New ABN Process Reduces Write-Offs and Increases Cash Flow At OHSU

In Brief

3-Minute Read

Through a 20-year relationship, Oregon Health & Science University (OHSU) and Huron have collaborated to address revenue cycle challenges and test innovative, forward-thinking performance improvement practices. As part of these efforts, OHSU implemented a best-practice Advanced Beneficiary Notice (ABN) process to increase cash flow and reduce ABN related write-offs.


A best-practice ABN process reinforces correct diagnoses selection by clinicians to maximize Medicare reimbursement, creates a process for educating patients about services not covered by Medicare and reduces administrative write-offs. While ABNs are critical, implementing an ABN process is challenging as it requires buy-in from many parties including physicians, department leadership and staff.

OHSU wrote-off nearly 17,000 patient encounters in fiscal year (FY) 2017. As they looked to automate their manual ABN process, they needed to address electronic implementation challenges at 360 locations.


OHSU sought to develop a leading-practice ABN process that seamlessly integrated into their electronic health record (EHR). OHSU and Huron created a process to address the needs of key stakeholders and minimize the number of clicks in the EHR while holding physicians accountable. To do so, we:

  • Developed a cohesive unified plan. Incorporated insights from physician, department leadership and information technology committees into the process.
  • Implemented a physician-focused approach. Engaged physicians in the planning and implementation process. The chief medical officer served as a physician champion and socialized changes with physician groups to gain buy-in and keep physicians informed.
  • Maximized existing technology investments. The EHR vendor and OHSU’s information technology team created the new process using OHSU’s existing technology, minimizing additional costs.
  • Developed physician and frontline toolkits. The training guides and procedural documentation served as resources for properly completing the ABN process within their respective workflows.
  • Facilitated virtual training. More than 5,000 employees, including 3,500 clinicians, were trained virtually through interactive online training programs.
  • Built custom reports. The new reports provide insights on unresolved ABN notices. They are discussed at daily department huddles.
  • Established a command center. To support clinicians during the transition to the new process, a command center offered real-time support and guidance.
  • Improved the patient experience. With an established process for educating patients about completing an ABN, OHSU staff are equipped to have conversations about cost.

OHSU is an academic medical center providing over one million patient visits annually. The public organization is dedicated to advancing health sciences.

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