Histonetters,

Having seen the discussion on the Medicare regs. (not sure all mail
is coming thru tho)  I found it very timely.  Below is correspondence to
our staff and administration on how I am dealing with the subject.

Don




~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Don Hammer, Administrative Director            UNIVERSITY OF WASHINGTON
Hospital Pathology, Box 356100                     MEDICAL CENTER
1995 NE Pacific St.
Seattle Washington, 98195                  ~Where Knowledge Comes To Life~
(206) 548-6401 Fax: (206) 548-4928
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


---------- Forwarded message ----------
Date: Thu, 19 Nov 1998 16:08:08 -0800 (PST)
From: "D. Hammer" <hammerd@u.washington.edu>
To: Paul Moore <paulm@u.washington.edu>
Cc: Sumiko Sumida <ssumida@u.washington.edu>,
    "J. Fisher" <fjulie@u.washington.edu>,
    Darlene Wood <woodd@u.washington.edu>, pamy@u.washington.edu,
    carander@u.washington.edu, dennis stillman <stillman@u.washington.edu>,
    ljw@u.washington.edu, rhaggitt@u.washington.edu, nbk@u.washington.edu,
    helen shawcroft <helens@u.washington.edu>, steve@u.washington.edu
Subject: Medicare referals


Paul,

Please pass this on to all the accessioning staff.  Julie, please put in
our procedure being developed.  I have dictated a letter to be attached to
billing invoices to clients.

                         ~Effective 11/18/98~
All patient specimens recieved from outside institutions whose insurance
carrier is Medicare, are to be billed to the institution.

The law requires this on inpatients but I am requiring it on out patients
as well.

It is near, if not impossible, to discern or get information from
the institutions regarding in or out pt status and determine if they are
within the 72 hour law.  Many specimens sent for referral have specimens
from past procedures as well as a recent one.

This, as you know is based on the Medicare regulations attempting to clean
up double billing.  ie: the procedure is paid for on a DRG to the
institution as an inpatient. If performed 72 hours prior to admit
Medicare considers the procedure to be part of the inpatient visit and
DRG

If a referral lab bills Medicare for a consultation or other services such
as Flow Cytometry, EM, ICC and so forth, these services, in Medicare's
mind, have already been paid for on the DRG

Medicare is establishing APG's for outpatients.  In anticipation of a
similar law to the inpatient billing, I am designing our policy to handle
in and out patients the same,now, rather than make additional changes and
incur additional costs later.


I think this stance will keep our institution and the refering institution
with in the law, in the least complicated way and the most cost effective
manner.

Don

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Don Hammer, Administrative Director            UNIVERSITY OF WASHINGTON
Hospital Pathology, Box 356100                     MEDICAL CENTER
1995 NE Pacific St.
Seattle Washington, 98195                  ~Where Knowledge Comes To Life~
(206) 548-6401 Fax: (206) 548-4928
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~