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.

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.