Guidry & East has assisted numerous Transplant Centers to maintain profitable programs to compete in today's marketplace. We specialize in conducting Full Financial Audits with clinical analysis in reference to Medicare Organ Acquisition Cost Reports. In addition, we conduct Desk Reviews of Medicare Cost Reports for Transplant Centers, HLA Labs, and OPOs. Guidry & East also offers Transplant Centers a comprehensive Strategic Financial Assessment as well as a complete Transplant Financial Feasibility Study.
Guidry & East conducts a Full Financial Audit and Clinical Analysis of supporting documentation which utilizes all expenses filed for specific Medicare Organ Acquisition Cost Reports. We will audit all details that tie to Worksheet D-6.
A detailed Full Financial Audit & Clinical Analysis addresses:
As part of our Audit Report, our lead auditor will discuss specific issues found in each of the Organ Acquisition Cost Reports filed to Medicare with details that may be used by your facility to file amended Medicare Organ Acquisition Cost Reports for the purpose of capturing under-reimbursed fees and expenses or, in some cases, to correct overstated items and take appropriate corrective action with CMS/Medicare.
Why Transplant Centers find themselves facing serious Compliance issues relating to the Medicare Organ Acquisition Cost Report can generally be summarized in three categories: 1) First and foremost, the lack of communication between Transplant Administration and Finance/Reimbursement relating to adjustments required to insure the appropriate assignment of Pre-Transplant costs driven by Clinical activities; 2) Mistakes made because traditional Reimbursement Specialists, both internal and external, have limited experience with the unique and complex Federal Regulations governing Solid Organ Transplant programs; and 3) Knowledge drain caused by significant personnel changes in Reimbursement and/or Transplant Administration.
In addition to the full financial audit, Guidry & East will review the clinical documentation and components that tie to the Medicare Organ Acquisition Cost Reports - items such as compliance, cost recoveries, lost revenue and proper reporting. In over ten years of conducting Full Financial Audits of filed Medicare Organ Acquisition Cost Reports, most of the discrepancies that have been uncovered fall in the realm of clinical activities. This is not meant to imply improper patient care, but the lack of proper documentation necessary to support an adequate audit trail. In our experience, we have seen system and personnel problems from Pre-Transplant Patient Registration, proper allocation of excised Cadaver Organs, adequate Pre-Transplant Time Studies, and co-mingling of multi-organ expenses in a single organ Cost Report.
It is important to note, because Guidry & East's work on a financial audit and clinical analysis project is totally Pre-Transplant related, our entire fee and travel expenses may be placed on the Transplant Center's next Medicare Organ Acquisition Cost Report for reimbursement. Additionally, even after our client centers took what appeared to be appropriate measures to insure the accuracy of their Cost Reports, over the last ten years, Guidry & East has successfully identified through our audits over $70,000,000 in recoverable cost dollars for our client Transplant Centers. Most of our client Transplant Centers contract with Guidry & East to audit three to five years of multi- organ or single organ filed Medicare Organ Acquisition Cost Reports.
Typically, a Desk Review includes the following:
Guidry & East has been engaged by numerous Transplant Centers that initially looked at the "Transplant Event" only as their total Transplant Product Line. It is imperative that Transplant Centers evaluate their total Transplant Product Lines from pre-transplant evaluation through post-transplant care.
A Strategic Financial Assessment by Guidry & East may also include the following:
Medicare Organ Acquisition Cost Report: Full Financial Audit & Clinical Analysis
Transplant Centers engage Guidry & East to audit specific Medicare Organ Acquisition Cost Reports, evaluate how costs are allocated to the Organ Acquisition Cost Centers, and assess program practices which impact the effective preparation of these cost reports.Guidry & East conducts a Full Financial Audit and Clinical Analysis of supporting documentation which utilizes all expenses filed for specific Medicare Organ Acquisition Cost Reports. We will audit all details that tie to Worksheet D-6.
A detailed Full Financial Audit & Clinical Analysis addresses:
- Pre-transplant financial clearance process
- Operational and functional program review for cost recoveries
- Pre-transplant Recipient, Living Donor Costs and Cadaver Donor Costs
- Pre-transplant staffing allocation for recoveries and review Pre-Transplant time allocations for Medicare Organ Acquisition Cost Report recoveries
- Allocations of appropriate non-salary expenses such as equipment, rent, travel, computers, etc.
- Compliance and operational issues in reference to Medicare Organ Acquisition Cost Report(s)
- Documentation requirements for Organ Acquisition Cost Report recoveries
- Pre-transplant Medicare indirect cost allocations
- Direct and indirect salary expense
- Medicare indirect cost allocation statistics
- Pre-transplant HLA Lab costs
As part of our Audit Report, our lead auditor will discuss specific issues found in each of the Organ Acquisition Cost Reports filed to Medicare with details that may be used by your facility to file amended Medicare Organ Acquisition Cost Reports for the purpose of capturing under-reimbursed fees and expenses or, in some cases, to correct overstated items and take appropriate corrective action with CMS/Medicare.
Why should a Transplant Center undergo a Full Financial Audit and Clinical
Analysis of its Medicare Organ Acquisition Cost Reports?
For most Transplant Centers, this question can be answered in one word: COMPLIANCE.Why Transplant Centers find themselves facing serious Compliance issues relating to the Medicare Organ Acquisition Cost Report can generally be summarized in three categories: 1) First and foremost, the lack of communication between Transplant Administration and Finance/Reimbursement relating to adjustments required to insure the appropriate assignment of Pre-Transplant costs driven by Clinical activities; 2) Mistakes made because traditional Reimbursement Specialists, both internal and external, have limited experience with the unique and complex Federal Regulations governing Solid Organ Transplant programs; and 3) Knowledge drain caused by significant personnel changes in Reimbursement and/or Transplant Administration.
In addition to the full financial audit, Guidry & East will review the clinical documentation and components that tie to the Medicare Organ Acquisition Cost Reports - items such as compliance, cost recoveries, lost revenue and proper reporting. In over ten years of conducting Full Financial Audits of filed Medicare Organ Acquisition Cost Reports, most of the discrepancies that have been uncovered fall in the realm of clinical activities. This is not meant to imply improper patient care, but the lack of proper documentation necessary to support an adequate audit trail. In our experience, we have seen system and personnel problems from Pre-Transplant Patient Registration, proper allocation of excised Cadaver Organs, adequate Pre-Transplant Time Studies, and co-mingling of multi-organ expenses in a single organ Cost Report.
It is important to note, because Guidry & East's work on a financial audit and clinical analysis project is totally Pre-Transplant related, our entire fee and travel expenses may be placed on the Transplant Center's next Medicare Organ Acquisition Cost Report for reimbursement. Additionally, even after our client centers took what appeared to be appropriate measures to insure the accuracy of their Cost Reports, over the last ten years, Guidry & East has successfully identified through our audits over $70,000,000 in recoverable cost dollars for our client Transplant Centers. Most of our client Transplant Centers contract with Guidry & East to audit three to five years of multi- organ or single organ filed Medicare Organ Acquisition Cost Reports.
Medicare Organ Aquisition Cost Report: Desk Review
Guidry & East conducts a Desk Review to determine if your Transplant Center is recovering all of its appropriate and allowable pre-transplant costs.Typically, a Desk Review includes the following:
- Review pre-transplant allocations of living donor work-ups, recipient evaluation costs and donor (living and deceased) costs
- Review filed Medicare Organ Acquisition Cost Report(s)
- Review recently Filed Medicare Cost Reports
- Review all pre-transplant cost
- Assess and review HLA Lab cost associated with Medicare Organ Acquisition Cost Report(s)
Transplant Center Strategic Financial Assessment
A Transplant Center Strategic 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 is the End Stage Organ Failure revenues for each specific organ. Guidry & East has been engaged by numerous Transplant Centers that initially looked at the "Transplant Event" only as their total Transplant Product Line. It is imperative that Transplant Centers evaluate their total Transplant Product Lines from pre-transplant evaluation through post-transplant care.
A Strategic Financial Assessment by Guidry & East may also include the following:
- Review financially all aspects of the Transplant process creating a Financial Impact Statement for Transplant Center including all cost and revenue streams
- Financially review HLA Lab Costs
- Financially review allocations for the Medicare Organ Acquisition Cost Report
- Ascertain current Transplant market share
- Recommend methods to increase patient referrals for Transplant
- Review Managed-Care Contracting for pricing and recoveries
Transplant Feasibility Study
Guidry & East is often called to assist hospitals in determining the feasibility to start, enhance or expand a Transplant program. A Transplant Feasibility Study written report encompasses wide-ranging aspects of the Transplant program addressing organization, direct administration, operations, finances, and marketing. Guidry & East will provide a comprehensive strategic document whereby Senior Executive Leadership will be able to make appropriate decisions in reference to the Transplant program.
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.