Scott W.Thomas, CEO
For decades, hundreds of budding entrepreneurs have been trying to push the envelope in healthcare management, where innovation has become the shibboleth. However, many find themselves stalled by lack of a groundbreaking thought. For Scott W. Thomas, CEO at Revenue Management Solutions (RMS), it was the ability to think outside of the box, while still grounding those ideas in reality that led to the creation of an innovative product. The result was a robust and scalable electronic remittance management platform for healthcare providers and banks. Behind the scenes, RMS uniquely enhances the accuracy of legacy Electronic Medical Records (EMR) interpretation by incorporating data from banks and financial institutions into its solutions that makes Revenue Cycle Management (RCM) more effective. “By merging banks and healthcare organizations under one platform, we streamlined the entire remittance process,” explains Thomas.
In other words, for healthcare providers, the Oklahoma-based company offers technology solutions that use lower the costs of processing paper EOB posting alleviate the manual Electronic Remittance Advice (ERA) reconciliation, trim Accounts Receivables (AR) days, and improve free cash flow. Banks get advanced lockbox solutions that enhance value for their provider deposit customers, while the solution helps healthcare institutions lower the costs of posting paper Explanation of Benefits (EOB) remittances and allows their staff to focus on following up on denied or underpaid claims.
The Game Changer
RMS firmly believes their innovative technology solutions are the key to helping solve the challenges that faced by the healthcare sector. While pressing on the key market challenges, Thomas points out data interpretation as the hardest piece of the puzzle. “Analyzing the payment is a complex process, the key lies in offering consistency in the interpretation process minimizing human errors,” he adds. RMS makes data interpretation easy by mapping data and codes into a single format unique to the individual healthcare provider, which reduces the chance of human errors. For RMS, MedRx is one of the key platforms that electronically imports healthcare revenue cycle data—claims, remittances, and payments—quickly and securely, and then extracts the claim and service line data, re-associates, and balances payments against the claims.
Our solution automates the matching and segregation process so that the real funds can be allocated to each variant within the healthcare group
Healthcare providers see improved efficiency, reduction of costs, and increased cash flow because RMS is able to match disparate data elements and create a streamlined feed into the Patient Accounting System (PAS). “First, we import the data from the claims file, payment information, and remittance details by leveraging the client and bank data feeds. In addition, this entire process is carried out in a 24-hour cycle,” describes Thomas. While most of their counterparts focus on keying data, RMS believes in leveraging technology to offer accuracy, match different variants or categories, and find the critical pieces of data in a holistic approach.
Matching payments to remittance is another key task that RMS’ solutions focus on. “Often, large groups have a perception that the electronic remittances received from carriers are completely automated and do not require any manual effort. That is not the case, there is generally quite a bit of human effort required to match critical data and payment information to ensure receipt of funds and proper allocation,” states Thomas. RMS fills this gap by automating the workflow process to match patient payments to the right claims. Shedding more light on the company’s expertise, Thomas also brings in an example—A large health system approached RMS through one of their banking partners to manage their entire paper remittance processing. “They found the electronic method much easier. We implemented our solutions into their systems and within six months, they reduced their payment posting workforce from 30 to three. The company reallocated the resources according to their skill set, saving money and providing a meaningful ROI,” recalls Thomas.
“Large institutions often use a complex database that manages workforce, supplies and infrastructure, and EMR. In most cases, we deliver remittances back as EDI while providing insight into the entire revenue management cycle. Our solution automates the matching and segregation process so that the real funds can be allocated to each variant within the healthcare group,” asserts Thomas. RMS today processes more than 7 million remittance related transactions on a monthly basis with more than 20 Banking partners.
RMS also employs big data analytics to help healthcare organizations understand the trends in healthcare reimbursement and provide greater insight to denied claims, underpayments and trends in patient payments.
Since this involves private and financial information, the compliance factor becomes a tricky one.
“To navigate the associated risk factors, we have developed a proprietary platform operating on secure, dedicated hardware that incorporates a multi-tier security model,” elaborates Thomas.
Tapping New Models
The company offers a compliant Software-as-a-Service (SaaS) platform for the healthcare industry, which facilitates customers to access the data through a web portal. “No more paper storage or lugging boxes from the basement only to find that someone else has the file you want. With the click of a button, the entire workforce has the data it needs,” he adds.
The MedRx platform accounts for all types of transactions within the healthcare remittance process allowing clients to easily monitor the progress of the work queues from a single screen and set customizable alert thresholds. In addition, separate denial and correspondence workflows are incorporated into the solution to allow healthcare organizations greater insight and management of these specialized exception processes. “Utilizing the MedRx Workflows, clients have complete control of how data is separated for various departments in a healthcare organization to accomplish tasks,” claims Thomas.
"By merging banks and healthcare organizations under one platform, we streamlined the entire remittance process"
MedRx also helps in combining the claim submission information, remittance advice, and payment data to one single screen. Then the analytic tool will clearly segregate and match the payment details—a detailed insight on the billed figure and what is actually received from health plans and patients.
The Future Lies in Technology
Thomas truly believes that the workhorse of healthcare lies in technology, and a walk into RMS’ work culture makes it evident. RMS fosters a culture similar to start-ups, despite the company’s employee strength crossing over the 100 mark. “The key in understanding the market gap is to listen to the clients, their concerns, industry demands and how technology can bridge the gap to alleviate these challenges,” says Thomas. RMS is making their platform more efficient and scalable, capable of processing millions of transactions in a single day. “We recognize and analyze the daily market trends to redefine business roles, and create bleeding edge solutions. In the last two years, our daily transactions have doubled, while our operations staff has increased by only 15 percent,” reveals Thomas.
“Healthcare is a huge ocean, often the industry tends to get distracted from our focus point easily. As they say there are no right ways or wrong ways here, we chose to solve market problems in a way that no one had done before,” advises Thomas. “Our future lies in big data analysis, there is vast opportunity out there for analytics, which makes the future wide and bright,” he concludes.