Revenue cycle workflow automation benefits

RCMS Revenue Cycle Workflow Automation Benefits

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

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

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.


Correspondence & Third Party Follow Up for Revenue Cycle Management

PART 1 of a SERIES

RCMS Revenue Cycle Management Solutions cover a wide range of different patient billing areas where changes to manual work processes and the use of technology can have a significant impact on financial performance. In this article, we concentrate on three Post-Encounter areas that take place before payment processing, validation and bank reconciliation. These areas include: Correspondence Management; Third Party Follow Up; and Self-Pay/Customer Service.

Correspondence Management

By capturing and routing correspondence through rules based workflows, RCMS provides for items to be entered and worked faster, reducing turn-times and increasing productivity. The result is improved patient satisfaction and reduced callbacks. The key is having a solution capable of capturing correspondence in all forms, including: scanned mail, faxes, emails, or other business systems. Using the Artificial Intelligence (AI) and other technology, tasks such as auto-indexing, auto-classification and correspondence are routing automatically, directing documents to the appropriate personnel.

Third Party Follow Up

With patient liabilities continuing to rise, it’s important to find ways to collect co-pays/deductibles earlier in the process. RCMS can help to improve first-call resolutions, patient satisfaction and time to collect patient payments by providing immediate access to both clinical and financial data from both hospital and physician systems. Our proprietary, system generated worklists automatically identify accounts needing proactive follow up. For customer service representatives, our Account Inquiry function within AR Management provides a powerful tracking tool for activities and patient communications.

Self-Pay / Customer Service

By taking a proactive approach to AR management, processing delays are decreased, cash flows are increased, and overall cost to collect is reduced. RCMS provides a complete record of all outstanding payments and a history of denials. Accounts are tracked throughout the payment lifecycle, providing insight into where bottlenecks are occurring in claim generation and adjudication. Aged accounts are routed to user work queues for timely follow up.


About RCMS

RCMS Revenue Cycle Management Improvement Strategies are a blend of Business Management Consulting, Technology Solutions and Systems Integration expertise in connecting Health Information Management Systems (HIMS) and Line of Business (LOB) systems. Contact RCMS about improving the Revenue Cycle for your organization.


Payment Processing and Validation Strategies for RCM Improvements

PART 2 of a SERIES

RCMS Revenue Cycle Management Solutions improve a wide range of different patient billing areas where changes to manual work processes and the use of technology can have a significant impact on financial performance. In Part 1 of this Series, we discussed Correspondence Management, Third Party Follow Up, and Self-Pay/Customer Service.

In Part 2, we concentrate on three more Post-Encounter areas, including: Payment Processing; Payment Validation; and Treasury Reconciliation.

Payment Processing

By capturing and routing correspondence through rules based workflows, RCMS provides for items to be entered and worked faster, reducing turn-times and increasing productivity. The result is improved patient satisfaction and reduced callbacks. The key is having a solution capable of capturing correspondence in all forms, including: scanned mail, faxes, emails, or other business systems. Using Artificial Intelligence (AI) and other technology, tasks such as auto-indexing, auto-classification and correspondence are routing automatically, directing documents to the appropriate personnel.

Payment Validation

With patient liabilities continuing to rise, it’s important to find ways to collect co-pays/deductibles earlier in the process. RCMS can help to improve first-call resolutions, patient satisfaction and time to collect patient payments by providing immediate access to both clinical and financial data from both hospital and physician systems. Our proprietary, system generated worklists automatically identify accounts needing proactive follow up. For customer service representatives, our Account Inquiry function within AR Management provides a powerful tracking tool for activities and patient communications.

Treasury (Bank) Reconciliation

By taking a proactive approach to AR management, processing delays are decreased, cash flows are increased, and overall cost to collect is reduced. RCMS provides a complete record of all outstanding payments and a history of denials. Accounts are tracked throughout the payment lifecycle, providing insight into where bottlenecks are occurring in claim generation and adjudication. Aged accounts are routed to user work queues for timely follow up.


About RCMS

RCMS Revenue Cycle Management Improvement Strategies are a blend of Business Management Consulting, Technology Solutions and Systems Integration expertise in connecting Health Information Management Systems (HIMS) and Line of Business (LOB) systems. Contact RCMS about improving the Revenue Cycle for your organization.


RCMS A/R Collections and Denial Management Workflow Automation

PART 3 of a SERIES

RCMS Revenue Cycle Management Solutions improves a wide range of different patient billing areas where changes to manual work processes and the use of technology can have a significant impact on your financial performance. In Part 1 of this series we discussed Correspondence Management, Third Party Follow Up and Self-Pay/Customer Service. In Part 2, we focused on Post-Encounter areas that included Payment Processing Payment Validation and Treasury Reconciliation.

In Part 3, the last of this series, we concentrate on A/R Collections Management, Denial & Appeals Management, Contracts & Payor Rate Verification and Reporting & Data Analytics.

A/R Collections Management

RCMS helps to maximize collections by capturing information from disparate systems and identifying bottlenecks at the various stages of reimbursement. Automation is achieved through seamless integration of account comments and other financial transactions within host billing system, further promoting information sharing throughout your organization. Definable qualification criteria and customizable sorting and filtering make it easy for users to timely 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 organizations cost to collect can be significantly improved.

Denial & Appeals Management

To reduce denial rates, RCMS quickly isolates medical claim denials/defects and prevent future re-occurrences. This increasing cash flow and decreasing process delays. Denied claims are automatically captured and routed to the appropriate individuals, facilitating timely and effective follow-up with 3rd party payers. Denial trends can be analyzed and traced to specific areas — from patient access and eligibility to individual physicians, departments and type of service. 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 and providing a true process improvement solution.

Contracts & Payor Rate Verification

Having accurate historical data is critical to optimizing payor contract negotiations. RCMS ensures that your organization is receiving the best rate for services by automatically comparing reimbursements against payor contracts. With the payor rate matrix, you can systemically review all remittance data comparing against configured fee schedules. Exceptions are easily identified and routed to worklists for additional research and follow up.

Reporting & Data Analytics

Our ‘connected systems’ approach unlocks the potential of extensive data generated as a result of revenue cycle processes and workflows. RCMS clients can visualize and analyze real-time data with reporting tools that minimize the need for IT support. By providing reporting, drill-down data analytics, pivot charts and scorecards, 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.


About RCMS

RCMS Revenue Cycle Management Improvement Strategies are a blend of Business Management Consulting, Technology Solutions and Systems Integration expertise in connecting Health Information Management Systems (HIMS) and Line of Business (LOB) systems. Contact RCMS about improving the Revenue Cycle for your organization.