Wednesday, February 29, 2012

One day of four years

Why do families love to screw with each others. You have a daughter who is looking after her mother 24/7 and learn the other 3 sisters and their families are playing on a Georgia beach. She watches as her mother lingers in her hospital bed refusing to eat or drink; refuses to let the nurses draw blood, take blood pressure, take any meds. Others sisters sit on their porch drinking and chatting.

Thursday, February 23, 2012

Update of Medicare Modifier

"The KX modifier (Requirements specified in the medical policy have been met) is now a multipurpose informational modifier and will also be used identify services for transgender, ambiguous genitalia, and hermaphrodite beneficiaries in addition to its other existing uses. Physicians and non-physician practitioners should use modifier KX with procedure codes that are gender specific in the particular cases of transgender, ambiguous genitalia, and hermaphrodite beneficiaries. Therefore, if a gender/procedure or gender/diagnosis conflict edit occurs, the KX modifier alerts the MAC that it is not an error and will allow the claim to continue with normal processing." The modifier Code 45 is to be used by Hospitals and major medical centers.

The above modifier KX is used by doctor's office's billing departments. After gathering these changes about Medicare's billing modifiers from the NTCE, I took the copy back to my doctor's insurance person. I was amazed that she was pursuing the same questions from other billing offices around the country. It seems that someone on the West coast was able to use the billing modifiers with good results with Medicare paying for the services. We talked some more about her experiences with surgery being done in Thailand and how doctors from Britain and the US are getting additional surgicial training from the staff there. She said that she has used the same modifier when she was in Home-Healthcare to get additional services but was aware that it's use had been expanded for trans patients. She will re-submit my claims using the KX modifier.

Saturday, February 18, 2012

What a Nice thing to Say!

Tonight I went to the symphony with a guest. After I bought tickets for the concert, we learned that our Church Choir director had had a heart attack Thursday morning and has been in the hospital since. Last night and again tonight, Kay will spent the night with him in the hospital so his dear wife can get a good night's sleep. As I was leaving the concert hall with my guest, I saw and spoke to my old boss and his lovely wife who I hadn't seen in several years. He stopped and said, "Girl, I almost didn't recognize you, good to see you looking so well." and his wife waved hello too.
Could have knocked me over with a feather. It's nice to be 'recognized' for who you are, isn't it?

Override Code in Medicare

Original Medicare

To address inappropriate denials of coverage, the Center for Medicare and Medicaid Services (CMS) has approved a special billing code (condition code 45) to assist processing of claims under original Medicare (Parts A and B). This billing code should be used by your physician or hospital when submitting billing claims for services where gender discrepancies may be a problem. When used with standard billing codes doctors use for specific procedures, this code alerts Medicare’s computer system to ignore an apparent gender discrepancy and allow your claim to be processed. Details are explained in the Chapter 32 of the Medicare Claims Processing Manual (see instructions in last post).

Have talked with Mara Keisling of NCTE National Center of Transgender Equality, and she is working to make sure all the Regional Directors know about this code change.

Thursday, February 16, 2012

Trangender Medical billing fixed by Obama's Administration

Fighting Medicare?

As I have traveled my path determined by my transition, there have been some good fights that I must pursue; like breast cancer at the top of my list. There was the fight as to which bathroom I had to use (won), there was the fight to get my name changed (won), to get genital surgery to remove the source of bad hormones because of the cancer (won that after 2 appeals), to change the gender marker on my driver’s license (won after one appeal) that fight was the most fun of all.

So a little background on this fight; my healthcare is now through Medicare, and I have Tricare-For-Life to pay for prescriptions. Now because of the genital surgery that I had I still have my prostrate and must have it checked once a year for levels of PSA and PBH and evaluate my risks of cancer. So Medicare recognizes me as female and the clinical test I need from my Urologist are usually performed on male patient’s and all persons who still have their prostrate, which have to be examined (you know the way; bend over please). So I had my yearly checkup and the claim was denied as stated: “The diagnosis is inconsistent with the patients gender.”. And this was just for my blood work; I will get the same denial form with my doctor’s visit, which should be back soon. Things like this make me crazy sometimes and I call to sit down with the Insurance Advocate at the doctor’s office and discuss the denials and she explain all the steps she had taken to get them to pay the claims. She totally understands and is very supportive.

I realize that to fight with a Government Agency would be a lot of paperwork that is shuffled back and forth and might never be resolved to my satisfaction. But I find how to submit an appeal and find the government form, fill it out with all appropriate documents for justification and put it in the mailbox. Done and gone thinking that all I can do until I get the next rejection and denial.

Then I begin to think that if this happened to me, other trans men and women must have had a similar experience, if they could get gender reassignment surgery; and with female to male there would still be a need for medical care through Medicare, so I message the one person who seems to be on the frontline fighting the good fight for all trans people, and explain my situation.

I contacted Mara Keisling with the National Center for Transgender Equality with my question and concerns. I get a quick message back saying; “Sarah, actually, this problem was addressed last year by the Obama administration. Give me a call and I'll walk you through it. There is a billing code override.” This was already addressed and fixed? I knew that Mara was good at what she does and has an excellent working relationship with this administration but this is so cool; thank goodness my Medicare billing problem has been addressed and fixed by this Administration;
but this is more than I could have ever imagined, wow!! Now I have only to get her to explain the steps I have to do to follow through with fixing these billing problems.

So, for those of you who are just becoming Medicare eligible and could have the same billing problems there are the documents that the Center wrote. and look at the section; "What do I do when coverage is denied". I encourage you to contact the NCTE and Ms. Keisling for more information .

The following is taken from Chapter 32 of the Medicare Claims Processing Manual

240 – Special Instructions for Services with a Gender/Procedure Conflict (Rev. 1877, Issued: 12-18-09, Effective: 04-01-10, Implementation: 04-05-10)
Claims for some services for beneficiaries with transgender, ambiguous genitalia, and hermaphrodite issues, may inadvertently be denied due to sex related edits unless these services are billed properly.
The National Uniform Billing Committee (NUBC) has approved condition code 45 (Ambiguous Gender Category) as a result of the increasing number of claims received that are denied due to sex/diagnosis and sex/procedure edits. This claim level condition code should be used by institutional providers to identify these unique claims and alerts the fiscal intermediary that the gender/procedure or gender/diagnosis conflict is not an error allowing the sex related edits to be by-passed.
The KX modifier (Requirements specified in the medical policy have been met) is now a multipurpose informational modifier and will also be used identify services for transgender, ambiguous genitalia, and hermaphrodite beneficiaries in addition to its other existing uses. Physicians and non-physician practitioners should use modifier KX with procedure codes that are gender specific in the particular cases of transgender, ambiguous genitalia, and hermaphrodite beneficiaries. Therefore, if a gender/procedure or gender/diagnosis conflict edit occurs, the KX modifier alerts the MAC that it is not an error and will allow the claim to continue with normal processing.
240.1 - Billing Instructions for Institutional Providers (Rev. 1877, Issued: 12-18-09, Effective: 04-01-10, Implementation: 04-05-10)

Tuesday, February 14, 2012

Wake up and LIVE: Hate is Unconstitutional in California!

This is a reposting taken from Susan; Thank you!

Wake up and LIVE: Hate is Unconstitutional in California!: Marriage Equality rally 2010. Photo from PBS Newshour. "Proposition 8 serves no purpose, and has no effect, other than to lessen the stat...

Wake up and LIVE: Hate is Unconstitutional in California!

Marriage Equality rally 2010. Photo from PBS Newshour.
"Proposition 8 serves no purpose, and has no effect, other than to lessen the status and human dignity of gays and lesbians in California, and to officially reclassify their relationships and families as inferior to those of opposite-sex couples," Judge Stephen Reinhardt, 9th Circuit Court of Appeals.

The National Organization for Marriage is vowing to appeal the ruling. Let 'em try!

Saturday, February 11, 2012

Kay and I spent this past week at Disney World with the Grandkids and had a wonderful time. Spending time with this wonderfully family can't be bought, because we wouldn't have enough money; but because they are family we are very lucky to have them in our lives. We finally caught up with them at the Magic Kingdom in the early afternoon and after catching up with them in Tomorrow Land, Trinny finally saw BG and as always made a B-line for her big hug from both of us. After spending the day at the Park they left us as we looked around some more and stopped to see the light show on the Castle and the closing fireworks, which were Spectacular, and then drove back to the hotel and fell into bed exhausted.

The next day was spent at Epcot and while Kay went shopping with Trinny and her Mom, I went with the boys and Day to ride all the rides. If people could see what a great family this was they would be quite surprised. Epcot was where I acquired my Minnie Ears and got quite a few positive nods that I would wear them. We met together in the early afternoon for lunch and then took the tour of all the shows, like the Country Bear Jamboree., my favorite with "Big Al". And again the Kids had been very good but were tired so as they went back to the hotel, I managed to talk Kay into going back to the Japanese market to get something for my Kimono and look around. We left before the fireworks falling asleep before 10 pm.

Third Day, was spent at Animal Kingdom; lots of walking, and walking, and walking some more. By this time Kay, Trinny and her Mom went home early as the little one was very tired, so I hung with the guys and we took in more shows and sights.

This is the lucky picture I took of the mother lion as she sat on the rock when we took the Safari Tram through the Animal park. Them we took the train ride over to the research and Vet Hospital area. By this time it was getting late, so I was to take the boys back to the hotel. This parks directions signs are not very numerous and after getting lost more than once trying to get out we finally made our way to the bus; or so I thought. Again the signs are not very clear and so after walking out to the parking lot, I realized the bus stops were on the opposite side. With a very sore hip and in lots of pain we finally find the right bus stop after going the wrong direction again. Ugh hip pain is not fun people.

Our fourth day was spent at Hollywood Studio park and this is the picture us with the grandkids at the front of the park at the start of a grand day.

As you can tell we all had a great time, together. And I got to be a "Kid" again for a few days as you can see. I kind of like Star
Wars stuff and this was a great shot of me.

This was late in the day and Miss Trinny was getting fussy so I took her out of her stroller and we played tag and used the light pole for a drum and as you can see, we both played with this fire hydrant. Oh it can be so many things as we could imagined. It was fun for me and kept her happy and occupied until her brothers finished the ride on the "Tower of Terror" and we could go back to the hotel.

I would strongly suggest that if you are planning a family group visit to Disney World and everyone can't get there at the same time, do another park on the first day and then Everyone can go together through the Magic Kingdom together on the second day. And let the "Magic Begin" there, as the say!!!

Sunday, February 5, 2012

Spiritual Renewals

Spiritual Renewal comes to us in many forms. Confluence of happenstance also comes to us when we are least expecting it.

Saturday mornings Conference began with the delegates being led in song by our youth who just came from their lock-in the night before; all fired up I would say. For me standing as my total affirmed being in the room of youth exuberance and unified thought by the delegates flooded me and lifted my total being to a new height of spiritual awareness. Members of the youth delegation talked about their experience with the various youth programs about how their hearts were opened and their dedication for and with the Church of the future. I got a small taste of their shared christian experience and faith moved as I sat for two days as a delegate to our convention.

With Integrity's most visible presence as an exhibitor, I believe we made many friends. We provided the opportunity for those who have been hesitant to affirm support an outlet to speak publicly for members of their church who are gay or lesbian. We have hears whispers that some people have re-assed their thoughts and the ranks of supporters within our Diocese is growing. And that is most welcomed.

There were two different instances that came to my attention this weekend concerning trans women who are in the struggles of transition and their beginnings. One I might have direct input with and one is connected by military experience of which I will not say anything except for this. When I caught cross-dressed I was a class member of the Sergeant's Major Academy, from which I was quickly dismissed and eventually retired; honorable status thankfully. During which time I has to 'talk' with a psychologist who probable had no experience with GID and only told me to do 'Aversion Therapy'. This person is being treated with more respect and support by Mental Health Therapists during the time they are retired. That is a huge difference in how the military is treating transsexuals. We still can't serve but at least it seems that we are being treated with more compassion.

Saturday, February 4, 2012

New Day

What a difference a year and a new day can have on a person. Yesterday was the first full day of convention and I found myself being moved to tears of happiness and joy. My being a Lay Delegate for this convention was only by happenstance. The Delegates who were suppose to be her, had a family emergency at the last minute and wouldn't be able to fulfill their duties; since Kay and I were already registered with Integrity we were coming anyway and so the Church asked us to be the Delegates. It was Kay who suggested that I be the primary Delegate and she would be the Alternate.

Late last year events unfolded that allowed me to stand before the Bishop and Re-Affirm my Affirmation to the Church as Sarah; as me, a renewed and fully recognized member of my Church. A Baptized Woman first and Trans woman second; but a renewed member of the Body of Christ. And so I was a Seated Delegate with a recognized voice equal to every other Delegate seated in the Convention Hall. It is difficult to explain the power and Love that surrounded me yesterday as I sat among the other delegates at my table, both Clergy and Laity and in the Convention Hall. I was proud to sit at the table wearing my Believe Out Loud lapel pin and my Rainbow pin that proclaimed "Unity is Diversity". It didn't matter that the only Church business was to vote on Office vacancies, the Diocesan budget and a Proclamation to restructure and reframe how the Church should move forward proclaiming a new mission. I had a vote that would count. I was overcome by emotions of joy, cheeks covered by tears, of being connected again in full recognition that I, a trans woman, and member of the church was called to serve my Bishop.

I am so happy that the Diocese of Georgia has a Gentle and yet Strong Shepherd with Bishop Scott Benhase, who has refocused our direction of Ministry and Mission. How he has drawn the people with the skills of focused management in rebuilding church priorities with limited monies.

Thursday, February 2, 2012

Convention Begins

Today there wasn't much action around the convention center. We were able to set up the Integrity display this afternoon and got to meet old friends. Kay and I took a stroll on the river front this afternoon; beautiful autumn day with a lot of sun and hardly any clouds. This evening we went did a little shopping at J. Jill's outlet store. Very nice.

This evening we went to St Paul's Church for Evensong Service and the official start form the Convention. If you haven't seen this Church, it's huge and majestic. The Choir was totally awesome with the chanting and special music; but being accompanied by such a grand Pipe Organ added tremendously to the service. They did a great job tonight. Tomorrow everything starts at 0900 hrs; bright and early.

We finished the evening with a late supper at the Augsburg Haus German Restaurant in Evan, Ga. Great german food, very tasty and the Heffa Wissen beer was excellent.