Transplant Financial Coordinator Association Conference October 21-23, 2009 Presented By: Cecelia Devey, TFC Heart, Lung

1. Transplant Financial Coordinator Association Conference October 21-23, 2009 Presented By: Cecelia Devey, TFC Heart, Lung and VAD Programs

2. To make sure that all services rendered to our Comprehensive Transplant Center Patients are financially cleared, Prior to services being rendered. In order to secure the optimum reimbursement for the Hospital and the Physician. As well as reduce the financial liability for our patients. What is our Goal?

3. How do we accomplish this Goal? Team Work and Communication

5. Transplant Financial Coordinator and/or • Financial Management Analyst Responsibilities • Insurance Verification and Eligibility (every 3 to 6 months after Listing) • Clearance for Pre-Transplant Evaluation • Patient Financial Education • Donor Financial Education (Kidney) • Clearance for Transplant Listing • Authorization for all Clinic visits • Authorization for all Diagnostic Testing • Authorization for all Surgical Procedures • Clearance for all In-house Admits and Transfers • Notify all providers of Insurance and Authorizations via email • Registration • Anesthesia • Pathology • PFS • PBS • Imaging • Any consultants providing a service to the patient • Communicates with Case Managers at Insurance and Medical Group • Collects all claims for services going to OACC and verifies that it is correct and then forwards over to Pro-Fee disbursement Staff member for disbursement. • Works with patient on any billing issues.

6. Services that require Authorization for Financial Clearance Heart and Lung Transplant Pre-Transplant Evaluation All Diagnostic Testing Associated with the Eval (Imaging, Cardiology, etc) Follow-Up Visits All Diagnostic Testing needed (Imaging, Cardiology, etc.) Listing for Transplant Post Transplant Follow-up Visits All diagnostic Testing and Surgeries necessary for UNOS updates and Medical Management VAD All Devices and Accessories All Clinic Visits All Diagnostic Services (Imaging, GI, etc) All Surgeries Heart Failure Clinic: All clinic visits All Heart Caths All Diagnostic Services (Imaging, Labs, etc) All Surgeries *** ALL LABS MUST BE DONE AT THE PATIENT’S DESIGNATED LAB, IF THEY ARE AN HMO PATIENT***

7. Financial Clearance Process for Pre-Transplant Evaluation Prior to Patient coming in for Evaluation Appointment: • New referral entered into TeleResults by MA as “Finance to Eval” • Financial Coordinator runs Requested Authorization Report • Financial Coordinator verifies Eligibility and Benefits for all patients • Establish if the Evaluation Charges will go to the Organ Acquisition Cost Center • TFC Verifies Center of Excellence • TFC will review Pharmacy Benefits for adequate Post Transplant medications • Financial Coordinator notifies Case Manager at payer and transplant case is open. • Determines if Case Rate Starts with Evaluation or the day of Transplant • Financial coordinator clears pt for Evaluation by signing off in TeleResults clearing the patient and notifying the appropriate MA and Nurse Coordinator. Day of Evaluation • TFC will meet with pt and go over benefits and their responsibility for medical care and pharmacy expenses. • TFC will discuss Financial Agreement and have pt sign. Give pt a copy of agreement and benefits. • TFC will give pt and Family members their contact information (phone and email) Important!!! Benefits and eligibility must be reviewed and documented at least every six months.

8. Financial Clearance Process for Listing Transplant Patient Once the patient has finished their evaluation, they are presented at Selection Committee. If the Committee deems the patient as a suitable candidate for transplant, the following steps will occur: • The Pre-Transplant Team will put together an evaluation packet and give to the TFC. • TFC will then attach letter requesting, Authorization for Deceased Donor and/or Living Donor Transplant, which ever applies. They will send packet to the Case Managers at the Payer and Medical Group if necessary. (Packet will be sent UPS overnight or FAX) • TFC will follow-up with the Case Manager the next day to see if Packet was received and to find out when we can expect auth. TFC will document pt’s financial file in TeleResults. • Once Authorization is received, The TFC will send out an email to the Transplant Team notifying them of the approval, so they can go ahead and list the pt with UNOS. • TFC will then update Data Base (TeleResults) with the Authorization number and Valid till date. • TFC will run a report out of TeleResults, on a regular basis to identify which patients will be coming up for re-cert for Transplant. Important!!!!!! Patient’s Benefits and eligibility must be reviewed and documented at least every six months..

9. Financial Clearance Process At the time of Transplant When a patient gets an offer the TFC will receive a call from the Transplant Clinical Coordinator on call. The TFC will at that time let the coordinator know if the patient is cleared for transplant and if there are any outstanding financial issues or concerns. Once the TFC gives the official clearance the following steps must be taken: • TFC will make sure Authorization is still current. • TFC will notify the Case Manager at Insurance of the offer. If the transplant is a go and it was not cancelled for any reason, then the TFC will do the following: • Call Case Manager at Insurance to let them know if the pt received the transplant • TFC will send out an email notification to Transplant Team, Hospital registration, Patient Financial Services, Physician’s Billing, and all outside providers rendering services to the pt during the transplant phase of their care. Notification will include the following: • Patient’s Insurance Info. Including Case Managers name and number • Authorization number for the transplant • If case rate, then they will include start and end date • If the case rate is for both Pro-Fee and Facility or just Facility. • Billing address for claims, Pro and Facility

10. Finance Clearance Process for Post Transplant • We monitor the Case Rate Period if appropriate • Obtain authorization for Post Clinic Visits, Labs, and any diagnostic testing that maybe required. • Help patients with any Pharmacy Issues • Help patient with any billing issues they may have relating to their transplant.

11. How do we maintain the momentum?? Identify the challenges Reduce the duplication Communicate with our Teams, Patients and our outside customers to make sure our original goals are met.

12. Questions • Comments • Concerns • Advice