Taking a Comprehensive Approach to Denial Management and A/R

Posted on April 30, 2025May 1, 2025

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 drill-down reporting and scorecards by division, payor, location and more
Customized denial worklist parameters by account balance, aging from billing, discharge, or last follow-up date

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.

Improving A/R Management with Proactive Workflow Processes

Posted on March 9, 2025March 17, 2025

RCMS’ solutions can improve a wide range of different patient billing areas where changes to manual work activities and the use of technology can have a significant impact on a health system’s financial performance. With the right tools and workflow processes, first-call resolution and time to collect patient payments can be significantly improved.

Using AI-powered solutions, our technology can prioritize accounts to work claim denials more efficiently. System generated worklists can automatically qualify accounts for proactive follow up. For customer service representatives, account inquiries provide a powerful tracking tool for A/R collections and patient communications.

By being proactive in account follow-up and having automated tools to present financial and clinical data in a user-friendly solution, your A/R Management KPIs can be significantly improved.

Denial & Appeals Management

To reduce denial rates, our ReSolve® AI & Workflow Automation technology can isolate medical claim denials/defects and prevents future re-occurrences. This decreases processing delays and helps to maintain cash flow. By identifying the source of each denied claim, Denial Management allows staff to resolve the root cause of denials, thereby reducing the initial denial rate of future claims. ReSolve® can also facilitate decisive activities with predesigned correspondence and tracking capabilities, from generating appeals through rebilling and payment. Department supervisors can also track follow-up pursuits by user and work queue, enhancing departmental oversight and staff performance.

Identifying Hidden Trends and Isolating Problem Areas

With access to claims and revenue cycle data from the Hospital the Physician Practice Group’s HIT Systems, RCMS clients can visualize and analyze real-time data using Microsoft’s Power BI and SSRS reporting tools. By providing drill-down data analytics, pivot charts and scorecards in our reporting options, managers and executives can quickly identify hidden trends, isolate problem areas and ensure that they have an up-to-the-minute view of their revenue cycle operations.

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
Proactively work denial defects and true denials
Provide reconciliation from bank deposit through billing system to GL
Monitor KPIs and performance metrics

Minimizing Disruption to Cash Flow with System Migrations

By integrating with all of your Line of Business (LOB) applications, RCMS can improve data accuracy and automate workflows to significantly enhance revenue cycle and treasury management processes. Our proven ReSolve® technology also provides for a more strategic and successful migration plan to a new EHR/EMR system – with minimal disruption to cash flow.

Contact RCMS about improving revenue cycle operations for your organization.

Reducing Denials with Integration, Automation, ECM and Analytics

Posted on April 11, 2024May 13, 2024

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.

Creating Permanent Revenue Cycle Improvements

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.

Working with RCMS

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.