RCMS A/R Collections and Denial Management Workflow


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 prevents future re-occurrences. This increases cash flow and decreases 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.