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.

ECM and RCM steps to automation

Linking Enterprise Content Management with Revenue Cycle Automation

Six Steps Toward Taking Control of Your Business Office

Unstructured content plagues practically every healthcare organization. It’s the data that resides outside your organization’s core systems and processes. For patient care, it’s the patient information that exists outside your EMR. In patient finance, it’s the data outside your billing and financial systems. And in accounting, it lives beyond the reach of your ERP system. In this article, we look at six steps to manage content contained within these systems – in all file formats. Each step makes life easier for the people who rely on efficient access to current information.

Before thinking of new ways to better manage your unstructured content, you first need to understand what it is. For each organization, this content can exist across an assortment of documents and information spanning all departments. For example, in patient access, unstructured content can be everything from patient ID’s and insurance cards, to consent forms and waiver documents. In accounting departments, invoices and the information surrounding specific financial transactions often exist as unstructured content. Paper encounters, patient correspondence, EOBs and EDI transactions similarly hamper processes in patient financial services. The list goes on, but the key here is to understand the nature of the business content each work area processes. Talk to the people who deal with these issues every day. Then you can take steps to determine the best practice approaches to get it under control.

Odds are, paper and other physical content like forms, letters, photocopies and paper remittances are in someone’s way. Sifting through a stack of EOB’s for that one piece of paper that a patient account representative needs leads to frustration and reduces time spent collecting on outstanding accounts. It also increases the likelihood that another piece of information may be lost or misfiled. Even if your organization’s paper content is safely stored in a central filing location or document imaging system, those storage or indexing costs would likely be better allocated to collecting outstanding funds. Here’s where Enterprise Content Management (ECM) linked with Revenue Cycle Management (RCM) automation can help.

A unified ECM and RCM solution allows you to capture the diverse range of information and content within your organization – paper EOB’s and correspondence, faxed orders or requests for information, denied claims, insurance cards, patient IDs and more. By automating the capture of this documentation and combining the process of data collection with document indexing, the results can be astonishing.

First, that business content required for your HIS application is often the same data required for keyword index values to store and retrieve that same document. Additionally, ECM eliminates the need for physical storage and management, thereby reducing staff’s frustrations about navigating through a mountain of paper to find what they need. Saving on storage, indexing and filing costs also demonstrates a true return on investment that is sure to please everyone in your organization.

Capturing unstructured content is only the beginning. While many solutions stop at this point, if the data is not accurate, it has little to no real value. Today’s best practice solutions include client definable data validation routines that scrub extracted data and help determine the validity of converted data values. Why is Data Validation important? Well, with reimbursement rates shrinking and the cost to collect increasing, every denied claim represents an additional twenty-five to thirty dollars of cost for an organization.

To tackle these challenges, data validation routines help scrub the data to ensure its accuracy before generating the desired output. If errors are found, users have the ability to correct them during an “edit phase,” replacing the original converted data by simply keying the correct information, selecting data from a drop down list, or auto-populating the data from a database lookup. This work process ensures that correct information is available for resolving future issues such as patient billing, denied claims, disputed amounts or other patient inquiries.

Now that you’ve captured and cleansed that unstructured content, you need somewhere to store it. An ideal RCM solution provides you with a single, secure ECM repository for electronic storage of this business content. This helps reduce complexity in your IT environment by eliminating disparate, disconnected content silos.

Unstructured information also poses a security risk. An ECM solution (such as Hyland’s OnBase Platform) securely stores this content, reducing the risk of a HIPAA violation. Additionally, RCM/ECM systems that provide audit trails make compliance with 3rd party audits, Joint Commissions, Sarbanes Oxley and other initiatives much simpler – making life easier for both users and constituents.

For your content to be useful, the people who need to access it should be able to find it easily and quickly. By integrating with your organization’s core applications, an ECM solution provides instant access to content within those systems with a simple click of the mouse. For those in patient financial services, it means finding transactional billing data within the billing system instead of on an EOB or isolated EDI transaction. For those in finance and accounting, it means locating an invoice directly within the ERP system.

Ideally, users of a well-integrated RCM solution might not even be aware of its existence. They simply find what they need within the systems they know and use every day. Not only does this make them more productive, it also enhances the value of your existing applications because users have everything they need within your registration system, EMR, billing system, ERP and other applications.

You’ve identified your business content, captured and validated it, safely stored it and integrated it with your core systems. With an integrated RCM/ECM solution, you can use that content to help your staff work more efficiently.

For example, data warehouses can be automatically created or populated to provide drill-down business analytics. This provides benefits such as identifying collections trends with outcomes, integrating daily cash receipts to the bank deposits for bank reconciliation, or forecasting future cash flows from unbilled charges. Users, managers, directors and executives can work more efficiently within predictable parameters. As a result, your operations run more smoothly and efficiently, with staff more productive and content.


By capturing and routing correspondence through rules-based workflows, solutions such as our ReSolve® Correspondence Management facilitates items being entered and worked faster. Linked to ECM, we leverage Artificial Intelligence (AI) and Robotics Process Automation (RPA) to eliminate manual errors and to automate many of today’s revenue cycle processes. Contact Us today to schedule a discovery call or a presentation of our capabilities.

Editor’s Note:
A version of this article was originally published by ReMedics, LLC. ReMedics is a sister company of RCMS providing Business Process Outsourcing services to Physician Practice Groups, MSOs, Hospitals and Health Systems.

Key Solution Drivers for Creating Permanent Revenue Cycle Improvements

Implementing Efficient Data Capture and Workflow Automation

Whether you’re looking to implement a departmental solution or to install enterprise content management throughout the entire organization, RCMS has the ability and expertise to help you with gaining operational efficiencies and to increase revenue.

With the use of advanced data capture technology and robotics process automation, we eliminate wasteful, manual tasks that maximize the efforts of your workforce – while integrating with core business systems and any relevant patient or payor information. This includes the capture and indexing of all claims, remittances and correspondence, no matter how many different EMRs, billing systems, practice management systems and lockboxes are currently being used.

To accomplish your operational and revenue cycle objectives, we focus on creating permanent improvements (with key solution drivers) that can deliver the greatest impact on your bottom line.

Key Solution Drivers

RCMS utilizes the following key solution drivers in designing specific revenue cycle management (RCM) applications and with implementing changes to how information is captured, verified and processed for reconciling and posting payments to multiple systems.

  • Acquire diverse information to provide organized access to critical business records, regardless of format.
  • Unify disparate systems and software applications to improve information flow and automate redundant processes.
  • Streamline operational efficiencies with technology and best practices to deliver sustainable financial results.

About RCMS

With expertise in business office operations, revenue cycle management, and HIS integration, RCMS can improve your business office operations and the financial performance of your entire organization. Our solutions include the ReSolve­® A/R Management Platform, designed for the efficient capture, management and use of patient and payment information to dramatically improve posting accuracy and to exceed RCM benchmarks.

Contact RCMS today to schedule a call or presentation with your revenue cycle teams.


ECM and workflow solutions for all industries

Cost-Saving ECM & Workflow Solutions For All Industries

Automated Processes — Tailored to Your Business Needs.

While the main focus for RCMS is in providing technology to the healthcare market, our document management and workflow solutions can also be applied to many other business sectors. Just like healthcare, industries such as education, energy, financial services, insurance, and manufacturing continue to rely on a variety of decentralized electronic and paper-based documentation. In most cases, these documents and their corresponding data (such as customer no.) get stored in disparate information silos that lead to a wide variety of process inefficiencies and lost revenue.

RCMS solutions, including Hyland Software’s OnBase Enterprise Content Management (ECM), can be used to capture, index, and route any type of document and electronic file format in a single database. With ECM, disparate documentation can be organized and efficiently provided throughout a department, division, or worldwide network. ECM also provides for significant other benefits, such as audit trails, controlled access (by department or role) and fiduciary reporting.

Artificial Intelligence (AI) and Workflow Automation

Using AI with indexed documentation allows for the use of workflow automation to significantly reduce manual, repetitive processes. Working with your department managers and IT team, RCMS can develop a plan that explores all areas of your organization where repeated processes can be substantially improved. By automating repetitive tasks and worklists in conjunction with AI and machine learning, we can create processes that allow staff to be more productive and focus on higher-value work.


About RCMS

RCMS brings decades of business process experience to your specific departmental needs or for an entire organization. We specialize in connecting ECM to different systems and corporate financial applications, including AR, AP and GL. Contact RCMS for an assessment of your business needs and how we can improve your operations.


RPA - Robotics Process Automation from RCMS

Using RPA and Workflow Across Multiple EMR & Billing Systems

For RCMS clients with multiple EMR and billing systems, 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 applications. One of the many technologies we utilize to do this is robotics process automation (RPA).

Using RPA in healthcare business applications can significantly reduce manual, repetitive processes that are prone to human error and waste valuable time. In partnership with your Accounting and IT teams, RCMS can help your organization to develop an RPA plan that explores all areas of the revenue cycle — where repeated processes can be substantially improved.

Below are just a few examples of how RPA can benefit your organization:

  • Improved accuracy over redundant manual data entry
  • Unattended and attended RPA applications
  • Automates repetitive tasks in conjunction with AI and machine learning
  • Allows staff to be more productive and focus on higher-value work
  • Can move data across HIS applications
  • Connects multiple billing systems where APIs don’t exist
  • Data is stored for auditing compliance with regulatory requirements
  • Adjusts and scales to changes in underlying systems


About RCMS

RCMS brings decades of healthcare business office and software development experience to improve your revenue cycle. We specialize in working with IDNs having multiple EHR/EMRs and billing systems. Contact RCMS for an assessment of your business applications and how you can benefit from RPA to improve your operations.


ECM and Workflow for healthcare revenue cycle improvements

Improving Operational Efficiencies with ECM & Workflow

Are you ready to transform your business office?

With enterprise content management (ECM) and our custom workflow solutions, RCMS can transform static, unstructured information and documents into a dynamic part of your business office operations. Utilizing Hyland’s OnBase ECM software and the RCMS ReSolve® A/R Management Platform, our automated workflow technologies seamlessly integrate to your billing applications and revenue cycle processes, reducing and/or eliminating many of the inefficient, manual processes that require staff intervention. Using advanced document management programming tools, such as auto-indexing and auto-classification, correspondence routing becomes automated, directing documents to designated worklists and departmental work queues. By integrating multiple healthcare information systems and ECM with a common user interface, RCMS can increase productivity, identify defects for timely adjudication, and reduce your cost to collect.

ECM & Workflow Benefits

RCMS provides significant time-saving benefits in many areas, including:

  • Reduced manual tasks and data entry errors
  • Correspondence document management & indexing for quick retrieval
  • Data extraction & normalization of paper-based documents
  • Improved operational efficiencies and turnaround times
  • Integration with other business applications
  • Real-time analytics, reports and scorecards
  • Hosted or on-premise ECM deployment
  • Accountability and audit trails for all processes
  • Professional services team specializing in healthcare claims & billing
  • Easy-to-use intuitive interfaces and HIPAA compliant, secure access


About RCMS

RCMS brings decades of healthcare business office and software development experience to improve your revenue cycle. We can provide hosted or on-site document management and workflow solutions that provide staff with quick access to indexed, searchable documents in all formats. Contact RCMS about improving your operations.


RCMS Cash Management Prinipals

Cash Management Fundamental Design Principles for 2023

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!


Automated EDI Parsing Splitting Software

Case Study: Automated Parsing of EDI Transactions

Client Background:

The client is a large podiatry practice group that provides a full range of specialty services for the advanced treatment of foot and lower extremity conditions. The group has over 100 board certified podiatrists, providing medical services through a network of approximately 80 office locations. They are backed by a private equity investment firm that specializes in healthcare service investments.

Challenges:

The payment posting team was receiving EDI transaction payments for multiple business units/divisions within a single ERA file from their clearinghouse. Further complicating matters, each practice was being migrated to a new Practice Management platform as part of their onboarding process. In order to process remittances more efficiently and reduce work on the back-end of the revenue cycle, they needed a solution that could split payment data to the appropriate business unit’s practice management (PM) system as it was being received.

They also had a requirement to automate the splitting of payments processed without matching claim data. These payments included claims billed with attachments, as well as secondary billing, worker’s compensation, and other requirements for processing outside of the submitting clearinghouse.

The Solution:

  • ANSI 835 files are received from the client’s clearinghouse on a daily basis, where ERA/EDI files are ingested into a proprietary Single Cash Management System solution for data splitting, validation, and reconciliation.
  • Data is matched against corresponding claim feeds (ANSI 837 files) and reconciled to updated check/batch data contained within the ANSI 835 transactions.
  • Through custom configuration and multi-level splitting logic contained within the processing solution, corresponding payments and denial data are assigned to the appropriate EMR or PM system.
  • An optional RCMS hosted document management system is available to index and retrieve all transactional payment/ERA data for EOB storage and retrieval.

The Results:

Using advanced data capture and Business Process Automation (BPA) technology, RCMS ensures that all updated and re-balanced payment files are distributed to each business unit on a daily basis — and reconciled back to the check and original 835 file received from the Clearinghouse. The client no longer has to split and transfer payments “downstream” for each business unit, resulting in more timely and consistent cash flow.

Daily payment balancing and posting reports are delivered to the client to assist with distribution, reconciliation, and identification of processed work. RCMS also provides a separate electronic 835 ERA file and corresponding reports for any transactions that do not qualify for a pre-defined entity, such as transactions that contain any unidentified payments for external systems that fall outside of the project scope.

Due to the efficiencies created by these services, the client is able to devote more time towards business expansion initiatives. Client personnel can now quickly search and retrieve electronic files by Business Unit, Patient Name, Check Number, Service Date, Paid Amount and many other options to quickly identify information needed for payment posting or follow-up activities.

Positioned for Growth

With the RCMS technology in place, new business units can quickly be added to the Client’s existing EDI splitting and payment processing services — while continuing to use their current practice management system(s). By adopting a multi-submitter, single receiver workflow to capture all their payments, acquired or merged groups maintain their billing autonomy while reporting up to a single corporate Tax ID through their PM system conversion plan. At a future date in time, RCMS can help to develop and implement a systems migration strategy to a common platform.


Editor’s note: this case study was also published by ReMedics LLC, our sister BPO services company that provides outsourced remittance processing, data validation and bank reconciliation support to physician practice groups and management services organizations (MSOs) throughout the United States.


Contact RCMS

RCMS can deliver proven EDI data capture and parsing solutions that provide for significant productivity gains in your business office. Contact RCMS about improving staff efficiency and organizing your business information.