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OHSU Healthcare
Where we are now: OHSU POS Collections HFMA - Oregon ChapterFebruary 2014Mela Gant, Kippi Coffey & Kelly Smith
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Agenda 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
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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
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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
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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
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Patient Responsibility Estimator Pilot
In 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
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Patient Estimate Workflow Design
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04/19/23
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Since 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
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Go-live Workflow
Front End notifies PBS that estimate needed
Front End notifies PBS that estimate needed
PBS creates an estimate
PBS creates an estimate
Customer Service notifies Admitting of $
due at check-in
Customer Service notifies Admitting of $
due at check-in
Customer Service contacts
patient
Customer Service contacts
patient
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Go-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
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Current State
• Number of estimates produced to date:• Patients are satisfied• No increase in patient cancellations• Did not include ED or Radiology
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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
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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
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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
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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
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Next Steps
• Continue estimate accuracy analysis• Expand Pilot to scheduled radiology procedures
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Questions?
Mela Gant – Director, Patient Access Services
(503) 494-6588
Kippi Coffey– Patient Business Services Manager, Insurance Verification & Financial Medicare/Medicaid Services
(503) 494-6664
Kelly Smith – Assistant Director, Patient Business Services
(503) 494-9617
