Complexities in Transplant Revenue Management

Abstract

Numerous payment methodologies, contract types, and income reimbursement methods exist in the highly complex environment of transplantation. A fundamental understanding of the transplant environment and the various compensation schemes involved with transplant revenue management is necessary to stay viable in such a complicated system. Knowledge of resources such as Medicare, commercial insurance, Medicaid, and self-pay individuals will allow a program to fully optimize allowable revenue streams. This multiple payer mix can be challenging, with payment arrangements ranging from a single global case rate that must cover all transplant-related services to individual payment arrangements for each stage of the transplantation process. Transplant programs must track each agreement to ensure optimal payment, and must therefore become proficient with central fiscal operations such as Medicare cost reporting and managed care contract negotiations. Outlier protection and risk pool strategies can also be used to remain competitive and profitable. A transplant program must have a thorough understanding of all available payment schemes and reimbursement optimizing strategies to facilitate the realization of a strong financial outlook.