Billing for living kidney donor care: Balancing cost recovery, regulatory compliance, and minimized donor burden.

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. 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.

Déclaration de conflit d'intérêts

Disclosures/Conflicts of Interest: The authors are volunteer members of the American Society of Transplantation Living Donor Community of Practice (LDCOP). Rebecca Hays, MSW, APSW2 consults for Novartis on living donation. The terms of this arrangement have been reviewed for objectivity in research and presentation.