Assumptions and open decisions
Every assumption baked into this demo, what it affects, and who needs to confirm it before build.
8 of 8 decisions · 0 confirmed
wd-1 · Compensation calculation basis
- Assumption in this demo
- Provider compensation is calculated from actual collected revenue.
- Open question
- Should compensation be calculated from the original charge, allowed amount, insurance payments only, or total collected revenue?
- Why it matters
- The selected basis changes every provider compensation calculation.
- Owner
- Arvon Leadership
- Decision
- Pending
wd-2 · Patient-responsibility payments
- Assumption in this demo
- Copays, coinsurance, deductibles, self-pay amounts, and secondary payments are included when collected.
- Open question
- Are copays, coinsurance, deductibles, self-pay payments, and secondary insurance payments included in the compensation calculation?
- Why it matters
- This determines which revenue sources contribute to provider earnings.
- Owner
- Arvon Billing
- Decision
- Pending
wd-3 · CH and CH+ assignment level
- Assumption in this demo
- The patient receives a default classification that is copied to each encounter and may be overridden by an authorized administrator.
- Open question
- Is CH or CH+ assigned permanently to the patient, separately to each encounter, or according to another rule?
- Why it matters
- Patient-level and encounter-level classifications can produce different compensation results over time.
- Owner
- Arvon Leadership
- Decision
- Pending
wd-4 · Provider-payable event
- Assumption in this demo
- An earning becomes payable after the payment is posted and reconciled.
- Open question
- When does a provider earning become payable: when the claim is submitted, when payment is posted, when funds are deposited, or after reconciliation?
- Why it matters
- This determines pay-period timing and the risk of paying providers before funds are final.
- Owner
- Arvon Finance
- Decision
- Pending
wd-5 · Refunds, reversals, and recoupments
- Assumption in this demo
- Negative financial events create negative compensation adjustments in the current open pay period.
- Open question
- How should refunds, payer recoupments, voided payments, corrected claims, and other reversals affect previously calculated or paid compensation?
- Why it matters
- The system needs a consistent method for recovering overpayments and preserving an audit trail.
- Owner
- Arvon Finance
- Decision
- Pending
wd-6 · Existing-system integration
- Assumption in this demo
- The demo uses local data that represents EHR and remittance information.
- Open question
- Can the existing EHR provide an API, payment report, CSV export, database feed, or 835 remittance data?
- Why it matters
- The available data source determines whether calculations can be fully automated and how frequently information can be synchronized.
- Owner
- Implementation Team
- Decision
- Pending
wd-7 · Payroll and payment responsibility
- Assumption in this demo
- The system calculates payables and exports payroll-ready data but does not initiate a real provider payment.
- Open question
- Does the biller only calculate and export provider compensation, send it to a payroll system, or directly initiate provider payments?
- Why it matters
- This determines whether the production system needs payroll integration, accounting integration, ACH functionality, or only reporting.
- Owner
- Arvon Finance
- Decision
- Pending
wd-8 · Provider statement access
- Assumption in this demo
- Providers receive encounter-level compensation statements.
- Open question
- Do providers currently receive encounter-level statements, and should they have direct portal access to current and historical statements?
- Why it matters
- This determines provider permissions, portal requirements, data masking, and statement-delivery functionality.
- Owner
- Arvon Leadership
- Decision
- Pending