(c) 2017 Transplant Solutions, LLC Capturing Donor Organs on the Medicare Cost Report- What to Count & When to Count (c) 2017 Transplant Solutions, LLC

(c) 2017 Transplant Solutions, LLC The Medicare Cost Report The Financial Lifeline of the Transplant Center Establishes the Standard Acquisition Charge (SAC) Provides for payment of the SAC for Medicare primary transplant services Reimbursement for Medicare’s share of pre-transplant costs including: recipient & living donor evaluation services, staff salaries, overhead, & benefits, and space utilization Medicare Secondary Payer Review (c) 2017 Transplant Solutions, LLC

Determining the Cost per Organ Pre-Tx Costs Transplants (c) 2017 Transplant Solutions, LLC

Determining the Medicare Ratio Medicare Organs (Total Organs – NonMedicare Primary Txs + MSP Txs)  Total Organs (Live Donor Organs + Deceased Donor Organs + Organs from the OPO) = Medicare Ratio* *The percentage of costs claimed on the Cost Report that will be reimbursed to the transplant program (c) 2017 Transplant Solutions, LLC

What are ‘Total Organs’? Organs recovered from a live donor, regardless of recipient relationship or location. Organs recovered from a deceased donor, regardless of recipient location. Deceased donor organs received from the OPO for a recipient within your transplant program. (c) 2017 Transplant Solutions, LLC

Which Live Donor Organs Are Counted? Recipient is in your transplant center. Recipient is in another transplant center such as a KPD transplant or adult living donor for a pediatric recipient in a pediatric center. Any organs meeting this criteria are included on the Cost Report, D-4 Line 70 ‘Organs Excised in Provider, Living Related’. Note-Recipient’s payer has no bearing on whether the organ is counted. (c) 2017 Transplant Solutions, LLC

Which Deceased Donor Organs Are Counted? Recipient is in your transplant center. Recipient is in another transplant center. Any organs meeting this criteria are included on the Cost Report, D-4 Line 70 ‘Organs Excised in Provider, Cadaveric’. Note-Recipient’s payer has no bearing on whether the organ is counted. (c) 2017 Transplant Solutions, LLC

Which Deceased Donor Organs Are Not Counted? Organs recovered for research. Organs recovered and discarded. Ask your OPO for the Organ Recovery & Utilization Report for your hospital at the end of each fiscal year to ensure accuracy. (c) 2017 Transplant Solutions, LLC

What are ‘Medicare’ Organs? Number of ‘Total Organs’ (50) Minus Number of Non-Medicare Primary Transplants (10) Plus Number of MSPR Transplants (2) 50 – 10 + 2 = 42 ‘Medicare’ Organs (c) 2017 Transplant Solutions, LLC

Determining the Medicare Ratio Medicare Organs (Total Organs – NonMedicare Primary Txs + MSP Txs)  Total Organs (Live Donor Organs + Deceased Donor Organs + Organs from the OPO) = Medicare Ratio* *The percentage of costs claimed on the Cost Report that will be reimbursed to the transplant program (c) 2017 Transplant Solutions, LLC

Determining the Profitability of the Transplant Program DRG Payments (all payers) + Medicare Cost Report D-4 Settlement = Total Reimbursement for Transplant Services (c) 2017 Transplant Solutions, LLC

Medicare Advantage Plans and Transplant Services A patient with a MA plan as primary does not count as a Medicare transplant for Cost Reporting purposes MA plans are required to pay for organ acquisition-may need specific language in the MA contract, though (c) 2017 Transplant Solutions, LLC

(c) 2017 Transplant Solutions, LLC Medicare Secondary Payer Review- Clarification of MSP Policy for Organ Transplants “A provider must submit a bill to Medicare when payment from the primary payer is insufficient to cover the entire cost of a transplant including both the DRG and organ acquisition costs.” Torris Smith, Associate Regional Administrator Division of Medicare Financial Management & FFSO June 29, 2008 (c) 2017 Transplant Solutions, LLC

Medicare Secondary Payer Review Sample language: Provider reserves the right to pursue additional payment via the Medicare Cost Report if the total payment from the payer, inclusive of the organ acquisition component, is less than the Provider would receive if Medicare had been the primary payer at the time services were rendered. (c) 2017 Transplant Solutions, LLC

(c) 2017 Transplant Solutions, LLC For more information… A complete breakdown of definitions and instructions for Worksheet D-4 can be found on-line https://www.costreportdata.com/instructions/Instr_D401.pdf (c) 2017 Transplant Solutions, LLC

(c) 2017 Transplant Solutions, LLC Questions? Laura J. Aguiar, Principal/Managing Partner Transplant Solutions, LLC Laura@TransplantSolutionsLLC.Com 623-302-3136 www.TransplantSolutionsLLC.Com (c) 2017 Transplant Solutions, LLC