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

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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

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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

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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)

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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

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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)

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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

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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)

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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

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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)

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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)

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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)

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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

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Kidney Volumes

Transplant Year 2005 2006 2007

Total Number of Transplants

27 35 19

Living Donor 9 12 10

Deceased Donor 18 23 9

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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

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Heart Volumes

Transplant Year 2005 2006 2007

Total Number of Transplants

7 13 12

Total Number of Referrals

25 34 28

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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

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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

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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

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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

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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

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Outside the Scope (cont.)

Charity Care No Insurance Limited Benefits Charity Care Interviews

Financial Liaison Payors Marketing Billing Leadership Social Workers Families

Camp

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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

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New Developments

Insurance Changes Medicaid Optum Healthcare

(previously URN) New Case Managers

Hospital Policies

System Crashes

Suggestions Data Management

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Do you need help??

Multiple Financial Interviews

Multiple Coverage Lead Insurance Verification

Unexpected Visitors• Parents• Patients

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Time to Relax!!!!!!!!

Vacation Time

When we can use it

How we get it approved

Who covers who TFC > TFC TFC > Lead Insurance Verifier