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.