Revised July 20, 2012
Transplant Financial Coordinator
Skill Assessments
Objective: Demonstrates basic navigation, process flow, work queue functions, charge entry, proper insurance attachment and account
maintenance.
Scale: Total Points Possible: 100
1-69 =
Not Met
70-79 =
Approaching: Novice. New learner; needs assistance
80-89 =
Proficient: Good understanding; performs function independently or with minimal assistance
90-100 =
Surpassing: Excellent understanding of function; able to serve as preceptor or support for peers
N/A
=
Not Applicable. Function not used/not required in current clinical area
Staff name:
Employee ID#:
Processes
Assessment
Process New Patient Referrals
Results
Scale
Points
Initial
Date
Total Possible:10
1. Verify and document Insurance 6 points
 Call insurance company to verify Transplant benefits and pharmacy coverage.
 Obtain transplant evaluation authorization if needed.
 Enter Transplant insurance package pricing contract if needed (refer to package
pricing list).
 If donor referral, verify if donor insurance is required.
 Document finance notes in Otis.
2. Enter patient in Mi-Chart to be scheduled 4 points
 Create Transplant Guarantor and add insurance for recipient, if donor- do not attach
any insurance coverage and confirm account as self-pay.
 Create Transplant Navigator with Pre-Evaluation Phase.
 Update/Add P/F Guarantor with insurance.
Comments:
Demonstration
Demonstration
6
Demonstration
Demonstration
4
Process Patients in Scheduled Appointment WQ Total Possible:10





Access Scheduled Appointment WQ.
Verify Transplant Guarantor was created with insurance for recipient, without
insurance for donors.
Link Transplant related episodes to visit.
Create hospital account record (HAR).
Complete checklist.
Demonstration
3
2
2
1
Demonstration
Demonstration
Demonstration
1
Revised July 20, 2012
Transplant Financial Coordinator
Skill Assessments
Processes
Assessment


Under Account Maintenance-verify billing phase is correct i.e. (evaluation, waitlist,
transplant, post-operative).
Defer appointment until the scheduled appointment date.
Results
Scale
Points
Initial
Date
Demonstration
1
1
Demonstration
Comments:
Process Patients Once Appointment is Completed Total Possible: 10



Access scheduled appointment WQ.
Update Transplant Navigator with Eval date if visit was for evaluation.
Re-verify Transplant Guarantor is marked if transplant related & the episode is
linked. If not transplant related, make sure P/F guarantor is attached.
 Under Account Maintenance-verify billing phase is correct (i.e. evaluation, waitlist,
transplant, post-operative).
 Complete Transplant Work queue Verification signature under documents.
Comments:
Demonstration
8
Demonstration
1
1
Demonstration
Process Patients in Post-Transplant Work Queue Total Possible: 10







Access the post-transplant WQ.
Verify/update Transplant Navigator.
Verify/update Clinical Billing Phase.
Review account for transplant package pricing needs.
If the visit should be part of the billing package, link episode
If the visit is not part of the billing package, make sure P/F Guarantor is attached.
Verify if visit requires a prior insurance authorization (i.e. BCN, Medicaid HMO,
Priority Health, Healthplus).
 If prior auth is needed, enter authorization into Mi-Chart.
 Defer scheduled appointment until the appointment date.
 Once appointment appears as completed follow the steps below:
o Update Transplant Navigator.
o Update Clinical Billing Phase.
o Verify that proper guarantor is attached.
o Complete Transplant Work queue Verification signature under documents.
Comments:
Demonstration
5
Demonstration
Demonstration
2
1
Demonstration
2
Demonstration
Demonstration
Demonstration
Demonstration
2
Revised July 20, 2012
Transplant Financial Coordinator
Skill Assessments
Processes
Assessment
Results
Scale
Points
Initial
Date
Process Patients in Transplant Admission Work Queue Total Possible: 10


Access Transplant Admission WQ.
Verify if this is a transplant admission, if non-transplant admission- verifies P/F
guarantor is attached and defer admission out 10 days.
 If this is the transplant admission, continue with the following steps:
o Re-verify patients insurance coverage and Medicare dates
o Link admission episode
 Update Transplant Navigator to transplanted and the date of actual transplant.
 Create HAR.
 Update Clinical Billing Phase to transplanted with either the date of the actual.
transplant or the day prior depending upon package pricing contracts.
 Notify billers and insurance company of transplant via phone and email.
 Add transplant insurance authorization into Mi-Chart.
 Add account note.
 If the admission is not transplant related: sign transplant work queue document and
remove from the work queue.
 If the admission is transplant related: leave patient in work queue until discharge.
Comments:
7
2
1
1
1
Demonstration
Demonstration
1
1
1
1
1
1
Charge Entry for Recipients Total Possible: 9
 Access the charge entry screen via the Epic button.
 Enter the organ acquisition fee.
 Verify that the charge posted to the account via account maintenance.
Comments:
3
3
3
Demonstration
Demonstration
Demonstration
2
3
3
2
Demonstration
Demonstration
Demonstration
Patient Ruled Out as Transplant Candidate/Donor Total Possible: 10
 Inform insurance company of status via phone call.
 Update Transplant Navigator to show closed.
 Update Clinical Billing Phase to show closed.
 Verify that transplant episode is resolved.
Comments:
3
Revised July 20, 2012
Transplant Financial Coordinator
Skill Assessments
Processes
Assessment
Results
Scale
Points
Initial
Date
Recipient Added to Transplant Waitlist Total Possible: 10



Comments:
Obtain Transplant Insurance Authorization and enter notes in Otis and enter auth
into Mi-Chart.
Update Transplant Navigator to show waitlisted.
Update Clinical Billing Phase to show waitlisted.
Demonstration
5
2
3
Demonstration
Demonstration
Create & mail patient financial agreement packet to recipient Total Possible:10
 Introduction letter.
 Business Card.
 Fundraising brochures.
 2 copies of financial agreement form.
 Transplant pharmacy letter.
 Return envelope.
Comments:
Institutional Client Accounts




2
1
2
3
1
1
Demonstration
Demonstration
Demonstration
1
1
1
1
Demonstration
Demonstration
Demonstration
Demonstration
1
Demonstration
Demonstration
Total Possible: 4
Access Mi-Chart and locate patient in registration.
Select encounter to be transferred.
Access hospital accounts/account maintenance/hosp tx inquiry.
Complete selection, code description and complete transfer.
Monthly/Quarterly Insurance Re-Verification and Authorization Renewal
Total Possible: 7





Obtain access to Mi Health, Web Denis and Medicare Eligibility.
For patients on the transplant waiting list: re-verify insurance each month (liver,
lung & heart), kidney reviews every quarter. Re-Verification via electronic
programs above or by calling insurance company directly.
Document in Otis that insurance was verified as active and your initials. Change
clearance date to the new expiration date of the authorization.
Update authorization renewal date on your spreadsheet.
For those patients that are due for transplant authorization renewal, print off
1
Demonstration
1
Demonstration
4
Revised July 20, 2012
Transplant Financial Coordinator
Skill Assessments
Processes
Assessment
Points


Comments:
recent clinic notes, labs, testing, and in-patient admission discharge summaries
since last authorization was given. These are faxed to insurance company for
review and transplant re-authorization.
Send an updated financial agreement to the patient.
Verify insurance information is current in Mi-Chart.
Results
Scale
Initial
Date
1
2
1
ADDITIONAL OVERALL COMMENTS:
Results:
N
A
P
S
Date
Assessed by:
Assessed by:
Department:
Supervisor:
5