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Where we are now: OHSU POS Collections HFMA - Oregon Chapter February 2014 Mela Gant, Kippi Coffey & Kelly Smith. Agenda Today. Overview OHSU POS Collections Where we were HFMA February 2013 Patient responsibility estimate Since then… Go-live Current state Estimate accuracy
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Where we are now: OHSU POS Collections HFMA - Oregon ChapterFebruary 2014Mela Gant, Kippi Coffey & Kelly SmithAgenda Today
  • Overview OHSU POS Collections
  • Where we were HFMA February 2013
  • Patient responsibility estimate
  • Since then…
  • Go-live
  • Current state
  • Estimate accuracy
  • Lessons learned
  • Next steps
  • Overview OHSU POS Collections
  • OHSU implemented a new Point of Service Collections tool (TransUnion/ClearQuote/Clear IQ) to create patient estimates which includes hospital, professional and anesthesia balances
  • Where we were HFMA February 2013
  • Hospital, Professional and Anesthesia working independently of one another
  • Limited use price estimator tool in medical practices for professional charges only
  • Manually gathering info for a “best guestimate”
  • Commercially insured patients with day or inpatient services were not being informed in advance of total patient responsibility at admission
  • Creates a very poor patient experience
  • Patient Responsibility Estimator Tool
  • FHS Clear Quote/TransUnion selected
  • One estimate that includes hospital, professional, and anesthesia charges
  • Posting payments: (1) Professional, (2) Anesthesia & (3) Hospital)
  • Patient estimate considers: benefits, median charges, contracts, provider variance
  • Contracted payers were notified
  • Loaded all hospital and professional contracts
  • One years worth of charge data, monthly refresh
  • HL7 ADT out interface with patient data
  • Patient Responsibility Estimator PilotIn Scope:
  • Scheduled inpatients and day surgery
  • High dollar Radiology
  • ED visits
  • Patients with an anticipated balance due i.e. copays, deductible, and coinsurance
  • Out of Scope:
  • Same day/next day admits
  • Hospital transfers
  • Patients with no out of pocket
  • Patient Estimate Workflow DesignSince then…
  • Completed Clear IQ build
  • Established Pilot Scope: Neurosurg, ENT, Plastic Surgery, OB & Bariatric Surg)
  • Validated 271 data interfacing
  • Validated accuracy of estimates (ongoing!!)
  • Detailed level draft of many sub work flows
  • Develop training materials
  • Trained end users
  • Pilot May 6, 2013
  • Go-live WorkflowFront End notifies PBS that estimate neededPBS creates an estimateCustomer Service contacts patientCustomer Service notifies Admitting of $ due at check-inGo-live Workflow
  • Change of plans
  • Instead of Customer Service completing both the estimate and call to patient, split out work between CCS and IVS
  • Shift to Huron
  • Current State
  • Number of estimates produced to date:
  • Patients are satisfied
  • No increase in patient cancellations
  • Did not include ED or Radiology
  • Estimate Accuracy
  • Patient Liability Estimate Log includes: estimated $, collected & due
  • Completed mini analysis with 20 accounts
  • Help from TransUnion
  • Accuracy has been difficult to determine- as a result, we have not been able to expand pilot
  • Lessons learned- Estimator Build
  • Benefits in estimate dependent on vendor relationships
  • Redirection of 270-271 direct connect interface
  • Changed estimate settings:
  • Reduced “auto add” threshold for adding to the primary CPT code
  • Reduced visit count threshold to be considered sufficient to create an estimate
  • Two years of charge data – not one – to increase related visit count
  • Contract issues
  • Mark contracts as “evergreen” instead of loading end dates
  • Contract updates to ClearQuote
  • Associating contracts with new Epic plans
  • Lessons learned- Estimate Results
  • Alignment of patient charges in estimator by date & provider (Duplicate or missing Anesthesia)
  • Contract alignment- may need to run separate estimates in some cases
  • In network vs Out of network- tool can only handle one scenario
  • Estimates for drugs not included since pharmacy fee schedule not loaded
  • Lessons Learned- Operations
  • Estimate shows patient deductible always filing to the hospital
  • Professional pre-payments required unique payment code for distribution on credit balances
  • Reallocating payments among PB, HB & Anesthesia
  • Reporting challenges on collections
  • Manual process since we are not using the tool
  • Next Steps
  • Continue estimate accuracy analysis
  • Expand Pilot to scheduled radiology procedures
  • Questions?Mela Gant – Director, Patient Access Servicesgantm@ohsu.edu(503) 494-6588Kippi Coffey– Patient Business Services Manager, Insurance Verification & Financial Medicare/Medicaid Servicescoffeyk@ohsu.edu(503) 494-6664Kelly Smith – Assistant Director, Patient Business Servicessmkelly@ohsu.edu(503) 494-9617
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