Key changes related to Organ Acquisition reimbursement include the following:
Additional Subscripted Lines for Worksheet D-4, Parts III and IV
Line 66 (Revenue for Organs Sold) is subscripted into two lines to separately report the Medicare Secondary Payer (MSP) organs primary payer payments between organ acquisition (line 66.01) and transplant (line 66.02 for informational purposes only).
Line 75 (Organ Transplants) is subscripted into four lines to further identify transplants for Medicare beneficiaries (line 75.01), kidneys transplanted into Medicare Advantage beneficiaries (line 75.02), MSP organs (line 75.03), and all other payer transplants (line 75.04).
Toyon’s take: The information for the new subscripted lines should already be included in the documentation, and the transition should require minimal adjustment.
New Worksheet D-6 series (effective for cost reporting periods beginning on or after 10/1/2020)
Transmittal 18 releases D-6 as a new form used to obtain cost-based reimbursement for inpatient allogeneic stem cell acquisition costs. Medicare’s reimbursement will be based on the ratio of Medicare to total transplants, much like the methodology for solid organ but only for inpatient HSCT transplants.
Toyon’s take: If your hospital is new to this cost-based reimbursement methodology for acquisition costs, this requires collaboration with Revenue Cycle for identifying internal hospital charges for prospective and actual live donors for allogeneic stem cell transplants (all payers). The donors’ insurance defaults to that of the recipient and charges for Medicare beneficiaries should not be billed directly to Medicare. Also, review the departments mapped to line 77 to confirm the expenses meet the definition for allogeneic stem cell acquisition.
For further information, please contact Robert Howey at 888.514.9312 or firstname.lastname@example.org.