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

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