1 / 30

A Day in the Life of a HCT Financial Coordinator

A Day in the Life of a HCT Financial Coordinator. Rajwant Dhami, Sutter Medical Center, Sacramento, California Michelle Dodson, West Penn Hospital, Pittsburgh, Pennsylvania September 27, 2017. A Tale of Two Transplant Centers. Western Pennsylvania Hospital, Pittsburgh

veitch
Download Presentation

A Day in the Life of a HCT Financial Coordinator

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. A Day in the Life of a HCT Financial Coordinator Rajwant Dhami, Sutter Medical Center, Sacramento, California Michelle Dodson, West Penn Hospital, Pittsburgh, Pennsylvania September 27, 2017

  2. A Tale of Two Transplant Centers • Western Pennsylvania Hospital, Pittsburgh • 20 bed unit dedicated to transplant • 2016 Transplants Performed • 29 Autologous • 38 Allogeneic (14 Related & 24 Unrelated) • 6 Hematologist/Oncologist Transplant Physicians • 2 BMT Clinical Nurse Coordinators • BMT Clinical Program Quality Manager • Social Worker • Financial Coordinator • BMT trained auxiliary staff • Sutter Medical Center Sacramento (SMCS) • 16 beds combined Transplant & Acute Leukemia Unit • 2016 Transplants Performed • 36 Autologous • 25 Allogeneic (9 Related & 16 Unrelated) • 2 Transplant Physicians • 3 BMT RN Coordinators • BMT Clinical Program Quality Manager • Social Worker • Financial Coordinator • NMDP Coordinator • BMT trained auxiliary staff

  3. Essentials for What We Do • Financial Barriers to HCT • Prescription Drug Coverage • Highlights of Benefit Verification – coincide with clinical steps • Donor Billing

  4. TFC Responsibilities Aligning with Clinical Steps

  5. Step 6 Steps in Transplantation • Post Engraftment Step 7

  6. Step 1 – Transplant Referral

  7. Step 2 – Initial Consultation

  8. Step 3 – Pre-transplant Evaluation

  9. Step 4 – Stem Cell Collection - Allogeneic

  10. Step 4 – Stem Cell Collection - Autologous

  11. Step 4 – Stem Cell Collection - Financial

  12. Step 5 – Transplant

  13. Step 6 – Post-Transplant (Engraftment)

  14. Step 6 – Post-Transplant (Engraftment)

  15. Step 7 – Post-Transplant Care

  16. Highlights of Benefit Verification -Key Questions - Be Prepared! • Demographics, diagnosis and transplant type (with codes) • Physician NPI, address, phone and fax #s • Primary, secondary insurance (check COB) • Annual deductible, annual out of pocket max (met?), lifetime maximum, separate hospital admission co-pay? • Are benefits calendar year? • Is my facility CME (Center of Medical Excellence)/In-network for transplant services? • BLUEplans– do the benefits require Blue Distinction? If so, can an Out of Network exception be requested if facility is not BD?

  17. Highlights of Benefit Review - continued • Prescription drug coverage- tiers, co-pays, does total out of pocket include prescriptions? • Date , reference # of call to insurance and person’s name • TPA (Third Party Administrator) – what transplant network if any does the plan use for transplant? • What rates will our facility receive for professional and facility charges? • Are there travel and lodging benefits? • Who do I contact for transplant authorizations? • For Allogeneic transplants – are there donor benefits? Limit? • How should the related donor charges be billed?

  18. Donor Billing–Related and Unrelated • Know your contract language • Does the recipients insurance require donor insurance to be billed first? • What happens if the transplant does not take place?

  19. Donor Billing - Unrelated • Invoiced bi-monthly all charges entered on spreadsheet • Once patient receives transplant – all charges posted individually as Revenue Code 815 • If transplant does not take place, bill according to contract or Medicare guidelines (Cost Report), depending on recipients insurance.

  20. Topics of Discussion • Financial Barriers • Prescription Drugs

  21. Financial Barriers • None or Limited -Donor Search Coverage • Medicare Only • Transplant Cap

  22. Financial Barriers None or Limited -Donor Search Coverage: • Search Assistance Fund (SAF) grant through the National Marrow Donor Program(NMDP)-unrelated search • Related Search Assistance Grant (RSA) *These grants can be found on NMDP network website

  23. Financial Barriers Medicare Only: • Apply for secondary Medicaid • Apply for Medicare Supplement plan • Fundraise

  24. Financial Barriers Transplant Cap: • Seek assistance from your contracting department • Check with the Insurance Plan if Patient can appeal the transplant cap • Fundraise and co-pay assistance

  25. Prescription Drugs Post Transplant Drugs • Noxafil- www.merckhelps.com • Gengraf- www.abbviepaf.org • Cellcept- www.rxoutreach.org

  26. Resources for the NEW TFC • https://bethematch.org • www.copays.org • www.bmtinfonet.org • http://www.childrensleukemia.org • http://www.tfcassociation.com • https://www.medicare.gov

  27. Key to Success – Communication!

  28. Contact Us! • Michelle Dodson Financial Coordinator, Cell Transplantation Program AHNCI, West Penn Hospital 412-578-3534 Michelle.Dodson@ahn.org • Raj Dhami BMT Financial Coordinator Sutter Medical Center Sacramento 916-454-6930 DhamiR@sutterhealth.org

More Related