Medicare Cost Report Review

The nuances of the Medicare Cost Report for transplant programs are uniquely different from the Cost Report for the rest of the hospital in several key ways:

  • Methodology – transplant costs are typically calculated using a combination of actual costs and charges, while other services are typically based solely upon costs.
  • Cost Allocation – transplant costs are allocated to the organ transplant program(s), while other costs are allocated to different departments or cost centers within the hospital.
  • Reimbursement – reimbursement rates for transplant services are in general higher than for other services due to the complexity and specialized nature of the procedures.
  • Reporting Requirements – there are specific reporting requirements for transplant costs that are different from those for other services. For example, hospitals must report data on the number of transplants performed, the types of organs transplanted, and the outcomes of the procedures.

Correctly capturing all eligible expenses and documenting them correctly on the cost report is critical to the transplant program’s financial health. Overstating expenses, whether through lack of knowledge or error, is a compliance issue. Understating or not capturing expenses correctly is equivalent to leaving money on the table.

Guidry & East offers both prospective and retrospective reviews of cost reports.

  • Prospective review can:
    • Prevent unexpected audit adjustments
    • Ensure capture of all pre-transplant charges
    • Accurately enumerate all usable and Medicare usable organ counts
    • Capture Medicare secondary payor accounts
    • Confirm capture of all HLA costs
  • Retrospective review can:
    • Identify missed opportunities
    • Trigger a re-file for missed dollars
    • Help the center put into place policies and procedures
    • Detect any actual or potential compliance issues