CONTACTS 

SUBJECTS
Kaiser Regional Appeals Committee Hearing  Rspond MCRC Letter 071006

0603 -
0603 -    ..
0604 - Summary/Objective
0605 -
060501 - Follow up ref SDS 52 0000. ref SDS 48 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 52 TH8L, ref SDS 48 TH8L.
060904 -
060905 - On 071030 Paula called and advised that she investigated and confirmed
060906 - Kaiser ordered Millie's treatment at UCSF. ref SDS 48 5435  Kaiser
060907 - constructed an appeal on Millie's behalf based on 50 pages of
060908 - documents Kaiser received from CMS, ref SDS 48 E64H, which CMS printed
060909 - from Millie's patient history drawn from links in a letter to CMS
060910 - dated 070102. ref SDS 27 OY4Q  Paula contacted UCSF and requested
060911 - billing information. ref SDS 48 FM95  Millie received a letter from
060912 - UCSF confirming that Kaiser had requested information on paying UCSF
060913 - billings for Millie's care. ref SDS 48 WZ5J
060915 -  ..
060916 - The next day, on 071031 Millie received notices that UCSF planned
060917 - assigning to a collection agency for recovery of $265.02, ref SDS 50
060918 - TH8L, and further planned to terminate Millie's treatment at UCSF for
060919 - cancer because Kaiser has not paid the bills. ref SDS 50 KM4J  In the
060920 - call,
060922 -  ..
060923 - On 071105 called and talked to Paula, who reported delays getting
060924 - information from UCSF required to make payments, and asked for
060925 - assistance communicating with UCSF. ref SDS 52 K36H  UCSF was notified
060926 - that Kaiser needs documentation that supports payment.  Paula also
060927 - requested copies of UCSF letters to the customer that threaten
060928 - collection action and termination of treatment. ref SDS 52 K39X
060930 -  ..
060931 - Recently, Millie received another set of notices that UCSF would
060932 - assign a claim to a collection agency and terminate treatment because
060933 - Kaiser has failed to make timely payment for Millie's care.
060935 -  ..
060936 - Paula called again today for information to process payments to UCSF.
060937 - Submitted letter to Paula with copies to UCSF...
060938 -
060939 -    1.  Subject: B*** Account Kaiser Payment UCSF Documentation
060940 -        Date: Wed, 14 Nov 2007 21:26:35 -0800
060949 -         ..
060950 -    2.  Paula,
060952 -         ..
060953 -    3.  This confirms telecon this evening.  You called OA 1718 for
060954 -        assistance assembling the record on patient history in
060955 -        connection with paying UCSF for Kaiser's referral.  As we
060956 -        discussed, Millie is grateful for excellent care by Doctor
060957 -        Johnson at Kaiser and Doctor Rugo at UCSF.
060959 -         ..
060960 -    4.  To expedite payment to UCSF, you asked for the protocol on the
060961 -        triple negative study. ref DRP 2 A29F  During the call we found
060962 -        Jackie's transmittal received from UCSF on 070116, ref SDS 12
060963 -        0Q7I; this was posted briefly to the Internet so you could
060964 -        download and print a copy for support documentation that will
060965 -        be presented to the Appeals Committee.  After you obtained a
060966 -        copy, the UCSF document was removed from the Internet.  Please
060967 -        advise if you need this again.
060968 -
060969 -            [On 071128 Kaiser Appeals Committee approved payment for
060970 -            Millie's care on referral to UCSF. ref SDS 56 JZ5R
060972 -         ..
060973 -    5.  You asked that we notify Doctor Rugo's assistant, EJ, that our
060974 -        effort this evening satisfies your earlier request for the
060975 -        triple negative study document.  By copy to the doctor, UCSF is
060976 -        notified, and we will remind the medical team tomorrow at UCSF
060977 -        during the meeting at 0830.
060978 -
060979 -            [On 071115 Jackie will notify EJ that Paula has received
060980 -            the protocol for the triple negative study. ref SDS 53 W23I
060982 -         ..
060983 -    6.  You asked for dates of meetings with the medical team.
060985 -             ..
060986 -            [On 071116 Paula called again for assistance getting
060987 -            information from UCSF; plans to call the following day on
060988 -            final assembly for appleas committee submission.
060989 -            ref SDS 54 6K9G
060991 -             ..
060992 -            [On 071116 primary care physician reported authorization
060993 -            for referral to UCSF. ref SDS 54 EN78
060995 -         ..
060996 -    7.  During the call, we reviewed the record showing Millie met with
060997 -        Doctor Rugo, Brigid (nurse practitioner), and Jackie (clinical
060998 -        research coordinator) on 070130.  Millie met with Brigid and
060999 -        Jackie on 070201 to launch treatment starting that day.  Millie
061000 -        met again with Brigid and Jackie on 070208.  The next meeting
061001 -        with the medical team was scheduled for 070301; however, an
061002 -        exigent meeting was held on 070222 to assess expanding IBC on
061003 -        the left arm, ref SDS 17 B64F, observed initially by Doctor
061004 -        Johnson at Kaiser on 070202 performing oversight of referral
061005 -        work at UCSF. ref SDS 16 6Q5N
061007 -         ..
061008 -    8.  You requested any amounts Millie paid on Kaiser's behalf during
061009 -        dispute resolution with UCSF.  On 070907 Millie made payment of
061010 -        $312.08, as explained in Millie's transmittal letter shown in
061011 -        the record the day before on 070906. ref SDS 22 EB3P
061013 -         ..
061014 -    9.  You plan to call Bob Schwartz at UCSF tomorrow and obtain
061015 -        confirmation on this amount.
061017 -         ..
061018 -   10.  During the call today, you reported partial and conflicting
061019 -        documentation from UCSF and in Kaiser's computer, which
061020 -        complicates determination of payment owed to UCSF.  You plan to
061021 -        take this up with UCSF. [noted previously in correspondence to
061022 -        UCSF on 071011, ref SDS 36 K64W, and billing irregularities
061023 -        listed on 071026. ref SDS 43 X18J; conflicts between Kaiser and
061024 -        UCSF records was noted by Paula on 071030, ref SDS 48 FM6N;
061025 -        difficulty getting documents to support UCSF billings was
061026 -        reported on 071105. ref SDS 52 K36X]
061028 -  ..
061029 - Difficulty using computers on the job was reported in a case study on
061030 - 061024. ref SDS 8 9W4O
061031 -
061032 -            [On 071116 Paula called again for assistance getting
061033 -            information from UCSF; plans to call the following day on
061034 -            final assembly for appleas committee submission.
061035 -            ref SDS 54 6K9G
061037 -             ..
061038 -            [On 071126 Paula called for further help obtaining patient
061039 -            history to justify UCSF billings on referral from Kaiser.
061040 -            ref SDS 55 H67W
061042 -         ..
061043 -   11.  Your current time table is to complete assembling the appeal
061044 -        case by the end of the week or first of next week.  You further
061045 -        seemed to indicate an opinion of the Appeal Committee can be
061046 -        expected OA 071206, as noted in your letter dated 071006 and
061047 -        received on 071010 noting 60 days for the appeals process.
061048 -        ref SDS 35 813X
061049 -
061050 -            [On 071126 Paula advised Appeals Committee will review
061051 -            Millie's case the next day on 071127. ref SDS 55 H75W
061053 -             ..
061054 -            [On 071128 Kaiser Appeals Committee approved payment for
061055 -            Millie's care on referral to UCSF. ref SDS 56 JZ5R
061057 -         ..
061058 -   12.  The letter to Kaiser MCRC on 071105 offered direct support
061059 -        within Kaiser's doctor/patient partnership model to assemble
061060 -        the record of patient history, ref SDS 52 K43W, required in
061061 -        this case to avoid administrative errors and omissions
061062 -        discussed during the call today.
061063 -
061064 -            [On 071126 Paula called to apply doctor/patient partnership
061065 -            for accessing patient history to justify UCSF billings on
061066 -            referral from Kaiser. ref SDS 55 H67W
061068 -         ..
061069 -   13.  Additionally, I request again opportunity to review the case
061070 -        packet planned for submission to the Appeals Committee, and in
061071 -        order to add comments to ensure a complete and accurate record.
061073 -         ..
061074 -   14.  You asked about further telephone support.  We will be at UCSF
061075 -        tomorrow until OA 1400.  If it helps, call us on the cell at
061076 -        ************ and we can coordinate with folks on the ground.
061077 -        Otherwise leave a message here at home, and we can continue
061078 -        discussions at your convenience.
061080 -         ..
061081 -   15.  Thanks very much for good work on a complex matter.
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