RCM Automation and Analysis

Clear technology solution delivers customized automated process or automation solutions that target on

• Patient demographic capture
• Eligibility verification
• Coding Assistance Platform (CAP)
• Submitted claims status
• Denials management
• Patient Billing statement generation
• Credit balance resolution
• Risk adjustment optimization (RAO)

 Advantages Of Automation in RCM Operation 

• copies the work of a manually processed applications and computes web based or system –based work
• Merges both user interface recognition technologies and work flow execution.
• Automatically process transaction, controls the data, triggers responses and communicate with other systems.
• Decreased Costs
  Reduces the cost of performance.
• Improved Efficiency 
  Can work 24×7.
• Reduced Errors 
  Eradicates human delay and error.
• Increased Scalability
  Can dial up or down the number of bots deployed according to the volumes.
• Increased Collections and Revenues 
  Better accuracy boosts collections. Efficient and faster billing enables rapid and effect payments for providers and facilities.
• Process Improvement
  Identifies adversities and helps in optimizing and enhancing the core processes.
• Patient demographic capture
• Eligibility verification
• Coding Assistance Platform (CAP)
• Submitted claims status
• Denials management
• Patient Billing statement generation
• Credit balance resolution
• Risk adjustment optimization (RAO)

Potentialities of RCM Automation:

• Using payer websites, this big data analyses the information and provides actionable insights.
  • Collects Data
  • Analyses State of the Claim
  • Comes up with the Set of Actionable Insights
  • Performs certain Follow Up Tasks
  • Improves the Quality of Work by Achieving Consistent Accuracy
• Analyses the claims which are being generated. It implements and checks various business rules. It also initiates corrective action or routes the actionable insights to the right agent to take prompt action. The RPA bot enables supervised learning and has self-learning modules that constantly upgrades the knowledge repository.
  • Boost up the Clean Claim Rate
  • Decreases Denials
  • Efficiently Improves Resolution Time
• The intelligent automation is powered to learn the relationship patterns within and among different processes, production, audits and the like by machine learning algorithms. Later, after this step, it analyses the data and acknowledges undiscovered bottlenecks, areas for process improvement and some uncanny statistical information to streamline business processes.
• The Denials automation inspects the incoming ERA (835) files and exhibits the following appropriate actions:
  • Checks for Invalid Combinations
  • Automatically Corrects and Resubmits the Claim
  • Generates a Set of Actionable Insights for the Respective Responsible Parties on the Identified Issues
  • The automation is capable of converting a paper EOB to ERA (835) file so that the data can be fed into the system without any form of delay or human intervent

Classic RMC Client Dashboards include:

• Key Performance Indicator (KPI) Dashboard
• Detailed KPI Dashboard
• Statistics Dashboard
• Charges Dashboard
• Payments Dashboard
• Denials Dashboard & Trends
• A/R Summary Dashboard & Trends
• CPT Trend Analysis
• Patient Dashboard