CONTEXT

The lack of uniformity in the reporting of direct and indirect costs by organ acquisition cost centers, diagnosis-related groups, and in physician reimbursement often results in Medicare overpayment and findings of unjustified charges in audits conducted by the Office of the Inspector General. Although it is true that organ transplantation costs vary widely, uniform cost-report accounting is needed.

OBJECTIVE

Henry Ford Transplant Institute has developed systematic auditing protocols that result in acceptable compliance with Medicare. The differences between those protocols and the methods used elsewhere are illustrated by the results of a national survey of transplant centers.

DESIGN

The survey addresses 10 crucial questions, drawn from the cost-reporting model used at Henry Ford Transplant Institute. Setting-Surveys were distributed via the United Network for Organ Sharing listserv, with replies from 43 centers.

PATIENTS OR OTHER PARTICIPANTS

The participants were transplant administrators.

RESULTS

Several important practices that are audited by the Office of the Inspector General were not followed by a number of reporting institutions. About 30% did not account for pretransplant charges, 15% did not track pretransplant services, 40% do not use an external consultant, and the frequency of physician time studies varied. On the other hand, the vast majority of institutions perform frequent time studies and manually review pretransplant charges. These results suggest that most centers use accounting methods similar to those used at Henry Ford Transplant Institute, which will significantly improve recognition of pretransplantation costs.