1. Implementing POS at LVHN The Ups and Downs Lynnette Clinton – Manager, Rev Cycle Systems Tricia DeBlass – Subject Matter Expert Stephanie Erwin – Systems Analyst Mary Beth McMenamin – Manager, Patient Receivables

3. Who We Are ▪ Largest academic community hospital in PA ▪ Largest Level 1 Trauma Center in region ▪ Certified Comprehensive Stroke Center ▪ Employees – 11,967 ▪ Medical Staff – 1,193 ▪ Nurses – 2,334 ▪ Magnet Hospital ▪ 173,678 ED visits ▪ 54,056 admissions ▪ 981 acute care beds ▪ 3 hospital campuses ▪ Revenues over $2 Billion

4. Our Purpose ▪ To gain a better understanding of where other facilities find themselves with Point of Service (POS) ▪ Share the “Ups and Downs” of implementing POS at LVHN ▪ Facilitate discussion for learning opportunities

5. Background ▪ Inconsistent cash collection procedures throughout LVHN ▪ Non existent pre-service cash collection for deductibles and co-insurance ▪ Collections based on co-pays identified on cards or electronic eligibility responses ▪ Missed opportunity to educate patients on patient financial responsibility ▪ Best practice survey identified opportunities for POS cash collection

6. Proposed Solutions ▪ Implement a payment estimator software system that incorporates contract information, procedure specific charges and insurance information to produce a valid estimate of services. ▪ Implement a workflow software system that incorporates CPT codes and scheduled procedures to develop work list items and improve workflow. ▪ Implement a payment collection software system that allows for an automated process to collect money due at time of service, generate patient receipts, provide accurate point of service reporting, eliminate manual payment logs, and allow automatic payment remit processing via 835 to replace manual cash posting

7. Ideal State

8. ▪ Patients are educated on financial responsibility ▪ Automated POS cash collection process ▪ POS estimates are accurately completed and communicated to the patient prior to DOS ▪ Collection process is automated and auto posted to the patient account ▪ Standardized and automated metric reporting ▪ Smooth system integration ▪ Increased revenue Ideal State

9. What does POS mean to you? ▪ Copays from the insurance card? ▪ Deductibles? Coinsurance? ▪ Credit cards/checks/cash? ▪ Estimates? ▪ Systems ?

10. Where are YOU with POS? ▪ Patient types? ▪ All areas or limited? ▪ How long have you been doing it? ▪ Comfort level? Patients vs. staff?

11. What does POS mean to LVHN?

13. What does POS mean to LVHN? Process Flow ▪ Reservation from MD Office via fax or Order/Reservation request system ▪ Reservation stored in POS Workflow system (WS) ▪ Information sent to Patient Access from POS WS to create account in Hospital Information System ▪ Information sent to OR scheduling from POS WS to schedule case on OR system

14. What does POS mean to LVHN? Process Flow ▪ POS WS sends a work-list item to Eligibility Verification department ▪ From Eligibility Verification workflows are generated to: Pre-Certification Pre-Certification Benefits and Verification Benefits and Verification Pre-Admission Testing (PAT) Scheduling Pre-Admission Testing (PAT) Scheduling

15. ▪ Benefits and Verification POS WS is used to list patients who need to have the insurance information verified. POS WS is used to list patients who need to have the insurance information verified. Work list is generated for the Financial Counselors and Pre-Admission Testing area if patient has financial responsibility for procedure. Work list is generated for the Financial Counselors and Pre-Admission Testing area if patient has financial responsibility for procedure. What does POS mean to LVHN? Process Flow

16. ▪ Financial Counselor Creates Estimate using Payment Estimator System (PES) Creates Estimate using Payment Estimator System (PES) Sends letter generated from PES Sends letter generated from PES Follow up phone call/s to patients asking for payment using Payment Collection System (PCS) Follow up phone call/s to patients asking for payment using Payment Collection System (PCS) 1 st attempt for collection using PCS 1 st attempt for collection using PCS Charity / Payment Plans / Additional Insurance Charity / Payment Plans / Additional Insurance

17. What does POS mean to LVHN? Process Flow ▪ Financial Counselor, continued POS WS work-list item sent to Pre-Admission Testing area to notify collection status from the Financial Counselor POS WS work-list item sent to Pre-Admission Testing area to notify collection status from the Financial Counselor PAT staff document PES to update collection status PAT staff document PES to update collection status 2 nd attempt to collect using PCS 2 nd attempt to collect using PCS

18. What does POS mean to LVHN? Process Flow ▪ Date of Service Day prior report and estimates are printed out from the PES Day prior report and estimates are printed out from the PES Notes reviewed in PES to see collection status Notes reviewed in PES to see collection status 3 rd collection attempt using PCS 3 rd collection attempt using PCS Opportunity to collect / educate / offer financial assistance Opportunity to collect / educate / offer financial assistance

19. Where is LVHN with POS? Ups and Downs ▪ Patient types/locations Before POS initiative: Before POS initiative: – Emergency Room – Ambulatory (Limited) – Inpatient (Limited) – Recurring (Limited Rehab) After POS initiative: After POS initiative: – Emergency Room (Waiting…) – Ambulatory (All) – Inpatient (Increased) – Recurring (All Rehab) – Outpatient (Limited)

20. What does POS mean to LVHN? Ups and Downs ▪ Systems Before POS initiative: Before POS initiative: – Eligibility/Benefit Verification software – Insurance Company websites – Information from patient – Credit card machines – Manual logs, paper receipts After POS initiative: After POS initiative: – 3 new products, 2 replacement products, 4 different vendors – 2 paper workflow processes replaced – Detailed POS reporting

21. What does POS mean to LVHN? Ups and Downs ▪ Copays, Deductible, Coinsurance Before POS initiative: Before POS initiative: – ED, Rehab, 1 ASU location – Only copays in limited areas from cards or electronic eligibility After POS initiative: After POS initiative: – Rehab, All ASU locations, Diagnostic Care Centers, Financial Counselors, Customer Service, ED (still using old process) – Expanded collection to co-pays, deductible, and co-insurance for elective ambulatory and select in- patient procedures

22. What does POS mean to LVHN? Ups and Downs ▪ Credit cards/checks/cash Before POS initiative: Before POS initiative: – Cash, checks, credit cards – No eChecks – Manual posting After POS initiative: After POS initiative: – Cash, checks, eChecks, credit cards – Automated posting

23. What does POS mean to LVHN? Ups and Downs ▪ Estimates Before POS initiative: Before POS initiative: – No formal estimates After POS initiative: After POS initiative: – Interim manual process at one ASU location via excel spreadsheet. April 2011 - January 2012 – First use of payment estimation software, February 2012

24. ▪ How long have we been doing it? Before POS initiative: Before POS initiative: – Initial POS activities started in 2004 with collections of copays in the ED After POS initiative: After POS initiative: – New cash collection tool started in August 2011 – Estimation tool started in February 2012 What does POS mean to LVHN? Ups and Downs

25. Where is LVHN with POS? Ups and Downs…… ▪ Hurdles

26. Where is LVHN with POS? Ups and Downs…… ▪ Hurdles

27. Where is LVHN with POS? Ups and Downs…… ▪ Hurdles System System – Multiple systems, integration limitations – Vendor selection process Staffing Staffing – Skill set – Added workflow without addition of staff Patient Refusal Patient Refusal – Cannot require patient to pay prior to procedure – Insurance companies advising patients not to pay prior to insurance payment Scheduling physicians’ cooperation to provide accurate information to facilitate completion of the estimate Scheduling physicians’ cooperation to provide accurate information to facilitate completion of the estimate Economy Economy – Increase in Reduced Cost of Care and Medical Assistance applications

28. ▪ Comfort level - Patient vs. staff Unreliable electronic eligibility information limits the automated estimation capabilities Unreliable electronic eligibility information limits the automated estimation capabilities – Phone calls still appear to be more accurate Percentage of patients prefer to be balance billed after insurance Percentage of patients prefer to be balance billed after insurance What does POS mean to LVHN? Ups and Downs

29. Where is LVHN with POS? Ups and Downs…… ▪ Results- Elective Ambulatory and select Inpatient procedures Elective Ambulatory and select Inpatient procedures

30. Where is LVHN with POS? Ups and Downs…… ▪ Results- Elective Ambulatory and select Inpatient procedures Elective Ambulatory and select Inpatient procedures

31. ▪ Results- Elective Ambulatory and select Inpatient procedures Elective Ambulatory and select Inpatient procedures Where is LVHN with POS? Ups and Downs……

32. ▪ Results- Elective Ambulatory and select Inpatient procedures Elective Ambulatory and select Inpatient procedures Where is LVHN with POS? Ups and Downs……

33. Where is LVHN with POS? ▪ What are our future plans? Rollout to other outpatient departments Rollout to other outpatient departments Increase physician office compliance Increase physician office compliance – Expand volume of patient procedures – Increase estimate accuracy Expand to secondary insurance Expand to secondary insurance Training - ongoing…… Training - ongoing……

34. Where are YOU with POS? What is the answer for You? ▪ Training? ▪ Hurdles? ▪ Successful? How do you define it?