Missing or incorrect information collected at any point in the healthcare revenue cycle can ultimately result in a claim being denied. The use of bots and AI by insurers is also making it easier for them to deny payment. According to a recent survey published by the American Medical Association (AMA), three in five physicians (61%) are concerned that health plans’ use of AI is increasing their prior authorization denials1. Because of this, improving data quality and account follow up is necessary now more than ever. One of the ways to combat this issue is to take a more aggressive, comprehensive approach to both reducing denials and working them with more efficiently.
ReSolve® automates critical business processes, work queues and reports, allowing staff to identify and address denial issues much faster. For even greater efficiency, ReSolve® also provides for the capture and indexing of correspondence documents. Links to the correspondence are then added to our worklists for one-click access and review.
Implementing Workflow Automation and Tracking Performance
When you’ve done everything possible in your bill editing to prevent unnecessary errors, account follow-up can be limited to only those issues that truly need a collector’s attention. ReSolve® Denial Management is a comprehensive workflow solution designed to improve cash by enabling follow-up staff to work and resolve more accounts, reduce cost to collect by automating follow-up activity, reduce A/R days by enabling you to predict and prevent denials, and to track performance with dynamic, drill-down reporting and charting tools. The results are reduced costs, lower A/R days and improved collections.
ReSolve® Solution Benefits include:
- Automated payment posting: Streamlining and automating the capture and posting of payment information
- Payment variance resolution: Identifying and resolving payment variance issues
- Credit balance account follow-up: Identifying and resolving credit balance accounts
- Aged account follow-up: Identifying and managing accounts that have been billed, but no payment or denial has been received
- Claim status follow-up: Begin early follow-up on denials using claim status
- Uncoded/unbilled charges follow-up: Identifying and resolving uncoded/unbilled charges
- Automated denial reconciliation: Automatically closes denials when manual payments or adjustments are made in your billing system
- Detailed reporting by any required parameters for divisions, payors, locations, etc.
About RCMS and ReSolve®
Utilizing AI and workflow technology, each ReSolve® module substantially increases data capture and business process automation in key areas of need for hospitals, physician groups or health systems. These inter-related, layered modules are designed to attack specific deficiencies in common revenue stream processes that typically need improvement and waste valuable staff resources.
ReSolve® is complimentary to existing billings systems, also known as ‘host systems’, and other disparate software technology. As systems integrators, RCMS can connect these various Healthcare Information Systems (HIS) with RCMS designed interfaces, in addition to those of our business partners.
Contact RCMS today to learn more about all of our Revenue Cycle Management solutions and services. Contact us online — or call 440–671–7750.
Citations
1American Medical Association (AMA): February 25, 2025 – Physicians Concerned AI Increases Prior Authorization Denials.