Transplant Centers are tracking more data than ever before. The challenge is determining the key performance indicators for the Transplant Center. Medical Centers have contracted with Guidry & East to compare their Transplant Programs with others of like size.

Guidry & East has an extensive database of valuable comparative data for hospitals looking to benchmark their performance against their peers in such categories as:

• Filed Medicare Organ Acquisition Cost Reports
• Pre-transplant evaluations, live donor excision and cadaver donor costs at the facility
• Pre-transplant recipient, living donor costs and cadaver donor costs
• Length of stay
• Gross charges for Transplant
• Hospital-based HLA costs

Guidry & East specializes in conducting financial audits with clinical analysis in reference to Medicare Organ Acquisition Cost Reports. We have assisted numerous Transplant Centers in re-filing cost reports and in enhancing the profitability of their programs, allowing them to compete more effectively in today's competitive marketplace.

Transplant Centers engage Guidry & East to audit specific Medicare Organ Acquisition Cost Reports to evaluate how costs are captured and allocated to the Organ Acquisition Cost Centers and to assess program policies and procedures which impact the effective preparation of these cost reports. The audit steps include an analysis of the supporting financial and clinical documentation reported on Worksheet D-6. In addition we review the cost report Worksheets A, A-6, A-8, and B-1 which determine direct costs and overhead allocations that are so important for proper cost report settlements.

Guidry & East performs reviews of the Medicare Organ Acquisition Cost Reports prior to filing with the Fiscal Intermediary. This is an extremely valuable service to have a company who works only in the field of transplant to perform such a highly specialized service given the numerous federal regulatory agencies and their guidelines that can impact the cost report.

In performing this service in the past, we have corrected cost reports prior to filing where the organ count is inadequate, excised organs have been counted incorrectly, in-house cadaver donor costs have been omitted, Medicare organ counts were misstated, Medicare secondary remainder liability was not calculated, and HLA costs were understated to name a few. We have saved Medical Centers, by reviewing their cost report prior to filing, unnecessary surprises on audit settlement.

Guidry & East has consulted with numerous Transplant Centers that initially looked at "The Transplant Event" as the only element of the Transplant Product Line. It is imperative that Transplant Centers evaluate all elements of the Transplant Product Line. Therefore, Guidry & East's Transplant Center Financial Assessment includes pre-transplant evaluations, pre-transplant medical and surgical maintenance, the transplant event, post-transplant follow-up, and post-transplant re-admissions. A major component of the Transplant Product Line, and therefore of great importance in the financial analysis of the program, is the End-Stage Organ Failure revenues for each specific organ that a Transplant Center transplants.

Guidry & East evaluates and assesses the overall financial strengths and weaknesses of the Transplant Center. We review the processes in place to capture and report revenues and expenses associated with pre-transplant evaluations, pre-transplant medical and surgical maintenance encounters, the transplant event, and post transplant follow-up and re-admissions.

Guidry & East creates a Financial Impact Statement for the Transplant Center, measuring cost and net revenue streams for the latest fiscal year-end. The impact statement will include medical and surgical encounters related to donors and transplant recipients. In addition we develop a Contribution Margin analysis for the latest fiscal year-end to include pre-transplant evaluations and the transplant event for each organ type.

Guidry & East contracts with hospitals to manage the Month-End Close process for Solid Organ Transplant Programs. The Month-End Close ensures that all transactions are posted and reflected in the hospital's general ledger system. The Month-End Close process allows hospitals to more accurately measure transplant net income on a real-time basis eliminating year-end surprises, i.e., unexpected pickups or hits to the bottom line. By monitoring net income monthly, management can react quickly to surpluses or shortfalls, adjusting departmental expenses where appropriate. This assists managers in reaching budget goals.

The Month-End Close process also allows hospitals to accurately state the Medicare third party payable/receivable balance by booking a Medicare journal entry each month for organ acquisition. This now provides documentation for any third party audit review. The detail for the Month-End Close process can provide documentation for the Fiscal Intermediary, should a hospital request an adjustment to its Medicare bi-weekly "pass thru" payment.

The Month-End Close model includes "benchmarks" that flag situations where the actual monthly numbers are at a variance from anticipated results, allowing the hospital to initiate an investigative review in a timely manner. The Month-End Close Process provides for a systematic, monthly accumulation of data for the Medicare organ acquisition cost report.

The Financial Assessment of a hospital's Histocompatibility Lab typically incorporates:

• The Profit and Loss Statement for the HLA Lab, and where appropriate, underlying reports, to assure that all appropriate Departmental Direct Costs are included on the Medicare cost report.
• Staffing and make sure appropriate costs are claimed in the Direct Costs.
• Charges to assure that all appropriate tests have been billed and captured appropriately for Medicare cost reporting purposes. Additionally, assure that all amounts charged are in agreement with the Charge List published by the Medicare Intermediary for the HLA Lab (IHLA Lab Only)or tied to D-6 for direct cost pre test (Hospital-based HLA Lab).
• B-1 Statistics for the HLA Lab to assure that they have been appropriately identified and claimed for cost reporting purposes.
• Worksheets C and D to assure that only Pre-Transplant Tissue Typing Charges have been claimed for cost reporting purposes.
• Costs to determine if the HLA Lab provides appropriate charges to the Transplant Center.
• Operational aspects of the HLA Lab to assure that all appropriate parties understand how the HLA Lab should interact with the Transplant Center and understand how the work of the HLA Lab is to be reimbursed.
• Contract and payments between the OPO and the HLA Lab.

Guidry & East is a full-service transplant consulting firm specializing in the audit and clinical analysis of Medicare Organ Acquisition Cost Reports. Our transplant consultants have assisted medical centers in developing transplant business solutions specifically designed for growing transplant programs, improving transplant operations, and the transplant financial product line. Additional offerings to transplant centers include the development of transplant strategic plans, transplant outreach programs, transplant feasibility studies, interim transplant management, and review of transplant Conditions of Participation (COP). Guidry & East also provides transplant consulting for hospital-based HLA Labs as well as Independent HLA Labs.