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Agenda Today

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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Agenda Today

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  1. Where we are now: OHSU POS Collections HFMA - Oregon ChapterFebruary 2014Mela Gant, Kippi Coffey & Kelly Smith

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. Patient Estimate Workflow Design

  8. 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

  9. 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

  10. 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

  11. Current State • Number of estimates produced to date: • Patients are satisfied • No increase in patient cancellations • Did not include ED or Radiology

  12. 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

  13. 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

  14. 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

  15. 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

  16. Next Steps • Continue estimate accuracy analysis • Expand Pilot to scheduled radiology procedures

  17. 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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