RCM Workflow Configuration
A user-driven tasking feature is introduced for the revenue cycle management system. Though currently limited to the Collection Manager, this feature will soon be expanded to all important billing modules. The configuration allows the creation of similar functional user groups (known as “Teams”) and the setting up of predefined workflow rules that would essentially drive the provisioning/allocation of a user’s daily tasks /user worklists. The benefits of this new feature are the following:
* Clearly defined work allocation with time expiration based on the configured rules.
* Work automation- No human intervention is required for the daily provisioning of work.
RCM workflow configuration is set up through Advanced Setup-> Billing Options(see Image 1). Click on ‘Configure’ to move to the Rule setup screen.
Rule Listing Screen
On clicking ‘Configure’ in the Billing Options page, the user is taken to the RCM Workflow Configuration screen where all the existing rules are listed. These rules can be edited using icon provided at the right end(Image 2).
Team Setup Screen
* Note: Functionality related to the fields Esc. Days, supervisor and Administrator will be implemented in future releases.
Rule Creation Screen
Fields in Rule Set Up Screen
|Rule Name||Name of the Rule; Provide a unique name|
|Rule Code||Unique code for the rule|
|Teams||Select Teams to be part of this rule; This is a multi-select drop-down.|
|Legal Entity||If rule is based on specific LEs, select the LEs. This is a multi-select drop-down|
|Provider||If rule is based on providers; Select the providers here; This is a multi-select drop-down|
|Payer ID||Multi-select drop-down; select the payer IDs for the rule|
|Payer Name||Multi-select drop-down; select the payer names for the rule|
|Payer Type||If the rule is to be based on payer types; select them; Multi-select drop-down|
|Case Type||If the rule is based on case types; select them; Multi-select drop-down|
|Denial category||If rule is based on certain denial categories, select them|
|Rank||If rule is based on claim rankings; select the required ranks here|
|Claim Age||If rule is based on claim age; select the range here giving the ‘From’ and ‘To’ days|
|UTL||If Untimely Filing Limit is included; provide the range here|
|Resp. Threshold||If response limit threshold is part of the rule, provide the range here|
|Bill Amount||If rule is based on the bill amount, provide the range here|
New RCM workflow in Collections Manager:
When a user logs into Collections Manager, the system will load only those claims assigned to the team of which the user is a part of.
Even so, the assigned to Filter will be defaulted to ‘ALL’ in the following scenarios:
a. If the user is not part of any team.
b. If user is assigned a team which is not assigned any Active rules.
c. If the account has not configured the new RCM workflow.
RCM Audit Log
RCM workflow configuration, Teams set up and adding users to teams are made available for audit and details can be viewed under the following Modules inside Audit Viewer:
RCM Workflow configuration, Teams, Team Users.