Cash Management Fundamental Design Principles for 2023

Posted on January 4, 2023May 5, 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!

Case Study: Automated Parsing of EDI Transactions

Posted on December 14, 2022May 5, 2023

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.

RCMS Revenue Cycle Workflow Automation Benefits

Posted on August 17, 2022May 5, 2023

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.

Streamlined PLB Adjustments with Payment History and ICN

Posted on May 31, 2022May 5, 2023

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:

Recovery of overpayments
Balance forward (when recovery of overpayments exceeds payments in a specific ERA)
IRS withholding
Capitation payments
Performance bonuses
Interest payments
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.

Integrating Enterprise Content Management (ECM) with Workflow Automation

Posted on November 30, 2021May 5, 2023

How do you transform static, unstructured information and slow moving processes into a dynamic, fluid part of your operations? For RCMS clients needing to keep up with increased demands, an integrated ECM and Workflow Solution provides the best option for automating back-office processes. Our combination of document management and custom programming capabilities can improve just about any high-volume, document-heavy department, from AP and AR to Customer Service. Once implemented, a single workflow solution can save a significant number of hours in data entry, scanning, filing and document retrieval time for your staff. Automated workflows can increase efficiency, improve data accuracy, index documents, generate work queues for additional follow-up, and provide management with valuable reporting tools.

Document Routing to Departments and Work Queues

By capturing and routing documents through rules-based workflows, RCMS provides for invoices, checks, BoL, orders and other correspondence to be worked much faster, reducing turn-times and increasing productivity. The result is a more efficient staff with immediate access to captured documents and information. The key is having a scalable, enterprise solution, capable of managing any type of document format, including: scanned mail, PDFs, images, faxes, and emails. Using advanced sorting technology, such as auto-indexing and classification, files can be routed automatically to the appropriate department and work queue.

Accounts Receivable and Customer Service

For busy Accounts Receivable and Customer Service Departments, it’s important to find ways to resolve a customer dispute or collect on overdue invoices as earlier as possible. RCMS can help to improve first-call resolutions by providing immediate access to all of the customer’s documents, communications and orders. Our Account Inquiry function provides a powerful tracking tool for documenting customer activities and communication issues. System generated worklists can automatically identify accounts that need proactive follow-up on overdue invoices and schedule tasks in the system for a specific department or team of individuals.

About RCMS

RCMS Revenue Cycle Management Improvement Strategies are a blend of Business Management Consulting, Technology and Back-Office Solutions for just about any type of industry and vertical market. Contact RCMS about improving processes for your organization.