Transplant – Organ Acquisition Reimbursement

Organ acquisition is a significant area of concern to hospitals due to the complexity, materiality and related compliance issues. The cost-based reimbursement for organ acquisition services has brought much scrutiny in recent years from many regulatory agencies, including regional Medicare Audit Contractor Audits (CMS), Office of Inspector audits and continues to be an area of focus in compliance reviews.

Our services are designed to ensure that transplant hospitals receive full Medicare reimbursement while maintaining compliance with Medicare regulations. Our comprehensive approach involves gaining a thorough understanding of the hospital transplant program operations and organizational structure. Next, we assess whether the reimbursement is appropriately claimed on the cost report by reviewing processes for data collection and the data elements included in the cost report reimbursement calculation. We provide the client with a written report with recommendations based on our findings.

Our review of the transplant program and related Medicare reimbursement will generally include the following:

Evaluation of pre-transplant evaluations charge capture and reporting
Review of time studies
Training for transplant program staff
Assist with cost report preparation
Direct and indirect expense analysis
Review cost allocation (statistical) methodologies and data
Review of organ count
Medicare Secondary Payor (MSP) organ count procedures
Living and cadaver donor charges and statistics
Consultation on managed care contracts-strategies

We would like to use our experience and knowledge to build a relationship with our clients. We hope to become transplant hospitals most trusted advisor while building a collaborative partnership to produce exceptional results.

Together, we can discover the solutions your organization needs.