Automated Workflow for 835 ERA Payment Processsing

Automated Workflow for Payment Processing and Data Validation

Using Artificial Intelligence (AI) and Robotic Process Automation (RPA) for Efficient Processing of ERA and Paper-Based Remittances.

ReSolve® Payment Processing provides for the efficient capture, management, and use of all patient, government and third-party insurance payment data to dramatically improve posting accuracy and exceed benchmarks. Our Payment Processing solutions integrate with existing host billing systems, through a variety of Data Capture, Artificial Intelligence (AI), and Robotic Process Automation (RPA) systems integration methodologies; thereby allowing for efficient and accurate processing of both ERA/EDI and paper-based remittances. Once complete, the system sends transactions directly to the billing system using native 835 file integration or client-definable RPA technology while monitoring denials and other conditions.

ReSolve® Payment Validation helps to correct any errors in remittance data prior to posting, regardless of how the data was captured. This automated workflow process is used to validate the entirety of information needed for processing, thus improving data integrity.

Once all information is captured, ReSolve’s Payment Validation begins analyzing the data with over 200 available client-definable business rules to scrub and cleanse potential errors prior to posting, while routing any errors back to exception work queues for user correction.

ReSolve® Reporting & Data Analytics unlocks the potential of your extensive data generated as a result of revenue cycle processes and workflows. Our platform provides for the automation, scheduling and distribution of reports on a daily, weekly, or monthly schedule via network share, email, SFTP and other delivery options.

With integration to Microsoft SSRS and Power BI tools, authorized users can tailor their own reports and scorecards with a ‘drag and drop’ interface, enabling managers to dynamically see report layouts as they are created.

RCMS brings decades of healthcare business office and workflow automation experience to improve your revenue cycle. We specialize in working with Healthcare Systems and IDNs having a Central Business Office (CBO) for processing payments across multiple EMRs and Practice Management systems. Contact RCMS for an assessment of your remittance and treasury reconciliation processes and how you can benefit from our solutions.

Connecting HIT with Systems Integration

Connecting Disparate Systems to a Single A/R Management Platform

Systems Integration for Aggregated Environments

Ensuring the smooth flow of claims from the Provider to the Payor, as well as funds from the Payor back to each Hospital or Practice Group, requires several different supporting organizations to receive and share information.

RCMS specializes in the capture and conversion of all data types from disconnected information silos, including HIT, Clearinghouses and Banking systems. This allows us to leverage the most current Robotics Process Automation (RPA) and AI Machine Learning technologies to efficiently verify and/or correct defects that can delay or reduce revenue from being collected. As a result, our ‘connected systems’ approach unlocks the potential of extensive data being generated from all your claims and remittance processes.

By capturing information from disparate systems and identifying bottlenecks at the various stages of reimbursement, our ReSolve® A/R Management Platform helps to maximize collections. Automation is achieved through seamless integration of account comments and other financial transactions within the host billing system(s), further promoting information sharing throughout the organization.

ReSolve® worklisting tools provide for definable qualification criteria, customizable sorting and filtering that makes it easier for users to resolve account deficiencies. By being proactive in account follow-up and having tools which present financial and clinical data in a user-friendly solution, your organization’s cost to collect can be significantly improved.

A significant amount of time and attention in revenue cycle management is reactive. Fixing claim errors, looking for missing information and reworking denials that ultimitely lead to delays and lost revenue. With the ReSolve® platform, bottlenecks and errors in processing claims, reconciling payments, and with managing denials can be analyzed and traced to a specific location, department or type of service. By connecting systems and data in an aggregated business environment, we can provide pre-scheduled reports, scorecards and analytical data that helps to identify hidden trends, isolate problem areas and implement changes that lead to permanent revenue cycle improvements.

Our Revenue Cycle Management (RCM) Strategies are a blend of Data Capture, Workflow Design, RPA, AI, Enterprise Content Management (ECM) and Systems Integration — connecting HIT systems, Clearinghouses, Banking partners and other Line of Business (LOB) applications to maximize efficiency. Contact RCMS today to schedule a call.

RCMA robotic process automation

Can RPA Technology Revolutionize Your Business Office?

A subset of Artificial Intelligence (AI), the goal of Robotics Process Automation (RPA) is to create a streamlined process where the need for human intervention is minimized and/or removed. Using RPA in healthcare business office applications can significantly reduce manual processes by mapping interactions between traditional data entry tasks and core Line of Business (LOB) information systems. RCMS can help your organization to develop an RPA implementation plan that explores all areas of the revenue cycle — where repeated processes can be substantially improved.

RPA Revenue Cycle Improvement Benefits

Robotics Processing Automation provides significant opportunities in the business office for creating permanent revenue cycle improvements, including:

  • Improved accuracy over redundant manual data entry processing
  • Unattended and attended claims and billing applications
  • Automated repetitive tasks in conjunction with AI and machine learning
  • A more productive staff, focused on high-value work
  • Ability to move data across healthcare information system (HIS) applications
  • Connecting disparate systems where APIs don’t exist
  • Data is efficiently stored for auditing and regulatory requirements
  • RPA processes can adjust and scale to changes in underlying systems

About RCMS

RCMS brings decades of healthcare business office experience to improve your revenue cycle. We can provide a wide range of Technology Solutions that provide for workflow automation and increased data quality. Contact RCMS about robotics processing automation for your business office.