Tag Archives: data & analytics

A/R workflow automation for RCM

Improving A/R Management with Proactive Workflow Processes

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RCMS’ solutions can improve a wide range of different patient billing areas where changes to manual work activities and the use of technology can have a significant impact on a health system’s financial performance. With the right tools and workflow processes, first-call resolution and time to collect patient payments can be significantly improved.

Using AI-powered solutions, our technology can prioritize accounts to work claim denials more efficiently. System generated worklists can automatically qualify accounts for proactive follow up. For customer service representatives, account inquiries provide a powerful tracking tool for A/R collections and patient communications.

By being proactive in account follow-up and having automated tools to present financial and clinical data in a user-friendly solution, your A/R Management KPIs can be significantly improved.

Denial & Appeals Management

To reduce denial rates, our ReSolve® AI & Workflow Automation technology can isolate medical claim denials/defects and prevents future re-occurrences. This decreases processing delays and helps to maintain cash flow. 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. ReSolve® can also facilitate decisive activities with predesigned correspondence and tracking capabilities, from generating appeals through rebilling and payment. Department supervisors can also track follow-up pursuits by user and work queue, enhancing departmental oversight and staff performance.

Identifying Hidden Trends and Isolating Problem Areas

With access to claims and revenue cycle data from the Hospital the Physician Practice Group’s HIT Systems, RCMS clients can visualize and analyze real-time data using Microsoft’s Power BI and SSRS reporting tools. By providing drill-down data analytics, pivot charts and scorecards in our reporting options, 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.

Keys to Maintaining A/R Processes

  • Integration with host billing systems
  • Use best available capture solutions
  • Same day processing of today’s receipts
  • Capture all adjudication data
  • Automate separation of remittance data
  • Use data validation rules to cleanse, scrub and normalize payment data
  • Proactively work denial defects and true denials
  • Provide reconciliation from bank deposit through billing system to GL
  • Monitor KPIs and performance metrics

Minimizing Disruption to Cash Flow with System Migrations

By integrating with all of your Line of Business (LOB) applications, RCMS can improve data accuracy and automate workflows to significantly enhance revenue cycle and treasury management processes. Our proven ReSolve® technology also provides for a more strategic and successful migration plan to a new EHR/EMR system – with minimal disruption to cash flow. 

Contact RCMS about improving revenue cycle operations for your organization.

RCMS Business Intelligence for RCM

Improving Your Revenue Cycle with Enterprise Business Intelligence (BI)

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Uncovering hidden trends within your billing and payment data can play a critical role in developing a strategic, successful revenue cycle plan — and in monitoring the progress of incremental modifications. This is especially true when implementing changes across a network of disparate financial applications and processes. RCMS’ systems integration experience and capabilities facilitate seamless data exchange between multiple HIT Systems, Banks and Clearinghouses, streamlining workflows and improving accuracy.

RCMS solutions include customized Power BI Scorecards that can help to drive accelerated, intelligent decision making in your revenue cycle. To start, we provide the means to capture and process all payments, denials, exceptions, adjustments and follow up activity from multiple business systems into our ReSolve® A/R & Workflow Automation platform. This allows for a variety of scorecards to be created by payers, business units, specialty groups and facility locations. With drill-down reporting and visualization features provided by Microsoft’s Power BI, our scorecards help to quickly identify and correct problematic areas that lead to sustained, measurable improvements.

RCMS and Power BI Reporting Benefits

  • Systems integration experience with healthcare delivery networks
  • Ability to connect with disparate data sources
  • Customized scorecards for each revenue cycle area
  • Accelerated decision making with real-time data visualization
  • Denials scorecard by payers, physicians, business units and locations
  • Analytic data available from desktop, tablet or smartphone
  • Ability to share scorecards with all department managers
  • Options for self-serve reporting & dashboard manipulation

Contact RCMS to Discover the Full Potential of your Revenue Cycle

RCMS can help Regional Hospitals, Health System IDNs and Practice Groups to leverage and enhance their current EHR/EMR/PM business applications. By identifying negative trends and inconsistencies across multiple sources of claim and payment information, we can help to develop changes and/or make corrections to current technology and processes. Contact RCMS today to discover the full potential of your revenue cycle.

Denial Management Software

Reducing Denials with Integration, Automation, ECM and Analytics

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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.

Creating Permanent Revenue Cycle Improvements

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.

Working with RCMS

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.

Business Intelligence

Connecting Your Line of Business (LOB) Applications

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Line of Business (LOB) commonly refers to a set of critical applications that run an enterprise. When working through the layers of disconnected information silos in an organization for effective workflow, being able to connect key foundational systems can become a critical stumbling block for creating true revenue cycle improvements.

RCMS solutions provide a single platform to normalize and standardize data for integration to existing LOB applications and external partners critical to the revenue cycle. Standardized data provides for a complete solution in aggregated environments, with a higher degree of data accuracy in complex, multi-vendor conditions.

LOB Integration Benefits

  • Systems integration experience with healthcare delivery networks
  • Ability to connect with disparate data sources
  • Customized scorecards for each revenue cycle area
  • Accelerated decision making with real-time data visualization
  • Denials scorecard by payers, physicians, business units and locations
  • Analytic data available from desktop, tablet or smartphone
  • Ability to share scorecards with all department managers
  • Options for self-serve reporting & dashboard manipulation

Contact RCMS

RCMS can help Hospital Systems, IDNs and Practice Groups to leverage and enhance their existing core business systems. By identifying negative trends and inconsistencies across multiple sources of rev cycle information, we can help to develop changes and/or make corrections to current technology and processes. Contact RCMS today about maximizing the power of your business intelligence.