Revenue Cycle Management System (RCMS) is the financial process that healthcare facilities use to track patient care episodes from registration and appointment scheduling to the final payment of a clinical process.

Revenue cycle management unifies the business and clinical sides of healthcare by coupling administrative with medical data such as insurance processing which includes proper diagnosis and procedures; deductibles and co-pay management; submission; reconciliation; re-submission etc.

Challenges currently faced in the effective implementation of this system includes

• Inability of the system to discover and correct wrong patient registration
• Most of the current systems do not have appropriate auto design for coding level.
• Inability of the system to identify proper diagnosis and procedures
• Inability of the systems to identify prior approval required procedures thereby leading to rejection from Insurance Companies
• Inability of the system to reconcile submitted to approved, rejected and missing claims. Medical Centres traditionally import from the existing system into excel files and manually compares. This is prone errors, timing consuming and expensive manpower.
• Inability of the system to identify freshly submitted claims from re-submitted claims (Re-submitted claims has to be approved within specified period otherwise it becomes permanently rejected)
• Existing system does not have the ability to reconcile revenue amounts from submitted to approve claims thereby leading to unexplained differences.
• System does not have the mechanism to identify the ability and performance manage Medical Coders.

RFR Professionals leveraging on its industry experience, IT solution platform, strategic business process and Enterprise Risk Management provides an end to end customised solution solving the weaknesses identified in the existing system.

Our solution is an integrated Revenue Cycle Management System (RCMS) that runs on Oracle Database, Spring MVC (Java); and Hibernate with EJB Clustering to manage multiple entities within a system.

It includes a consolidated dashboard with real time data processing plus Business Intelligence (BI) process which allows the administrator to identify the correlation of every aspect of the business on real time basis.

Existing disconnected systems is integrated into this solution using API services which will allow seamless integration to the RCMS.