Transplant Authorization And Financial Process

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Transplant Authorization And Financial Process
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Making Sense Out Of The And Cents Of
Transplantation

• Bessie Plummer
• Transplant Operations Manager
• Thomas Jefferson University Hospital
• Transplant Services

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Understanding The And Cents Of
Transplantation

• Transplant financial coordinators role and
  responsibilities.
• Transplant programs financial commitment to
  transplant patients and their families.
• Financial expectations of the transplant patient
  and their family.
• Transplant authorization process.

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What Is A Transplant Financial Coordinator?(TFC)

• History of the Transplant Financial Coordinator.
• TFC and Social Worker.
• What is the role of the Transplant Financial
  Coordinator.

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History of the Transplant Financial Coordinator

• Evolution of the Transplant Financial
  Coordinator.
• Approval from the UNOS Board of Directors.
• Defining the Transplant Financial Coordinator.

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Transplant Financial Coordinator and the Social
Worker

• Social Workers and Financial Coordinator work
  closely together.
• Financial issues only a portion of Social Worker
  responsibility as a resource and advocate.
• Financial Coordinator and finances and billing.

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The Role of the Transplant Financial Coordinator

• To provide accurate financial information to our
  patients and their families in a compassionate
  and tactful manner.
• Function as a liaison between transplant center,
  insurance carriers and governmental bodies.
• Works cooperatively with other members of the
  transplant team to establish the most beneficial
  financial outcome for our patients.

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The Transplant Financial Coordinator And The
Healthcare Payers

• The transplant financial coordinator functions as
  a liaison between the transplant candidate and
  the patients insurer.
• The TFC works in collaboration with the
  transplant case manager to obtain insurance
  authorization for pre-transplant, transplant
  surgery and post-transplant needs of the patient.
• The TFC notifies case manager of changes to the
  patients medical or financial status.
• The TFC remains current with modifications with
  the healthcare payers and governmental agencies.

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What Is the Transplant Patients Responsibility?

• Provide accurate insurance information to the
  transplant center.
• Notify the transplant financial coordinator or
  social worker of financial concerns.
• Report insurance changes in a timely manner.

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Transplant Financial Authorization Process
Flow
Pt referred to transplant program
Transplant benefits verified and evaluation
auth obtained
Financial counseling if benefits are
insufficient for transplantation
Transplant evaluation is initiated
Transplant team Approves/Disapproves suitability
for transplantation
Pt counseled on financial options and team
notified of insurance issues
Patient placed on the UNOS waitlist
TFC continually verifies patients insurance
coverage and obtains re-certifications
until transplantation
If approved TFC obtains insurance authorization
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THANK YOU!