Top Ten Things Financial Coordinators Should Know About Organ Transplantation

1. Top Ten Things Financial Coordinators Should Know About Organ Transplantation Andrea L. Tietjen, CPA, MBA Director of Transplant Finance and Data

2. Disclosure I have no financial relationships to disclose.

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8. TFCA’s Top 10 List 2017:Things Financial Coordinators Should Know About Organ Transplantation

9. Top Ten Things Financial Coordinators Should Know About Organ Transplant 10 – Financial Coordinators are a critical member of the disciplinary team

10. Top Ten Things Financial Coordinators Should Know About Organ Transplant Map out your multi-disciplinary flow…

11. Top Ten Things Financial Coordinators Should Know About Organ Transplant • Know what happens and when • All team members need to know this too • Look for triggers or weaknesses in your flow

12. Top Ten Things Financial Coordinators Should Know About Organ Transplant • Define who does what • For example…

13. Top Ten Things Financial Coordinators Should Know About Organ 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 government (CMS, Medicare, Medicaid). • Works cooperatively with other members of the transplant team to establish the most beneficial financial outcome for our patients.

14. Top Ten Things Financial Coordinators Should Know About Organ Transplant Social Workers and Financial Coordinator work closely together. Financial issues only a portion of Social Worker responsibility as a resource and advocate. Financial Coordinator deals with insurance companies, admitting and billing.

15. Top Ten Things Financial Coordinators Should Know About Organ Transplant

16. Top Ten Things Financial Coordinators Should Know About Organ Transplant Why Financial Coordinators and Social Works need to work together: • Patient states he has Medicare A & B and secondary • Insurance is verified and coverage is adequate • But – patient’s dialysis unit is paying for the Part B and the secondary… and patient has financial stressors and cannot afford the Part B premiums or the secondary insurance post transplant

17. Lay the foundation for your team SW MD RN IDLA FC

18. Why the foundation of your team is so important… IDLA FC RN SW MD

19. Top Ten Things Financial Coordinators Should Know About Organ Transplant 9 – Timing is everything

20. Top Ten Things Financial Coordinators Should Know About Organ Transplant Financial Clearance for your recipient must occur at multiple time points

21. Top Ten Things Financial Coordinators Should Know About Organ Transplant • At time of referral • At time of evaluation • At time of listing • Prior to scheduling of Living Donor Transplant • At time of re-evaluation (per your policy…1 month, 6 months, 1 year, etc.)

22. Top Ten Things Financial Coordinators Should Know About Organ Transplant For Kidney Paired Exchange: • Prior to consideration for exchange • At time of registry/exchange entry • At time of match • Prior to scheduling of transplant

23. Top Ten Things Financial Coordinators Should Know About Organ Transplant Remind your team and your patients how important it is to notify the finance team of any insurance changes

24. Top Ten Things Financial Coordinators Should Know About Organ Transplant 8 – Know your recipient and donor policies

25. Top Ten Things Financial Coordinators Should Know About Organ Transplant Know in advance so you can be confident in your communication and educate the patients, and their care givers, correctly.

26. Top Ten Things Financial Coordinators Should Know About Organ Transplant Does your center: • Accept out of state Medicaid patients? • Require recipients to have Medicare? • Require donors to have insurance? • Pay for donor complications? • Have contractual agreements with payors? • If so, what are they? • How do they impact the facility and the patient?

27. Top Ten Things Financial Coordinators Should Know About Organ Transplant Does your center: • Access donor insurance? • Have employed or private providers? • What resources are available? • How are patients educated?

28. Top Ten Things Financial Coordinators Should Know About Organ Transplant If your patients know what to expect, they will not be disappointed. Establish process and use tools to assist….

29. Top Ten Things Financial Coordinators Should Know About Organ Transplant

30. Top Ten Things Financial Coordinators Should Know About Organ Transplant 7 – Communication is key

31. Top Ten Things Financial Coordinators Should Know About Organ Transplant It is not only what we say to the patient, but how we say it. Explain the “why” behind the sensitive questions you are asking

32. Critical Elements to Donation The donor gives

33. Critical Elements to Donation The team living donor assesses the donor and gives care the throughout continuum.

34. Critical Elements to Donation MD SW IDLA RN FC

35. Top Ten Things Financial Coordinators Should Know About Organ Transplant • Communication between team members is vital • Helps to provide key information about the patient to determine suitability – both medically and psycho-socially • Adherence • Support • Financial stressors

36. Communicate what the transplant patient’s responsibility will be: 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.

37. Why is communication so important? Patients change coverage At least annually Patients are educated at multiple time points throughout evaluation, at listing, and at time of transplant, but often do not realize coverage until they are paying.

38. Many plans and programs have strict guidelines and timelines. Patients can easily lose coverage either temporarily or permanently if they do not pay attention to notices. Why is communication so important?

39. Insurance is complicated Patients, and their support, can be overwhelmed by the details, despite assistance available to them. Patients also do not always admit that they do not understand or are concerned about insurance until an issue arises. Why is communication so important?

40. Top Ten Things Financial Coordinators Should Know About Organ Transplant And don’ forget about the case manager (if applicable) Case managers can assist with: • Patient communication • Benefits information and insurance updates • Claims payment • Travel

41. Top Ten Things Financial Coordinators Should Know About Organ Transplant 6 -It’s all about the recipient’s insurance…

42. Top Ten Things Financial Coordinators Should Know About Organ Transplant Rule of thumb – the donor costs are billed to and covered by the recipient’s insurance. However, some centers do access donor insurance. Don’t forget...you need to know your centers policies*

43. Top Ten Things Financial Coordinators Should Know About Organ Transplant • Assess your patients • Consider financial language in your consent/education • For both recipients and donors • The team collectively should include all psycho-social/financial aspects such as: • Ability to maintain health insurance • Ability to pay premiums/copays • Family/social support • Other financial stressors • Past/present social history

44. Top Ten Things Financial Coordinators Should Know About Organ Transplant Sample education for a recipient

45. Top Ten Things Financial Coordinators Should Know About Organ Transplant Sample education for a donor

46. Top Ten Things Financial Coordinators Should Know About Organ Transplant • Is there a global agreement? • If so, how does it work? • What is the plan for coverage for donor complications? • Are there limits? • 30 days, 90 days, etc. • Co-pays, deductibles, etc.

47. Top Ten Things Financial Coordinators Should Know About Organ Transplant

48. Top Ten Things Financial Coordinators Should Know About Organ Transplant

49. Top Ten Things Financial Coordinators Should Know About Organ Transplant

50. Top Ten Things Financial Coordinators Should Know About Organ Transplant