RCMS Revenue Cycle Workflow Automation Benefits

Posted on August 17, 2022July 20, 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, 2022July 20, 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, 2021July 20, 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.