Denial Management Software

Reducing Denials with Integration, Automation, ECM and Analytics

Minimizing Payment Delays with Synchronized Activity Across Multiple Applications

RCMS works to improve a wide range of revenue cycle areas where changes to manual work processes and the use of workflow automation technology can have a significant impact on the financial performance of healthcare provider organizations. Our ReSolve® Denial/Defect Management enables simultaneous access to both billing and ECM document imaging systems — a key step for creating efficient workflow. It first queries eligibility and authorization files to determine a course of action, then routes the denials to appropriate work queues. ReSolve® then facilitates decisive activities with predesigned correspondence and tracking capabilities, from generating appeals through rebilling and payment.

An optional component of the ReSolve® A/R Management Platform, the Denial/Defect Management module can track follow-up pursuits by user, KPIs and work queue, enhancing departmental oversight and staff performance.

In addition to providing configurable worklists for more efficient and organized user activity, ReSolve® can also synchronize denial and appeal actions to multiple EMR/EHR billing applications and/or Practice Management systems. This is extremely beneficial to Central Billing Offices (CBOs) having to reconcile and post payments for multiple systems.

Our ‘connected systems’ approach unlocks the potential of extensive data generated as a result of revenue cycle processes. Integrated with Hyland Software’s OnBase Enterprise Content Management (ECM) solution, the ReSolve® Platform combines the advantages of ECM with systems integration and automated workflow. With this capability, RCMS clients have access to automated reports, drill-down data analytics, pivot charts and customized scorecards — where denial trends can be analyzed and traced to specific areas, from patient access and eligibility to individual physicians and departments. By identifying the root cause of denials and taking corrective actions, the initial denial rate of future claims is therefore reduced.

With enhanced productivity through improved data collection and automated workflow processes, our ReSolve® applications can work across your entire revenue cycle for a tightly integrated solution. Contact RCMS to discuss all of your remittance processing, data validation, treasury reconciliation and denial management objectives.

RCMS Follow Up & Collections

Maintaining A/R Management Processes In Migrating to a New System

Depending on the EMR systems and other purpose-built applications being used, a “rip and replace” migration strategy that dramatically changes A/R management and financial reporting processes can significantly effect revenue and collection cycles essential to a steady cash flow.

RCMS’ proprietary technology and systems integration experience allow us to specialize in the capture and conversion of all data types from disconnected information silos. By utilizing our ReSolve® A/R Management Platform that is designed to be a system agnostic front-end solution, we can leverage the most current RPA and AI technologies to optimize all the revenue cycle information being generated or received.

By integrating with the host billing systems, practice management systems, enterprise content management (ECM), and other line of business (LOB) applications, RCMS can improve data accuracy and automate workflows to significantly enhance your cash management and revenue cycle processes. This also provides for a more strategic and successful migration – with minimal disruption to cash flow.

Please visit our Systems Integration page for additional information.

Keys to Maintaining A/R Processes

  • Integration with host billing systems
  • Use best available capture solutions
  • Same day processing of today’s receipts
  • Capture all adjudication data
  • Automate separation of remittance data
  • Use data validation rules to cleanse, scrub and normalize payment data
  • Provide reconciliation from bank deposit through billing system to general ledger (GL)
  • Performance monitoring metrics by payor/user

Working with RCMS

At RCMS, we are experienced in working with most every major EHR/EMR, Clearinghouse and PM system. We utilize Artificial Intelligence (AI) and Robotics Process Automation (RBA) in order to enhance and automate workflow for a wide variety of medical claims and billing processes. Our solutions, featuring the ReSolve™ A/R Management Platform, provide business process improvements in all areas of the revenue cycle. Contact RCMS about helping to develop a systems migration strategy for your organization.