TFC Tag Teams – How to help My buddy with cross Coverage
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TFC Tag Teams – How to help My buddy with cross Coverage

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  • 1. TFC Tag Team How to help my buddy with cross coverage Neferteria D. Ector ( BMT) Diane D. Bethea (Solid Organ) Children’s Healthcare of Atlanta @ Egleston 1405 Clifton Road, NE Atlanta, GA 30322
  • 2. Objectives
    • The Programs We Service
    • Volumes
        • BMT and Solid Organ number of Referrals (past 3 yrs)
        • Number of Transplants Performed
    • The BMT and Solid Organ TFC roles and expectations
        • Referral > Evaluation > Transplant
        • Financial Interviews
        • Managed Care
        • Fiduciary
        • Charity Care
        • Financial Liaison
    • Our Partnership (how it all links together)
        • OTTR (financial module)
        • Sharing ideas or new things learned
        • Volunteering assistance when your partner is bogged down
        • Lead Insurance Verification
        • Vacation Time
    • Question & Answer
  • 3. Pediatric Blood and Marrow Transplant
    • The inception of the BMT program was in 1985
    • The following transplant options are available @ Children’s:
        • Matched Sibling Donor (MSD)
          • Matched Related Donor (MRD)
        • Partially Matched Related Donor (PMRD)
          • Haplo Identical
        • Matched Unrelated Donor (MUD)
        • Cord Blood (allogeneic & autologous)
        • Peripheral Blood Stem Cell (auto & allo)
    • FACT Accredited Facility
    • The only Pediatric BMT program in the State of Georgia
    • The BMT program is a part of the Aflac Cancer Center and Blood Disorders Service @ Children’s
  • 4. Who makes the BMT team?
    • Physicians
      • Dr. Ann Haight, MD (Interim Program Director)
      • Dr. K Y Chiang, MD, PhD
      • Dr. John Horan, MD, MPH
      • Dr. Leslie Kean, MD, PhD
    • Mid Level Providers
      • Ellen Olson, RN, MS, CPNP
      • Deborah Lutterman, RN, MSN, CPNP
      • Elyse Bryson, PA
    • Clinical
      • Audra Thompson, RN, BSN (Clinical Nurse Coordinator)
      • Norah Keeley, RN, BSN
      • Liz Weinzierl, RN, BSN
      • Pamela Rowland, RN, BSN, MS (Research Nurse)
    • Non-Clinical
      • Kristy Applegate, MBA, CHTC (Project Manager)
      • Becky Lavendar, LCSW
      • Dara Jackson, CCLS
      • Diana Worthington-White, BSc, M Ed (Manager of Cellular Therapies Lab)
      • Ashley Wissing, BSc (Clinical Research Lab Tech)
      • Lisa Musto (Program Data Coordinator)
  • 5. Kidney Transplant Program Highlights
    • The inception of the program was in 1980
    • Performs deceased and living donor transplants
    • Children’s partners with Emory University Hospital for the living donor population
    • Full renal services available, i.e. dialysis and Chronic Renal Insufficiency (CRI)
        • Hemo-dialysis
        • Peritoneal Dialysis
  • 6. Who makes the Kidney team?
    • Physicians
      • Dr. Laurence Greenbaum, MD, PhD, Director Division of Pediatric Nephrology
      • Dr. Leonard Hymes, MD (Pediatric Nephrologist)
      • Dr. Barry Warshaw, MD (Director Transplant Services)
      • Dr. Sandra Amaral, MD (Pediatric Nephrologist)
    • Clinical
      • Stephanie Byrd ( of Kidney Transplant, Dialysis & CRI)
      • Shannon Luetkemeyer, RN, BSN (Living Donor Coordinator)
      • Debbie Stearns, RN, BSN (Transplant Nurse Coordinators)
      • Nancy O’Brien, RN, BSN (Transplant Nurse Coordinators)
      • Emily Abercrombie, Nutritionist
    • Non-Clinical
      • David Cooper, LCSW (Social Worker)
      • Ginger Tuminello (Child Life Specialist)
      • Kerrie McHardy (Program Data Coordinator)
  • 7. Liver Transplant Program Highlights
    • The inception of the program was in 1990
    • Since 1997 the program has been lead by Dr. Thomas Heffron, Program Director
    • Performs deceased and living donor transplants
    • First living donor right lobe liver transplant from a mother to her teenage son - the first of its type performed in the United States
    • First pediatric split liver transplant in Georgia
    • The first split liver transplantation in Georgia for two unrelated recipient
    • Transplanted the world’s youngest (10 days old) and smallest (5.72 pounds) living pediatric liver transplant recipient
  • 8. Who makes the Liver team?
    • Physicians
      • Dr. Thomas Heffron, MD ( Program and Surgical Director)
      • Dr. Rene Romero, MD (Medical Director of Hematology)
      • Dr. Miriam Vos, MD
      • Tim Barnett, PhD
    • Clinical
      • Jill DePaolo, RN, BSN
      • Katherine Casper, (Research Scientist)
      • Nicholas Raville, (Research Coordinator)
    • Non-Clinical
      • V. Patricia Tatro, LCSW (Social Worker)
      • Sundari Sekar, (Research Project Coordinator)
      • Greg Smallwood, PharmD
      • Denia Williams, (Program Data Coordinator)
  • 9. Heart Transplant Program Highlights
    • The inception of the program was established in 1988.
    • The heart transplant team has performed more than 200 transplants on children from around the country and all over the world.
    • Multidisciplinary approach to patient care
    • One of only a few children’s hospitals nationwide to have pediatric heart surgeons perform multiple pediatric ABO-incompatible heart transplants
  • 10. Who makes the Heart team?
    • Physicians
      • Kirk Kanter, MD (Director of Heart Transplant)
      • Robert Vincent, MD (Co-Medical Director of Heart Transplant)
      • William Mahle, MD (Co-Medical Director of Heart Transplant)
      • Paul Kirshbom, MD (Cardiac Surgeon)
      • Brian Kogon, MD (Cardiac Surgeon)
    • Clinical
      • Alexandria Berg, CPNP (Program Manager)
      • Kelci LaPorte, CPNP
      • Robin Epstein, CPNP
      • Donna Ramaswamy, CPNP
    • Non-Clinical
      • Tracey Shelby, LCSW (Social Worker)
      • Althea “Vivian” Olokodana (Program Data Coordinator)
  • 11. Who Covers All 3 Solid Organs?
    • Amy Hauser, RN, BSN (Director of Transplant Services)
    • Rochelle Schmidt , Pharm D
    • Stephanie Hawthorne , RN, BSN (Clinical Educator)
    • Diane Bethea , (Transplant Financial Counselor)
  • 12. We Both Belong To…..
    • Transplant Fiduciary Team:
        • Joyce Davis , (Transplant Fiduciary Manager)
        • Diane Bethea, (Solid Organ Transplant Financial Counselor)
        • Neferteria Ector, (Blood and Marrow Transplant Financial Counselor)
        • Charisma Addison , (Transplant Operations Analyst)
        • LaJean Turner , (Lead Insurance Verifier)
  • 13. BMT Volumes Transplant Year 2005 2006 2007 Total Number of Transplants 73 49 57 Autologous 40 16 21 Allogeneic 33 33 36 Number of Referrals 83 80 76
  • 14. Kidney Volumes Transplant Year 2005 2006 2007 Total Number of Transplants 27 35 19 Living Donor 9 12 10 Deceased Donor 18 23 9
  • 15. Liver Volumes Transplant Year 2005 2006 2007 Total Number of Transplants 18 28 25 Living Donor 0 1 0 Deceased Donor 18 27 25 Total Number of Referrals 49 38 41
  • 16. Heart Volumes Transplant Year 2005 2006 2007 Total Number of Transplants 7 13 12 Total Number of Referrals 25 34 28
  • 17. BMT Referral Sources
    • Aflac Cancer and Blood Disorders Services @ Children’s ( all three Children’s Locations)
      • Egleston
      • Scottish Rite
      • Hughes Spalding
    • Emory Children’s Center
      • Genetics
      • Immunology
    • Statewide Referrals
      • Augusta
      • Macon
      • Savannah
      • Columbus
    • Out of State Referrals
  • 18. Solid Organ Referral Sources
    • Kidney
      • Emory Children’s Center / Pediatric Nephrology
      • Dialysis @ Children’s (hemo and peritoneal)
      • Chronic Renal Insufficiency Team @ Children’s
      • Local Pediatric Groups and statewide referrals
    • Liver
      • Emory Children’s Center Hepatology Team
      • Local Pediatric Groups and statewide referrals
    • Heart
      • Sibley Heart Center Cardiology
      • Cardiology Team @ Children’s
      • Local Pediatric Groups
  • 19. What We Do
    • BMT & Solid Organ
    • Referral received by the Clinician
    • TFC verifies benefits
    • Authorizations are obtained for the patient’s evaluation
    • Financial Interview is conducted
    • Authorization is obtained for the patient’s transplant
    • Transplant Account is created
      • BMT TFC creates HLA and donor search accounts
    • In-Patient precert is obtained for the transplant admission
  • 20. The Differences
    • BMT Perspective
      • Evaluation
        • Donor Search
        • Donor Evaluation
        • Stem Cell Collection
    • Solid Organ Perspective
      • Evaluation
        • Living Donor
        • UNOS Listing
      • Emergent Transplant
        • Fulminate Liver
        • STAT Heart
  • 21. Outside the Scope
    • Managed Care
      • Out of Network Patients
        • Spot Contracts
        • Non-Participating Providers Tracking
      • Contract Language
      • Global and Local Agreements
    • Fiduciary
      • Referral
      • Global Period
      • Payor Codes
      • Global Case Tracking
  • 22. Outside the Scope (cont.)
    • Charity Care
      • No Insurance
      • Limited Benefits
      • Charity Care Interviews
    • Financial Liaison
      • Payors
      • Marketing
      • Billing
      • Leadership
      • Social Workers
      • Families
      • Camp
  • 23. Building a Partnership
    • Organ Transplant Tracking Record (OTTR)
      • Financial Module
        • Who has access???
        • Benefits
        • Authorizations
        • Benefit Verification Reports
        • YTD Transplant Reports
        • Data Querying
    • Voicert
        • Pixcert
  • 24. New Developments
    • Insurance Changes
      • Medicaid
      • Optum Healthcare (previously URN)
      • New Case Managers
    • Hospital Policies
    • System Crashes
    • Suggestions
      • Data Management
  • 25. Do you need help??
    • Multiple Financial Interviews
    • Multiple Coverage
      • Lead Insurance Verification
    • Unexpected Visitors
      • Parents
      • Patients
  • 26. Time to Relax!!!!!!!!
    • Vacation Time
    • When we can use it
    • How we get it approved
    • Who covers who
      • TFC > TFC
      • TFC > Lead Insurance Verifier