says the hospital was already paid to care for you for 90 days.  They cannot bill you.  If you have a procedure or a reoperation, they are to attach 'modifiers' and submit the bill to recipient insurance and they should get paid.  If not, is not the donor's problem.