Tag Archives: workflow automation

PLB adjustments lookup

Streamlined PLB Adjustments with Payment History and ICN

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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:

  1. Recovery of overpayments
  2. Balance forward (when recovery of overpayments exceeds payments in a specific ERA)
  3. IRS withholding
  4. Capitation payments
  5. Performance bonuses
  6. Interest payments
  7. 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.

ECM Workflow Automation

Integrating Enterprise Content Management (ECM) with Workflow Automation

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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.