Automating RCM Workflow

Automating RCM Workflow for Multiple EHR/EMR Systems

For larger hospital systems and IDNs with multiple facilities, they can often include hospitals, clinics and physician practice groups with disparate EHR/EMR and Practice Management (PM) systems. Processing claims and payment information from multiple systems and clearinghouses can create certain challenges that result in business office inefficiencies and lost revenue.

The goal of RCMS is to collect all of the claim, payment and deposit information needed to post and reconcile on one platform, so that automating revenue cycle processes can be optimized for the highest level of data accuracy and workforce efficiency. Customized rules can also be applied in the workflow for specific client requirements, such as allocating funds to divisions or for routing defects and exceptions to specific groups or work queues. We also use this ‘aggregated data’ to create a more complete analysis of the revenue cycle throughout the entire organization, eliminating the need to manually duplicate information to spreadsheets for management and reporting purposes.

For Health Systems and IDNs with multiple EHR/EMRs and PM systems, our ReSolve® A/R Management Platform provides the means to consolidate resources and improve business office processes – providing additional time for more productive tasks such as A/R collections and customer service. By using Intelligent Automation (IA) for improving workflow processes across multiple systems, we can significantly reduce and/or eliminate repetitive data entry that is prone to human error and a waste of valuable resources. Our integration with OnBase ECM, also provides significant staff efficiency with being able to retrieve and view correspondence documentation, indexed to the patient account.

In supporting a multi-system, complex business environment, some of the many benefits of ReSolve® include:

  • Automated repetitive tasks in conjunction with machine learning
  • Automated splitting/parsing of EDI transactions for more efficient processing
  • Connects multiple billing systems where APIs don’t exist
  • Hospitals and Practice Groups can maintain existing EHR/EMR and PM Systems
  • All ERA correspondence can be captured and indexed to the patient account for data validation, evidence of pre-authorizations and efficient follow up
  • BAI integration for full bank reconciliation from deposits to the individual billing systems
  • Robust reporting tools with integration to Microsoft Power BI and SSRS data visualization
  • Data analytics with drill-down capabilities for decreasing and preventing denials – and for creating permanent revenue cycle improvements
  • All revenue data is stored for auditing compliance with regulatory requirements
  • Workflow solutions for Eligibility (270 / 271) and Claims Status (276 / 277) inquiries
  • Allows staff to be more productive and focus on higher-value work

Working with RCMS

In partnership with your Accounting and IT teams, RCMS can work with your organization to develop a strategic plan that explores all areas of the revenue cycle. We bring decades of healthcare business office and software design experience that will help to improve your operations. Contact RCMS to schedule a discovery call or presentation of our company and its technology.

Healthcare Bank Treasury Reconciliation

Enterprise-Level Reconciliation from Payment Posting to Bank Deposits

Providing end-to-end reconciliation, from payment posting to bank deposits, ReSolve® Treasury Workstation turns your lockbox payment data into an exception-centric workflow that automates the matching and reconciliation of all posted and distributed remittances back to their associated lockbox deposits, without the need of third-party spreadsheets or manual re-entry of data.

ReSolve® Treasury Workstation automates the capture of electronic deposits received from your bank’s Banking Association Institute (BAI) data to create the source record for enterprise-level reconciliation. This includes multi-system environments in a centralized business office with two or more EHR/EMR billing systems.

With batch tracking and artificial intelligence (AI), all data is divided into four (4) areas: Bank Deposits; Treasury or Cash Journal; RCMS’ ReSolve® Payment Distribution; and the Host Billing System(s) for payment disbursements. The Cash Journal displays the Finance Department’s batching process for all deposits. The RCMS user interface displays the batches as posted in its Payment Processing system, and the Host Billing System displays batches as distributed to each unique billing system.

Contact RCMS

Are you ready to automate and improve your business office? ReSolve® provides workflow automation and data quality benefits that significantly improve revenue cycle processes and KPIs — with synchronize data for adjustments and transfers.

Contact RCMS today to schedule a discovery call and demonstration.

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Fundamental Design Principles for Effective Cash Management

What are your revenue cycle improvement goals for 2024 and beyond? By integrating with your EHR host billing system (or multiple systems), Clearinghouses and other Line of Business (LOB) applications, the RCMS ReSolve® A/R Management Platform can automate workflows that significantly improve a wide array of cash management and revenue cycle processes.

Below are some of the key areas we address when working with our Integrated Delivery Network & Health System clients.

Steps Toward Improving Cash Management:

  • Integrate with host billing systems
  • Synchronize data for adjustments and transfers
  • Same day processing of today’s receipts
  • Use best available capture solutions
  • Capture all adjudication data
  • Automate the separation of remittance with parsing/splitting technology
  • Use data validation rules to cleanse, scrub and normalize payment data
  • Provide reconciliation from bank deposit through billing system to corporate general ledger (GL)
  • Monitor key revenue cycle performance metrics by payor, provider, or division
  • Identify the source of denied claims to resolve the root cause
  • Ensure that claim processes are audited to stop recurring denials

By integrating multiple healthcare information systems and revenue cycle applications with a common A/R Management Platform, RCMS can increase productivity, automate workflows and identify defects for timely adjudication. These steps will improve your cash management processes and reduce your cost to collect.

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Contact RCMS

Contact RCMS today to improve your cash management with the right design principals, systems integration experience, and software technology. We’ll help to improve revenue cycle processes for your entire business office.

Outsourced RCM Services

Augmenting Your Business Office Staff with Outsourced Payment Processing

For many physician groups, medical clinics and hospitals, staffing shortages in the business office have contributed to a variety of cash flow obstacles. A/R backlog continues to affect cash management as the volume of unpaid claims is a constant concern. In a recent article published by Becker’s Hospital CFO Report, one Vice President of Revenue Cycle at a health system with 25 locations was quoted as saying that “high vacancies and leaves of absence are the top issue for many RCM departments.” Another commented that “My key focus right now is staff stabilization” (see Becker’s Hospital Review, October 5, 2022).

Adding to the complexities of maintaining revenue, many health systems are also in the process of updating or changing their outdated EMR/PM systems and legacy billing applications. Mergers and acquisitions also bring into play a significant amount of training and manual work to reconcile, distribute and report on all payments being posted (or re-worked) from multiple locations, business units, divisions and HIM sources.

Outsourcing RCM Functions

In obtaining help with outsourced RCM services, options range from more targeted areas of need to outsourcing a large portion of the entire revenue cycle. Many vendors specialize in one specific area, such as patient access, billing, coding or the collection of unpaid claims. Whatever your priorities are for staff augmentation, or with eliminating a constant backlog, identifying the right vendor is critical to making the process as efficient and effective as possible. One of the first steps in planning is to identify those processes where a vendor (or multiple vendors) can deliver the most financial impact within a designated time frame.

How Can RCMS Augment Your Business Office?

Along with ReMedics LLC, our BPO sister company, RCMS can provide for a variety of payment processing, data validation and bank reconciliation services that can optimize financial performance, reduce posting backlogs and increase cash. We can also assist with the splitting of ERAs to help with payment posting to legacy systems while going through a systems migration.

With the use of Robotic Process Automation (RPA) and other data management technology, our BPO services can also include the processing of PLB adjustments, co-pays, deductibles, co-insurance, transfers, write-offs, take-backs, remark codes, denials and much more.

RCMS Data Validation

Our Data Validation services ensure that correct information is applied to the patient account by helping to scrub and cleanse all of the captured data prior to posting. Once the data is received, our proprietary ReSolve® A/R Management Platform and automated workflow solutions will automatically begin to apply client-defined rules that find potential cash application errors before posting. We route those exceptions back to the client through dynamic worklists, while sending the validated information to the host billing system for posting.

RCMS Reporting & Data Analytics

RCMS provides pre-defined detailed reports and scorecards with key performance indicators (KPI) and other relevant data needed for monitoring of all the work being performed — across all departments and divisions. Clients also have the option to incorporate Microsoft Power BI as a data source for drill-down analytics and statistical analysis.

Contact RCMS

Let us know some details about your business office and outsourcing requirements. RCMS can arrange for a Cost/Benefit ROI Analysis and develop a detailed project plan. Long-term strategies for implementing permanent change, including the use of workflow automation technology, should also be considered. Contact RCMS today to improve your cash flow and entire revenue cycle.

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