Journal article
Billing for Living Kidney Donor Care: Balancing Cost Recovery, Regulatory Compliance, and Minimized Donor Burden
Current Transplantation Reports, Vol.6(2), pp.155-166
06/15/2019
DOI: 10.1007/s40472-019-00239-0
PMCID: PMC6580854
PMID: 31214485
Abstract
To provide standardized guidance for transplant programs to maximize financial reimbursement related to living donor care and to minimize financial consequences of evaluation, surgical, and follow-up care to living donor candidates and donors.In 2014, the American Society for Transplantation (AST) Live Donor Community of Practice (LDCOP) “Consensus Conference on Best Practices in Live Kidney Donation” identified inconsistencies in billing practices as a barrier to living donor financial neutrality and issued a strong recommendation that the transplant community actively pursue strategies and policies to make living donation a financially neutral act, within the framework of federal law. The LDCOP convened a multidisciplinary group of experts to review and synthesize current Medicare regulations and commercial payer practices related to billing for living donor care and the implications for transplant programs and patients. We developed guidance for transplant program staff related to strategies to: consistently and appropriately obtain reimbursement via the Medicare Cost Report by utilizing organ acquisition; coordinate available coverage for donor pretesting, evaluation, hospitalization, follow-up care, and complications; coordinate charges in kidney paired donation; and maximize coverage through private insurance contracting. We also offer recommendations to protect donor confidentiality in the context of billing and to educate and prepare donor candidates and donors about any remaining gaps in coverage related to donation.Best practices in billing for living donation-related care should focus on balancing cost recovery, regulatory compliance, and minimized donor burden. Herein, we offer nine recommendations for best practice. We also offer a platform of seven recommendations for research and advocacy efforts to better understand the climate of living donor medical costs and to optimize billing practices that support provision of living donor transplant services to all patients who can benefit and to achieve financial neutrality for living donors.
Details
- Title: Subtitle
- Billing for Living Kidney Donor Care: Balancing Cost Recovery, Regulatory Compliance, and Minimized Donor Burden
- Creators
- Andrea Tietjen - 0000 0004 0448 6212 grid.416350.5 Saint Barnabas Medical Center 94 Old Short Hills Road Livingston NJ 07039 USARebecca Hays - 0000 0000 9209 0955 grid.412647.2 Division of Surgery University of Wisconsin Hospital and Clinics Madison WI USAGwen McNatt - 0000 0001 0491 7842 grid.416565.5 Kovler Organ Transplantation Center Northwestern Memorial Hospital Chicago IL USARobert Howey - Toyon Associates Concord CA USAUrsula Lebron-Banks - 0000 0000 8499 1112 grid.413734.6 New York-Presbyterian Hospital New York NY USAChristie Thomas - 0000 0004 1936 8294 grid.214572.7 University of Iowa Organ Transplant Center Iowa City IA USAKrista Lentine - 0000 0004 1936 9342 grid.262962.b Saint Louis University Center for Abdominal Transplantation St. Louis MO USA
- Resource Type
- Journal article
- Publication Details
- Current Transplantation Reports, Vol.6(2), pp.155-166
- DOI
- 10.1007/s40472-019-00239-0
- PMID
- 31214485
- PMCID
- PMC6580854
- NLM abbreviation
- Curr Transplant Rep
- ISSN
- 2196-3029
- eISSN
- 2196-3029
- Publisher
- Springer International Publishing; Cham
- Language
- English
- Date published
- 06/15/2019
- Academic Unit
- Stead Family Department of Pediatrics; Obstetrics and Gynecology; Internal Medicine
- Record Identifier
- 9983986083002771
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