RCM-003Billing

Payor - Restriction on the BC selection option based on the comments section within that payor

Revenue Cycle Transformation

Recommended pathRoadmap / Innovation
Capability status
To be confirmed with PRN
Transformation phase
To be confirmed with PRN
Effort
To be confirmed with PRN

Current State / What We Learned

Observed today, as captured in the corrected assessment.

This is an option currently for P payors that we can add <BC:P> within the comments to limit the selection for that payor record to only the billcode of P.

Desired Future State

The target way of working PRN and Raintree are aiming for.

To help prevent mistaken selections the team would like the option for other payors to be able to indicate that the billcode can NOT be a P payor.

Requirement / Gap

Currently there is not an option and we are not prevented from adding a payor as a P billcode if the comment reads as <BC:<>P> which would be read as the Billcode is greater or less than (meaning not equal to) P.

Raintree Recommended Path

This would be an option to limit payors like the <BC:P> comment that would only allow a payor to be selected as a P, but instead would be something like does not equal a P. Currently this would be a custom request or a suggestion for a future enhancement.

Dependencies / Considerations

N/A as this would be an added safety precaution

Outstanding Questions / Decisions

N/A - The concern is that users may mistakenly select an insurance and place it in the P payor position mistakenly.

Evidence

Supporting screenshot 1 for RCM-003 — Payor - Restriction on the BC selection option based on the comments section within that payor

Supporting screenshots from the corrected Detailed Transformation Assessment.

Source

Detailed Transformation Assessment (Corrected)