Revenue Management Solutions
Automating Revenue Cycle Management in Healthcare Sector

Revenue management and cost reduction are of utmost importance for healthcare providers, usually requiring an entire department to manage manual, paper-based processes. Revenue Management Solutions (RMS) takes this burden off the healthcare industry by automating the remittance, payment and reconciliation process, reducing operating costs and freeing staff to focus on revenue-generating tasks and their essential healthcare services.

RMS started its journey in 2006 as a fintech company but has now grown as a leader in the revenue cycle management sector. Its primary role has been providing automation that easily interfaces with major EHRs and ERP systems like Epic, Meditech, Workday and others to maximize existing investments and reduce manual processes.

“We take pride in our ability to provide consultation and our expertise to revenue cycle teams and banks that might not know how to maximize the use of technology in their platforms,” says Amy Rinard, CRO at RMS. “Our goal is to help reduce cost and improve healthcare.”

The importance of what RMS does becomes apparent when one looks at the exhausting amount of paperwork healthcare providers have to handle. It takes paper transactions between patients, insurance companies, clearinghouses and banks, and connects them. RMS intakes scans of any paper-based transaction like paper remittances, EOBs or paper checks that come to the client lockbox, the client’s physical location or the payer website and uses AI and optical character recognition (OCR) technology to create an 835 file that is then matched to the payment at the claim level.

The whole healthcare ecosystem with the transaction data is brought together in an automated fashion to reduce expenditure in the revenue cycle while freeing staff for more crucial tasks.

RMS plays a key role related to electronic transactions and reconciliation. The RMS platform takes electronic remittance advice (ERA) data and matches that across any payment form, be it a check, ACH, credit card, etc. and creates fully funded transactions that the client can directly post into their practice management system. This process also removes duplicate paper remittances that may have come into the lockbox.

Apart from their core remittance and reconciliation services, RMS also offers letter-formatted correspondence indexing and routing. There it categorizes all the correspondence from insurance payers or patients and creates smart documents for the health systems workflow that are archived and retrievable for seven years. This helps them follow up on claims, keep workflows running efficiently and keep patient accounting systems and imaging systems updated and accurate. It also enables denial and follow-up processes. The goal is to easily interface with the imaging and practice management platforms, reducing cost and manual processes.

These services were put to the litmus test during the Change Healthcare breach of 2024 which posed a big challenge to the U.S. healthcare system. Rising to the occasion, RMS, with its considerable experience in automating paper-based transactions, helped large health systems and banks across the nation respond to payers adopting paper-based transactions overnight. It took on the largest share of the increased load to ensure the healthcare industry was operational.

As a part of its commitment, RMS also launched a service to enroll payers into electronic transactions. It creates direct connections for paper remittances through ERA enrollments across all payers nationwide, as the best way to reduce cost is by eliminating paper-based transactions. It also enrolls payment transactions into the cost-effective ACH or EFT modes.

Through these services it has been able to gain the trust of 56 referral banks and six big reseller banks across the nation, working with every financial system in the U.S. As those banks partner with the health systems through RMS, it touches almost every large healthcare system nationwide, helping them scale up their businesses. RMS continues to lead the way in the healthcare remittance and reconciliation space by continuously upgrading its model with newer technologies for the future.