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.

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.

Business Intelligence

Maximizing the Potential of Your Revenue Cycle Business Intelligence

Uncovering hidden trends within your billing and payment data can play a critical role in developing a strategic, successful revenue cycle plan — and in monitoring the progress of incremental modifications. This is especially true when implementing changes in the across a network of disparate HIT systems.

RCMS solutions include customized Power BI Scorecards that can help to drive accelerated, intelligent decision making in your revenue cycle. To start, we provide the means to capture and process all payments, denials, exceptions, adjustments and follow up activity from multiple business systems into a single A/R management platform. This allows for a variety of scorecards to be created by payers, business units, specialty groups and facility locations. With the reporting and visualization features provided by Microsoft’s Power BI, our scorecards help to quickly identify and correct problematic areas that lead to sustained, measurable improvements.

RCMS Power BI Features

  • Systems integration experience with healthcare delivery networks
  • Ability to connect with disparate data sources
  • Customized scorecards for each revenue cycle area
  • Accelerated decision making with real-time data visualization
  • Denials scorecard by payers, physicians, business units and locations
  • Analytic data available from desktop, tablet or smartphone
  • Ability to share scorecards with all department managers
  • Options for self-serve reporting & dashboard manipulation

Contact RCMS

RCMS can help Hospital Systems, IDNs and Practice Groups to leverage and enhance their existing core business systems. By identifying negative trends and inconsistencies across multiple sources of rev cycle information, we can help to develop changes and/or make corrections to current technology and processes. Contact RCMS today about maximizing the power of your business intelligence.