our
Expertise
comes from
Experience

TAG reviews the Medicare/Medicaid Cost reports prior to filings with the Medicare Administrative Contractor (MAC). This review includes a complete assessment of all organ acquisition cost centers, including direct and indirect costs.

We will perform a detailed analysis for direct and indirect costs: personnel and contractor expense reviews, indirect cost allocation statistics, transplant recipient and donor costs, and all pre-transplant related costs.

Reporting the correct numbers of Medicare/Medicaid patients and Medicare/Medicaid organs are critical in order to receive the true cost of services provided. We ensure that all patients entitled to Medicare/Medicaid benefits are included as Medicare/Medicaid patients on the annual cost report(s).

We provide recommendations based on the review of the direct and indirect cost centers to ensure maximum reimbursement, compliance with all the federal/state regulations and to strengthen business processes and procedures. Recommendations made in the past to hospital clients have led to substantial additional reimbursement dollars.

Our Services Include:

Audit of Organ Acquisition Cost Center including the following components:

• Payroll expense
• Non-salary expense
• Direct & Indirect costs and allocations
• Pre-transplant recipient and donor costs
• Analysis and review of the Medicare/Medicaid cost report general ledger expenses and revenues
• Surgeon and physician costs
• Pre-transplant routine and ancillary service costs
• Sq. footage/floor space
• Excising of an organ from live and/or cadaver donor(s)
• Organ preservation costs
• Transplant transportation costs

Audit of Organ Acquisition Charges/Revenues and Income (Cost Recoveries):


• Audit and review the transplanting hospital Standard Acquisition Charge (SAC) Rates
• Review and analyze standard detail departmental charges billed to or from the transplanting hospital
• Review complexities of the transplant multiple payer mix
• Develop a detail analysis of transplant patient charges to assist Medicare/Medicaid cost report allocation, classification and required revenue offsets

Audit and/or Analysis of Transplant Program Drugs:


• Audit of Medicare Part B immunosuppressive drugs following a covered transplant
• Audit of non-immunosuppressive drugs such as antibiotics, anti-fungal medications, anti-ulcer medications, diuretics, antivirals and statins

Medicare Billing Issues:


• Review Medicare billing for living donor and transplant recipients
• Review transplant program Medicare secondary payer, private payer, HMO payer and patient payments
• Review Medicare billing for cadaver donors