Category Archives: Revenue Cycle Management

Business Intelligence

Maximizing the Potential of Your Revenue Cycle Business Intelligence

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Implementing changes in the healthcare business office across a network of disparate HIT systems can be a difficult task. Uncovering the full potential of your billing and payment data is a key element to ensuring the success of those changes.

RCMS solutions include customized Power BI Scorecards that can help to drive accelerated decision making to your revenue cycle. To start, we provide the means to capture and process all payments, denials, exceptions, adjustments and deposit information 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 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 disparate information silos, 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!

CBO Multiple Billing System Environments

Reducing Manual Work in CBO Multiple Billing System Environments

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As systems integrators, RCMS can connect to multiple Healthcare Information Systems (HIS), in addition to those of our business partners. This includes multiple billing systems for the processing and posting of payments in a Central Business Office (CBO). With this connectivity in place, data-driven decision making can be automated, increasing the accuracy of information being processed – while reducing manual efforts for information capture, image capture, data entry, routing, and verification.

For RCMS clients with multiple EMRs and billing applications, the RCMS ReSolve™ A/R Management Platform provides the means to consolidate resources and improve business office processes – without having to eliminate hard to displace, vested systems. ReSolve™ is complimentary to existing billings systems, also known as ‘host systems’, and other disparate software technology.

In many cases, ReSolve™ is utilized in complex, multiple billing system environments specifically because of its ability to act as a common front-end interface for the posting of payments.

Central Business Office Keys to Success

  • Streamlined data capture from all systems, banks and clearinghouses
  • Improved processes with data-driven decision making technology
  • Reduced manual efforts with data validation, reconciliation and payment posting
  • Enhanced billing system functionality – at less cost than to upgrade or replace
  • Connected inter-related systems with proprietary custom interfaces
  • Allow for the sharing of information across multiple departments
  • Avoid missing data & incomplete claims, preventing denials
  • Automated payment posting and follow-up worklists
  • Integration & support for OnBase ECM document imaging
  • Detailed management reporting & real-time analysis
  • General ledger (GL) integration capabilities
  • Increased net collections & reduced risk of non-payment
  • Reduced or eliminated click-fee based expenses
  • Long term strategies for the consolidation of resources

Contact RCMS

RCMS and ReSolve™ will substantially improve key areas of need in your business office. With our ‘bolt-on’ technology enhancing and integrating your systems, key revenue cycle management objectives, from beginning to end, can be systematically targeted and achieved. Revenue Cycle BPO Services by our sister-company, ReMedics LLC, can also augment our software solutions and provide a long-term continuation of our business partnership.

 Contact RCMS about improving revenue cycle processes for your business office.

RCMS Cash Management Prinipals

Cash Management Fundamental Design Principles for 2023

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What are your revenue cycle improvement goals for 2023? By integrating with host billing systems, practice management systems, and other line of business (LOB) applications, RCMS can automate workflows that will significantly improve your 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.

Keys to Improving Cash Management:

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

By integrating multiple healthcare information systems (HIS) and Hyland’s OnBase enterprise content management (ECM) system with a common user interface, RCMS can increase productivity, identify defects for timely adjudication, and reduce your cost to collect.

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 processes for your entire business office!

Revenue cycle workflow automation benefits

RCMS Revenue Cycle Workflow Automation Benefits

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RCMS works with Integrated Delivery Networks (IDN) and multi-facility Health Systems to implement solutions aimed directly at improving their existing financial system(s). Below are a series of benefits that our ReSolve™ Revenue Cycle Management (RCM) Software can provide, including lower operating costs, streamlined procedures, denial tracking, and increased cash flow. If you’re looking to implement workflow solutions in your business office, contact us today to schedule a cost/benefit analysis.

Revenue Cycle Productivity Benefits:

  • Automated capture of patient and payment information from high volume paper-based EOBs
  • Reduced cash posting staff required for data entry
  • Elimination of posting distribution steps through improved data validation rules
  • Improvement of existing EDI matching and error correction time spent working electronic remittances
  • Elimination of manually creating reconciliation, user productivity and A/R reports
  • Automated capture, routing, and prioritization of denials information
  • Automated secondary billing process for required generation of matching EOB’s

Posting Accuracy Benefits:

  • Uniform application of data validation rules for all transactions, without error, twenty-four hours a day, seven days a week
  • Elimination of human interpretation and decision making during cash posting including facility matching and distribution process
  • Automated capture of a complete audit trail of payment batches and monitoring of batch integrity and balancing for all facilities
  • Comprehensive user productivity reporting of business office staff

Cash Flow Benefits:

  • Automated secondary billing for all payers currently being processed manually
  • Posting of all payments within 48 hours from receipt, reducing account follow up on payments that have already been collected
  • Improving accuracy and quality of patient statements
  • Lower AR days

Denial Management Benefits:

  • Capture of all denials, automatically routing them to predefined work queues for improved account qualification and user productivity
  • Automated tracking and trending of denials for complete process improvement throughout the entire revenue cycle
  • Easier assessment of the impact of follow-up activities
  • Automated documenting of increased cash flow from denials improvements.
  • Identification of denial patterns that are in violation of payor contract agreements
  • Improved reporting – including payments on denials and user productivity indicating how successful each collector’s efforts are in the appeal process

Enterprise Content Management (ECM) Benefits:

  • Efficient organization of data and documents in a central repository
  • Eliminates disparate, disconnected content silos
  • Improved customer service
  • Document version control
  • Integration with other systems
  • Provides for hosted or on-site installation

Contact RCMS

RCMS brings decades of healthcare business office experience to your organization. We can provide a wide range of proven RCM solutions that provide for significant productivity gains and cash management benefits. Contact RCMS about automating workflow in your business office.

PLB adjustments lookup

Streamlined PLB Adjustments with Payment History and ICN

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RCMS automated workflows and worklisting tools can increase efficiency, improve data accuracy, generate work queues and many other time-saving benefits. Identifying Provider Level Adjustments (PLB) within your ERA payments is just one example of how systems integration and workflow automation can be utilized to reduce and often eliminate manual data-entry tasks.

ERAs and Provider Level Adjustments

Provider level adjustments are reported in the 835 ERA records received by healthcare providers from insurers. PLB adjustments can decrease the payment or increase the payment depending on each remittance. In order to post payments into the patient accounting system, PLB information must be taken into consideration.

According to American Medical Association, “The ERA can include multiple types of reductions that are not specific to a claim reported in that ERA, or even reductions and payments not related to claims at all. Since the ERA is intended for computer processing, it is important that the Practice Management Systems track these adjustments back to the original claims, when appropriate, for automation and basic validation.”

Examples of provider level adjustments include:

  1. Recovery of overpayments
  2. Balance forward (when recovery of overpayments exceeds payments in a specific ERA)
  3. IRS withholding
  4. Capitation payments
  5. Performance bonuses
  6. Interest payments
  7. Recovery check acknowledgment

See the American Medical Association’s document Electronic Remittance Advice Processing Tips for additional information.

Driving Automation in the Revenue Cycle

Balancing for a single remittance that requires the total paid amount be equal to the total submitted charges (after PLB adjustments) can be labor intensive. Systems integration technology that connects all of the patient, insurance, claim and payment information, can provide significant opportunities to reduce manual work processes. With the use of Enterprise Content Management (ECM) and automated data validation rules, many of today’s patient accounting challenges can be enhanced and streamlined. Where the data is available, RCMS can automatically populate PLB adjustments that result in a zero balance for auto-posting. The key is having access to real-time data in order to drive automation and create greater efficiencies. Where adjustments can’t be identified, we create worklisting tools with the payment history and ICN information for staff to more effectively process the remittance prior to posting.

About RCMS

RCMS brings decades of healthcare business office experience to improve your revenue cycle. Our solutions are customized to work with your core applications and deliver significant time-saving improvements throughout the organization. Contact RCMS about improving your workflow processes.

managed services providers

Managed Service Providers (MSP) and HC Revenue Cycle Improvements

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For many healthcare delivery organizations, working with a Managed Service Provider (MSP) for specific IT, workflow and data management needs is an important part of their infrastructure. MSPs come in many different shapes and sizes and can range from remote support for software as a service (SaaS) to the outsourcing of data aggregation processes. These business relationships can often transpire as part of prior outsourced assignments that lead to long-term, strategic goals. MSPs can also provide Consulting Services that range from discovering inefficiencies in a single department to implementing an enterprise-wide solution.

A likely candidate for an MSP in healthcare is with revenue cycle management. RCM processes are typically improved with data capture, workflow automation technology and systems integration. Having the ability to integrate data between departments and other solution partners is a key element toward exceeding revenue cycle benchmarks, such as Initial Denial Rate and Days in AR.

Enterprise Content Management (ECM), combined with business processes automation (BPA), is another example of how MSPs can be utilized for improving back-office processes. Especially those that are document-driven, such as AP and Customer Service.

Other popular areas for contracting with an MSP is in billing, credentialing, coding, contracting, compliance and Systems Management. Look for an MSP that specializes in your specific business process and data aggregation needs.

About RCMS

RCMS Revenue Cycle Management Improvement Strategies are a blend of Business Management Consulting, Workflow Automation technology and Systems Integration for just about any type of healthcare business office need. Contact RCMS about improving processes for your organization and if a managed service contract is of interest to your organization.