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Transplant Authorization And Financial Process

Transplant Authorization And Financial Process. Making Sense Out Of The $$$$$ And Cents Of Transplantation. Bessie Plummer Transplant Operations Manager Thomas Jefferson University Hospital Transplant Services. Understanding The $$$$$ And Cents Of Transplantation.

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Transplant Authorization And Financial Process

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  1. Transplant Authorization And Financial Process

  2. Making Sense Out Of The $$$$$ And Cents Of Transplantation Bessie Plummer Transplant Operations Manager Thomas Jefferson University Hospital Transplant Services

  3. Understanding The $$$$$ And Cents Of Transplantation • Transplant financial coordinator’s role and responsibilities. • Transplant program’s financial commitment to transplant patients and their families. • Financial expectations of the transplant patient and their family. • Transplant authorization process.

  4. 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.

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

  6. 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.

  7. 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.

  8. The Transplant Financial Coordinator And The Healthcare Payers • The transplant financial coordinator functions as a liaison between the transplant candidate and the patient’s 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 patient’s medical or financial status. • The TFC remains current with modifications with the healthcare payers and governmental agencies.

  9. What Is the Transplant Patient’s 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.

  10. 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 patient’s insurance coverage and obtains re-certifications until transplantation If approved TFC obtains insurance authorization

  11. THANK YOU!

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