Under Payment Detection
Revenue Cycle Transformation
- 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 currently only in place within PRN database with some default values.
Desired Future State
The target way of working PRN and Raintree are aiming for.
Under payment detection is an option that can be refined and added continually to help surface scenarios where insurance is paying short of the anticipated reimbursement.
Requirement / Gap
This is a forward looking option to help ensure that payors are paying up to the contractual expectations.
Raintree Recommended Path
This can be defined differently for payors that reimburse based on a fee for service model or a flat fee per visit. Below will be a link to slides from prior TherapyCon sessions that demonstrate not only how to define these behind specific payors but also how to run reporting to help in ensuring the targets defined are in line with actual reimbursements received. Link: Underpayment Detection - Slides TherapyCon 2025.pdf
Dependencies / Considerations
Not discussed on call however noted in database
Outstanding Questions / Decisions
To be confirmed with PRN
Evidence
Supporting screenshots from the corrected Detailed Transformation Assessment.
Source
Detailed Transformation Assessment (Corrected)Related opportunities
Related by workstream and subject matter. These are not stated dependencies unless the assessment says so.