Billing for Living Kidney Donor Care: Balancing Cost Recovery, Regulatory Compliance, and Minimized Donor Burden
Billing for Living Kidney Donor Care: Balancing Cost Recovery, Regulatory Compliance, and Minimized Donor Burden
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DOI：
10.1007/s40472-019-00239-0
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发表时间：
2019-06-15
影响因子：
2.1
通讯作者：
Lentine, Krista L.
中科院分区：
文献类型：
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作者：
Tietjen, Andrea;Hays, Rebecca;Lentine, Krista L.
综述的目的：为移植项目提供标准化的指导，以最大限度地提高与活体供体护理相关的财务报销，并最大限度地减少对活体供体候选人和供体的评估、手术和后续护理的财务后果。2014年，美国移植学会（AST）活体肾脏捐赠实践社区（LDCOP）“活体肾脏捐赠最佳实践共识会议”确定了计费实践中的不一致是活体捐赠者财务中立的障碍，并强烈建议移植社区积极寻求战略和政策，使活体捐赠在联邦法律框架内成为财务中立的行为。LDCOP召集了一个多学科专家小组，审查和综合目前的医疗保险法规和与活体供体护理计费相关的商业付款人实践，以及对移植项目和患者的影响。我们为移植项目工作人员制定了相关策略指导：通过利用器官获取，通过医疗保险成本报告持续和适当地获得报销；协调供体预检测、评估、住院、随访护理和并发症的现有覆盖范围；肾脏配对捐献协调收费；并通过私人保险合同最大化覆盖范围。我们还提供建议，以保护捐赠者在计费方面的机密性，并对捐赠者候选人和捐赠者进行教育和准备，让他们了解与捐赠相关的覆盖范围中存在的任何缺口。为活体捐赠相关护理计费的最佳做法应侧重于平衡成本回收、法规遵从性和最小化捐赠者负担。在这里，我们提供了9条最佳实践建议。我们还为研究和宣传工作提供了一个包含七项建议的平台，以更好地了解活体供体医疗费用的环境，并优化计费实践，支持向所有可能受益的患者提供活体供体移植服务，并实现活体供体的财务中立。
Purpose of Review To provide standardized guidance for transplant programs to maximize financial reimbursement related to living donor care and to minimize financial consequences of evaluation, surgical, and follow-up care to living donor candidates and donors. Recent Findings In 2014, the American Society for Transplantation (AST) Live Donor Community of Practice (LDCOP) "Consensus Conference on Best Practices in Live Kidney Donation" identified inconsistencies in billing practices as a barrier to living donor financial neutrality and issued a strong recommendation that the transplant community actively pursue strategies and policies to make living donation a financially neutral act, within the framework of federal law. The LDCOP convened a multidisciplinary group of experts to review and synthesize current Medicare regulations and commercial payer practices related to billing for living donor care and the implications for transplant programs and patients. We developed guidance for transplant program staff related to strategies to: consistently and appropriately obtain reimbursement via the Medicare Cost Report by utilizing organ acquisition; coordinate available coverage for donor pretesting, evaluation, hospitalization, follow-up care, and complications; coordinate charges in kidney paired donation; and maximize coverage through private insurance contracting. We also offer recommendations to protect donor confidentiality in the context of billing and to educate and prepare donor candidates and donors about any remaining gaps in coverage related to donation. Best practices in billing for living donation-related care should focus on balancing cost recovery, regulatory compliance, and minimized donor burden. Herein, we offer nine recommendations for best practice. We also offer a platform of seven recommendations for research and advocacy efforts to better understand the climate of living donor medical costs and to optimize billing practices that support provision of living donor transplant services to all patients who can benefit and to achieve financial neutrality for living donors.