Billing for Living Kidney Donor Care: Balancing Cost Recovery, Regulatory Compliance, and Minimized Donor Burden

AbstractPurpose of ReviewTo 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.Recent FindingsIn 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 fi nancially 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 complica tions; 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 ...
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research