Where we are now: OHSU POS Collections
HFMA - Oregon Chapter
February 2014
Mela Gant, Kippi Coffey & Kelly Smith
OHSU Healthcare
Agenda Today
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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
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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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4/8/2015
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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
PBS creates an
estimate
Customer
Service contacts
patient
Customer
Service notifies
Admitting of $
due at check-in
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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
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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
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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
gantm@ohsu.edu
(503) 494-6588
Kippi Coffey– Patient Business Services Manager, Insurance
Verification & Financial Medicare/Medicaid Services
coffeyk@ohsu.edu
(503) 494-6664
Kelly Smith – Assistant Director, Patient Business Services
smkelly@ohsu.edu
(503) 494-9617
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