RCM-004Billing

Scheduling Restrictions in the Provider Table

Revenue Cycle Transformation

Recommended pathTo be confirmed with PRN
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.

When there are filtered entries for a provider within the provider table the option for scheduler limitations is no longer available. The schedule limitations only are an option to define behind a default entry for a specific provider.

Desired Future State

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

  • There are a few goals that would be desired:
  • A. No changes need to the current method used to structure entry of providers into the provider table where they are only applicable to the locations at which they actually treat
  • B. This would allow to set scheduling restriction rules specific for filtered entries based on insurance/payor to correspond with the provider’s credential status

Requirement / Gap

The schedule limitations only are an option to define behind a default entry for a specific provider.

Raintree Recommended Path

This would be an enhancement that would allow the scheduler restrictions to be put in place specific to the filtered entries within the provider table.

Dependencies / Considerations

Consider that the structure of the provider table currently includes filters for each provider for the locations at which they actually work out of.

Outstanding Questions / Decisions

When adding a filtered entry for providers this in turn causes the tab for setting scheduling restrictions to go away. The typical workflow is that the PRN team will always put provider in with filter to a typical location they work at, but they want the scheduling restrictions to put things such as "particular appt types are disallowed" for example that IE - initial eval is disallowed if this person is a PTA or there is a specific insurance filtered entry that the provider may not yet be credentialed with that payor.

Evidence

Supporting screenshot 1 for RCM-004 — Scheduling Restrictions in the Provider Table

Supporting screenshots from the corrected Detailed Transformation Assessment.

Source

Detailed Transformation Assessment (Corrected)