Mid Del Therapeutic Center, Inc. - Page 12

                                               - 12 -                                                  
            Medicare.  Medicare did not reimburse petitioners for nondrug                              
            supplies used in administering treatments.  Some private                                   
            insurers, however, did cover these charges.                                                
                  With respect to chemotherapy drugs, petitioners' claims for                          
            reimbursement included only charges for chemotherapy drugs                                 
            prepared from petitioners' own supply and administered by                                  
            petitioners’ nursing staff to the patient.                                                 
                  When petitioners received a payment from Medicare or an                              
            insurance company, they also received an "Explanation of                                   
            Benefits" (EOB), which detailed amounts allowed and disallowed as                          
            to each specific charge and amounts due (copay amounts) from                               
            secondary insurance or the patient as to each specific charge.                             
            Petitioners routinely wrote off disallowed charges as they                                 
            received EOB’s from the insurance companies.  Petitioners wrote                            
            off the disallowed charges because agreements with the insurance                           
            companies prevented petitioners from seeking payment for those                             
            charges from the patients directly.  Copay amounts were not                                
            written off as long as the patient continued to receive                                    
            treatments, even if the patient was indigent or full payment was                           
            not otherwise expected.  Petitioners kept daily, monthly, and                              
            annual summaries of charges, reimbursements, and writeoffs.                                
                  When PC's billing office determined from an EOB that an                              
            allowable charge had been disallowed, a corrected bill or                                  
            explanation was submitted, and the writeoff of the disallowed                              

Page:  Previous  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  Next

Last modified: May 25, 2011