Implementing POS at LVHN The Ups and Downs Lynnette Clinton – Manager, Rev Cycle Systems Tricia...

Implementing POS at LVHNImplementing POS at LVHNThe Ups and DownsThe Ups and Downs

Lynnette Clinton – Manager, Rev Cycle SystemsLynnette Clinton – Manager, Rev Cycle Systems

Tricia DeBlass – Subject Matter ExpertTricia DeBlass – Subject Matter Expert

Stephanie Erwin – Systems AnalystStephanie Erwin – Systems Analyst

Mary Beth McMenamin – Manager, Patient ReceivablesMary Beth McMenamin – Manager, Patient Receivables

Who We AreWho We Are▪ Largest academic community Largest academic community

hospital in PAhospital in PA▪ Largest Level 1 Trauma Largest Level 1 Trauma

Center in regionCenter in region▪ Certified Comprehensive Certified Comprehensive

Stroke CenterStroke Center▪ Employees – 11,967Employees – 11,967▪ Medical Staff – 1,193Medical Staff – 1,193▪ Nurses – 2,334Nurses – 2,334

▪ Magnet HospitalMagnet Hospital

▪ 173,678 ED visits173,678 ED visits

▪ 54,056 admissions54,056 admissions

▪ 981 acute care beds981 acute care beds

▪ 3 hospital campuses3 hospital campuses

▪ Revenues over $2 BillionRevenues over $2 Billion

Our PurposeOur Purpose

▪ To gain a better understanding of where To gain a better understanding of where other facilities find themselves with Point of other facilities find themselves with Point of Service (POS)Service (POS)

▪ Share the “Share the “Ups and Downs” Ups and Downs” of implementing of implementing POS at LVHNPOS at LVHN

▪ Facilitate discussion for learning Facilitate discussion for learning opportunitiesopportunities

BackgroundBackground

▪ Inconsistent cash collection procedures throughout Inconsistent cash collection procedures throughout LVHNLVHN

▪ Non existent pre-service cash collection for deductibles Non existent pre-service cash collection for deductibles and co-insurance and co-insurance

▪ Collections based on co-pays identified on cards or Collections based on co-pays identified on cards or electronic eligibility responseselectronic eligibility responses

▪ Missed opportunity to educate patients on patient Missed opportunity to educate patients on patient financial responsibilityfinancial responsibility

▪ Best practice survey identified opportunities for POS Best practice survey identified opportunities for POS cash collection cash collection

Proposed SolutionsProposed Solutions

▪ Implement a payment estimator software system that Implement a payment estimator software system that incorporates contract information, procedure specific incorporates contract information, procedure specific charges and insurance information to produce a valid charges and insurance information to produce a valid estimate of services.estimate of services.

▪ Implement a workflow software system that incorporates Implement a workflow software system that incorporates CPT codes and scheduled procedures to develop work list CPT codes and scheduled procedures to develop work list items and improve workflow.items and improve workflow.

▪ Implement a payment collection software system that Implement a payment collection software system that allows for an automated process to collect money due at allows for an automated process to collect money due at time of service, generate patient receipts, provide accurate time of service, generate patient receipts, provide accurate point of service reporting, eliminate manual payment logs, point of service reporting, eliminate manual payment logs, and allow automatic payment remit processing via 835 to and allow automatic payment remit processing via 835 to replace manual cash postingreplace manual cash posting

Ideal StateIdeal State

▪ Patients are educated on financial responsibilityPatients are educated on financial responsibility

▪ Automated POS cash collection processAutomated POS cash collection process

▪ POS estimates are POS estimates are accuratelyaccurately completed and completed and communicated to the patient prior to DOScommunicated to the patient prior to DOS

▪ Collection process is automated and auto posted Collection process is automated and auto posted to the patient accountto the patient account

▪ Standardized and automated metric reportingStandardized and automated metric reporting

▪ Smooth system integrationSmooth system integration

▪ Increased revenueIncreased revenue

Ideal StateIdeal State

What does POS mean to you?What does POS mean to you?

▪ Copays from the insurance card?Copays from the insurance card?

▪ Deductibles? Coinsurance?Deductibles? Coinsurance?

▪ Credit cards/checks/cash?Credit cards/checks/cash?

▪ Estimates?Estimates?

▪ SystemsSystems??

Where are YOU with POS?Where are YOU with POS?

▪ Patient types?Patient types?

▪ All areas or limited?All areas or limited?

▪ How long have you been doing it?How long have you been doing it?

▪ Comfort level? Patients vs. staff?Comfort level? Patients vs. staff?

What does POS mean to LVHN?What does POS mean to LVHN?

What does POS mean to LVHN?What does POS mean to LVHN?Process FlowProcess Flow

▪ Reservation from MD Office via fax or Reservation from MD Office via fax or Order/Reservation request systemOrder/Reservation request system

▪ Reservation stored in POS Workflow Reservation stored in POS Workflow system (WS) system (WS)

▪ Information sent to Patient Access from Information sent to Patient Access from POS WS to create account in Hospital POS WS to create account in Hospital Information SystemInformation System

▪ Information sent to OR scheduling from Information sent to OR scheduling from POS WS to schedule case on OR systemPOS WS to schedule case on OR system


▪ POS WS sends a work-list item to POS WS sends a work-list item to Eligibility Verification departmentEligibility Verification department

▪ From Eligibility Verification workflows are From Eligibility Verification workflows are generated to: generated to: •Pre-CertificationPre-Certification•Benefits and VerificationBenefits and Verification•Pre-Admission Testing (PAT) SchedulingPre-Admission Testing (PAT) Scheduling

▪ Benefits and VerificationBenefits and Verification•POS WS is used to list patients who need to POS WS is used to list patients who need to

have the insurance information verified.have the insurance information verified.•Work list is generated for the Financial Work list is generated for the Financial

Counselors and Pre-Admission Testing area Counselors and Pre-Admission Testing area if patient has financial responsibility for if patient has financial responsibility for procedure.procedure.



▪ Financial CounselorFinancial Counselor•Creates Estimate using Payment Estimator Creates Estimate using Payment Estimator

System (PES)System (PES)•Sends letter generated from PESSends letter generated from PES• Follow up phone call/s to patients asking for Follow up phone call/s to patients asking for

payment using Payment Collection System payment using Payment Collection System (PCS) (PCS)

• 11stst attempt for collection using PCS attempt for collection using PCS•Charity / Payment Plans / Additional Charity / Payment Plans / Additional

Insurance Insurance


▪ Financial Counselor, continuedFinancial Counselor, continued•POS WS work-list item sent to Pre-Admission POS WS work-list item sent to Pre-Admission

Testing area to notify collection status from Testing area to notify collection status from the Financial Counselorthe Financial Counselor

•PAT staff document PES to update collection PAT staff document PES to update collection statusstatus

• 22ndnd attempt to collect using PCS attempt to collect using PCS


▪ Date of Service Date of Service •Day prior report and estimates are printed out Day prior report and estimates are printed out

from the PESfrom the PES•Notes reviewed in PES to see collection Notes reviewed in PES to see collection

statusstatus• 33rdrd collection attempt using PCS collection attempt using PCS•Opportunity to collect / educate / offer Opportunity to collect / educate / offer

financial assistancefinancial assistance

Where is LVHN with POS?Where is LVHN with POS?Ups and DownsUps and Downs

▪ Patient types/locationsPatient types/locations• Before POS initiative:Before POS initiative:

– Emergency RoomEmergency Room– Ambulatory (Limited)Ambulatory (Limited)– Inpatient (Limited)Inpatient (Limited)– Recurring (Limited Rehab)Recurring (Limited Rehab)

• After POS initiative:After POS initiative:– Emergency Room (Waiting…)Emergency Room (Waiting…)– Ambulatory (All)Ambulatory (All)– Inpatient (Increased)Inpatient (Increased)– Recurring (All Rehab)Recurring (All Rehab)– Outpatient (Limited)Outpatient (Limited)

What does POS mean to LVHN?What does POS mean to LVHN?Ups and DownsUps and Downs

▪ SystemsSystems• Before POS initiative:Before POS initiative:

– Eligibility/Benefit Verification softwareEligibility/Benefit Verification software– Insurance Company websitesInsurance Company websites– Information from patientInformation from patient– Credit card machinesCredit card machines– Manual logs, paper receiptsManual logs, paper receipts

• After POS initiative:After POS initiative:– 3 new products, 2 replacement products, 4 different 3 new products, 2 replacement products, 4 different

vendorsvendors– 2 paper workflow processes replaced2 paper workflow processes replaced– Detailed POS reportingDetailed POS reporting


▪ Copays, Deductible, CoinsuranceCopays, Deductible, Coinsurance• Before POS initiative:Before POS initiative:

– ED, Rehab, 1 ASU locationED, Rehab, 1 ASU location– Only copays in limited areas from cards or Only copays in limited areas from cards or

electronic eligibilityelectronic eligibility• After POS initiative:After POS initiative:

– Rehab, All ASU locations, Diagnostic Care Rehab, All ASU locations, Diagnostic Care Centers, Financial Counselors, Customer Service, Centers, Financial Counselors, Customer Service, ED (still using old process) ED (still using old process)

– Expanded collection to co-pays, deductible, and Expanded collection to co-pays, deductible, and co-insurance for elective ambulatory and select in-co-insurance for elective ambulatory and select in-patient procedurespatient procedures


▪ Credit cards/checks/cashCredit cards/checks/cash•Before POS initiative:Before POS initiative:

– Cash, checks, credit cardsCash, checks, credit cards– No eChecksNo eChecks– Manual postingManual posting

•After POS initiative:After POS initiative:– Cash, checks, eChecks, credit cardsCash, checks, eChecks, credit cards– Automated postingAutomated posting


▪ EstimatesEstimates•Before POS initiative:Before POS initiative:

–No formal estimatesNo formal estimates

•After POS initiative:After POS initiative:– Interim manual process at one ASU Interim manual process at one ASU

location via excel spreadsheet. location via excel spreadsheet. April 2011 - January 2012April 2011 - January 2012

– First use of payment estimation First use of payment estimation software, February 2012software, February 2012

▪ How long have we been doing it?How long have we been doing it?•Before POS initiative:Before POS initiative:

– Initial POS activities started in 2004 with Initial POS activities started in 2004 with collections of copays in the EDcollections of copays in the ED

•After POS initiative:After POS initiative:–New cash collection tool started in New cash collection tool started in

August 2011August 2011–Estimation tool started in February 2012Estimation tool started in February 2012


Where is LVHN with POS?Where is LVHN with POS?Ups and Downs……Ups and Downs……

▪ Hurdles Hurdles


▪ Hurdles Hurdles • SystemSystem

– Multiple systems, integration limitationsMultiple systems, integration limitations– Vendor selection processVendor selection process

• StaffingStaffing– Skill setSkill set– Added workflow without addition of staffAdded workflow without addition of staff

• Patient RefusalPatient Refusal– Cannot require patient to pay prior to procedureCannot require patient to pay prior to procedure– Insurance companies advising patients not to pay prior to Insurance companies advising patients not to pay prior to

insurance payment insurance payment • Scheduling physicians’ cooperation to provide accurate Scheduling physicians’ cooperation to provide accurate

information to facilitate completion of the estimateinformation to facilitate completion of the estimate• EconomyEconomy

– Increase in Reduced Cost of Care and Medical Assistance Increase in Reduced Cost of Care and Medical Assistance applicationsapplications

▪ Comfort level - Patient vs. staffComfort level - Patient vs. staff•Unreliable electronic eligibility information Unreliable electronic eligibility information

limits the automated estimation limits the automated estimation capabilitiescapabilities– Phone calls still appear to be more accuratePhone calls still appear to be more accurate

•Percentage of patients prefer to be Percentage of patients prefer to be balance billed after insurancebalance billed after insurance



▪ Results-Results-• Elective Ambulatory and select Inpatient proceduresElective Ambulatory and select Inpatient procedures

Where is LVHN with POS?Where is LVHN with POS?

▪ What are our future plans?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 proceduresExpand volume of patient procedures– Increase estimate accuracy Increase estimate accuracy

•Expand to secondary insuranceExpand to secondary insurance• Training - ongoing……Training - ongoing……

Where are YOU with POS?Where are YOU with POS?What is the answer for You?What is the answer for You?

▪ Training?Training?

▪ Hurdles?Hurdles?

▪ Successful? How do you define it?Successful? How do you define it?

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