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Strategy 5: Financial Intelligence

Achieve transplant program financial strength through a detailed understanding of program finances, sound financial management, and excellent payer relations. 

To read more details about this strategy download the full Resource Guide, click here.

We are accepting submissions as potential contributions to the Transplant Resource Tools. Please email Hedi Aguiar at haguiar@odt-alliance.org with any submissions.

       Job Descriptions & Orientation & Competency Tools

Tools to manage transplant center expenses or maximize revenue

340b Program Supplements Indigent Pharmacy Costs:

  • 340b Program Supplements Indigent Pharmacy Costdownload – abstract by B. Sullivan, The Johns Hopkins Comprehensive Transplant Center
  • Sample Contract Summarydownload

 

Templates or informational materials related to payor contracting

Matrix of what payers use to determine if transplant centers quality for center of excellence status:

Any resources helpful to an administrator for Medicare Cost Reporting of Organ Acquisition

Data

  • Maximizing Organ Acquisition Reimbursement – PPT – download – by B. Sullivan, NYU Langone Transplant Institute (2016)
  • Medicare Hospital Cost Reports – downloads by fiscal year of all of the hospital cost reports in the U.S. since 1994 – link
  • National Trends in Organ Acquisition Costs – Presentation about the history of organ acquisition methodology as well as analysis of national organ acquisition costs by organ type, fiscal year and other categories.  Good benchmarking data – download – by B. Sullivan, The Johns Hopkins Comprehensive Transplant Center (2013)
  • OPO Kidney Standard Acquisition Costs and Histocompatibility Fees (Cahaba website) – link

Regulatory

  • Office of the Inspector General (OIG) – downloads available of all of the reports that the OIG has prepared after audits of transplant center hospitals’ organ acquisition costs on the Medicare Cost Report.  Information is interesting to help understand the history of organ acquisition cost reporting and what is allowable (and not allowable).  Reports can be accessed by going to the website – link – and searching on the words “organ acquisition”.
  • CMS Memo about Billing for Donor Post, Kidney Transplant Complication Servicesdownload – (2012)
  • Medicare Claims Processing Manual, Chapter 12 – Physicians / Non-physician Practitioners: Has information about how physicians can bill for immunosuppressive therapy management and other transplant and organ specific scenarios – link
  • Medicare Claims Processing Manual, Chapter 3 – Inpatient Hospital Billing – additional details about hospital billing for transplant patients – link
  • Medicare Cost Report 101 PPT – download
  • Medicare Part B Immunosuppressive Drug Claims Guidancelink  New!
  • Medicare Provider Manual Chapter 31 – Instructions for Organ Acquisition Cost reporting – instructions about how to report organ acquisition costs on the Medicare Cost Report, as well as what are allowable costs and services – link – (2016)
  • Operational Management of Medicare Organ Acquisition Cost Centersdownload – by Robert Howey, Mayo Clinic (2016)
  • Organ Acquisition Billing Scenarios – PPT – download – by B. Sullivan, NYU Langone Transplant Institute (2016)
  • Knowing Your Business to Plan Your Businessdownload – by Jennifer Milton, University Transplant Center
  • United States Renal Data System:  National data system that collects, analyzes, and distributes information about chronic kidney disease (CKD) and end-stage renal disease (ESRD) in the United States. Includes information about the volume, outcomes and costs of patients on dialysis, receiving a kidney transplant, and post-transplant – link
  • Milliman and Robertson 2014 U.S. organ and tissue transplant cost estimates and discussion – This 2014 report summarizes estimated U.S. average costs per member per month, billed charges, and utilization related to transplant admission for treatment for organ and tissue transplants – link
  • Cost of Lifetime Immunosuppression Coverage for Kidney Transplant Recipientslink NEW!
  • Financial Brochure for Transplant Candidates – download
  • Financial Assistance – link – American Transplant Foundation
  • Financial Assistance for Living Donorslink – The National Living Donor Assistance Fund
  • Financial Introduction Letter – download
  • Financing a Transplantlink – UNOS Transplant Living
  • Financial Help for Treatment of Kidney Failurelink NEW!
  • Kidney Disease Statistics for the United Stateslink NEW!
  • Kidney Transplant Costlink  New!
  • Living Organ Donation Networklink – American Foundation for Donation & Transplantation NEW!
  • Policy – Transplant Patient Assistance Funddownload – Northwestern Memorial Hospital (2013)
  • Public Policy and Kidney Disease link NEW!
  • Summary of Legal Aspects and Regulations Related to Living Donationlink – Living Donor 101
  • The Organ Transplant Process (Planning Your Finances)link New!
  • Transplant Funding Brochure – download
  • Transplant Patient Assistance Fund Request Form (Policy Appendix) – download – Northwestern Memorial Hospital (2013)
  • Policy – Granting Financial Clearance for Transplant Patientsdownload – The Johns Hopkins Health System (2012)
  • Protocol – Living Donor Patient Complicationsdownload – Northwestern Memorial Hospital (2012)
  • Kidney Donor Financial Lettersdownload – Northwestern Memorial Hospital (2015)
  • Liver Donor Financial Lettersdownload – Northwestern Memorial Hospital (2015)
  • Spanish Kidney Donor Financial Letterdownload – Northwestern Memorial Hospital (2012)
  • Transplant Financial Letter – download
  • Medicare Physician Fee Schedule (look up reimbursement and RVU values of CPT codes) – link
  • Policy – Employee Organ Donor Leave Policydownload – The Johns Hopkins Health System (2014)
  • Transplant Financial Coordinators Associationlink
  • Transplant Surgical Voucherdownload – (Sample billing sheet for abdominal transplant surgeons with commonly used CPT ICD10 diagnosis codes and RVU values)