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 General 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 evaluation charge capture and reporting
  • Review of time studies
  • Training for transplant program staff
  • Assist with cost report preparation
  • Direct & 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

Additional Services Provided:

  • Cost report audit support
  • Cost report amendment or reopening support
  • Cost report appeals
  • Financial analysis of various aspects of transplant program
  • Managed care contract and billing support
  • Time study policies and design
  • Transplant reimbursement policy review
  • Collaborate with hospital to develop tool for estimating interim receivable/payable for organ acquisition reimbursement
  • Audit history analysis
  • Square footage reviews
  • Other - Special projects

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