Presentation is loading. Please wait.

Presentation is loading. Please wait.

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

Similar presentations


Presentation on theme: "Where we are now: OHSU POS Collections HFMA - Oregon Chapter February 2014 Mela Gant, Kippi Coffey & Kelly Smith."— Presentation transcript:

1 Where we are now: OHSU POS Collections HFMA - Oregon Chapter February 2014 Mela 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 Mela

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 Mela

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 Mela

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 Mela

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 Mela

7 Patient Estimate Workflow Design
Mela

8 Mela 4/21/2017

9 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 Mela

10 Go-live Workflow Front End notifies PBS that estimate needed
PBS creates an estimate Customer Service contacts patient Kippi Customer Service notifies Admitting of $ due at check-in

11 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 Kippi

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

13 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 Kelly

14 Lessons learned- Estimator Build
Benefits in estimate dependent on vendor relationships Redirection of 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 Mela

15 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 Mela

16 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 Kelly

17 Next Steps Continue estimate accuracy analysis
Expand Pilot to scheduled radiology procedures Kelly

18 Questions? Mela Gant – Director, Patient Access Services (503) Kippi Coffey– Patient Business Services Manager, Insurance Verification & Financial Medicare/Medicaid Services (503) Kelly Smith – Assistant Director, Patient Business Services (503) Kelly


Download ppt "Where we are now: OHSU POS Collections HFMA - Oregon Chapter February 2014 Mela Gant, Kippi Coffey & Kelly Smith."

Similar presentations


Ads by Google