Two key questions about our next-generation RCM application

September 30, 2016 ABILITY

Since the introduction of our new all-payer RCM and health data analytics application, ABILITY | ACCESS® RCM, our representatives have been talking with a number of Strategic Partners. We’ve also hosted a series of webinars to demonstrate a few of its capabilities. This series has outlined:

  • A general overview of the application, including its claim-scrubbing capabilities, denial management, and uses for both institutional and ambulatory claims
  • The flexible rules engine that easily enables custom rules
  • The technology’s ability to show complete claim histories at a glance, letting users see all payer communications posted back to every claim in real time
  • The application’s end-to-end RCM integration, which eliminates the need for customers to use other tools for steps like audits and appeals

These webinars have also given us a chance to answer the most common questions our customers have about the application, and two questions have stuck out as particularly vital to helping customers understand this unique technology:

  1. How are the business rules applied, changed, and customized?

ABILITY | ACCESS RCM handles custom rules very differently from other clearinghouses. While the current industry practice is to “hard code” custom rules, which requires significant time and expense, our application is built with a non-code-based rules engine. This allows for custom business rules to be built affordably and far faster than the industry average.

During the implementation process, you can also create a “bundle” of custom rules, so you can ensure the system meets your needs from the very start, and maintain the flexibility to quickly adapt it down the road by simply making a request through ABILITY.

  1. Does the application track user edits as well as system edits?

Yes. As you probably know, HIPAA requires that a log is kept any time protected health information (PHI) is accessed or edited. Many software systems currently track who accesses data and when changes were made, but not necessarily what was changed. Not only does ABILITY | ACCESS RCM log all of these factors, but it also notes any instances in which an edit was automatically applied because of the software’s business rules.

For instance, a customer may have a business rule that ensures claims are submitted with the exact name under which eligibility was verified. In this case, if eligibility is confirmed for “Jane Abigail Doe” but a claim is later submitted for “Jane Doe,” the software will insert the middle name to ensure a match. In a case like this, ABILITY | ACCESS RCM will not only document the edit, but also the business rule that led to the change.

As you might guess, this technology has been very well received in the industry, and our team is working hand in hand with Strategic Partners to help them leverage its capabilities. Click here to learn more about the application and schedule your own custom demo!



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