Every hospital and clinic incurs costs for providing care. An uncovered expense is a liability that grows with each passing day. The longer your accounts receivable age, the greater your burden of carrying them becomes. Submitting claims—and often resubmitting them—drains time and money and takes away from providing care to patients. Here’s where Robotic Process Automation (RPA) can help improve efficiency and increase revenue within the revenue cycle process.
A recent HFMA survey revealed that 15% of healthcare revenue-cycle leaders plan to invest in some form of RPA, up from 0% the previous year. RPA holds intriguing potential as it mimics the actions of a revenue cycle staff member during insurance verification, prior authorization, claims administration, claim follow-up, and account segmentation—all while eliminating human error. RPA also can work on accounts 24/7 and complete tasks in a fraction of the time it takes a team member to perform the same work. The impact: increased accuracy and productivity, reduced labor costs, and a stronger bottom line.
The successes and failures of RPA applications in other industries offer healthcare organizations a roadmap for effectively implementing the technology and identifying cases where it can deliver results. For example, the insurance industry leverages RPA across a range of business processes. With access to a robust data repository, RPA can be used to quickly evaluate and issue low-risk insurance policies. Prospective customers benefit from timely service and underwriters are freed-up to focus on more complex tasks. The technology has also helped reduce claims-payments administration from days to hours—while eliminating human error. Using RPA in similar scenarios in healthcare will deliver significant results.
Applying RPA to healthcare revenue-cycle processes will help in the following ways:
- Expedites cost-estimate generation: RPA automates the benefits-retrieval process and generates cost estimates.
- Assists pre-authorizations: RPA gathers information from websites and other disparate systems and integrates it directly into the Health Information Systems (in some cases, even submitting for pre-authorizations).
- Enhances patient-communication opportunities: After a call to discuss the cost of a service (or other customer-service question), RPA automatically generates an email that recaps the information discussed.
- Reduces manual data entry: When information is stored across systems, RPA aggregates the data and enters it into a central patient accounting system.
- Increases efficiency by integrating third-party tools: RPA serves as the middle-man between third-party tools that don’t “talk” to each other. This allows for data sharing and processing between the tools without human intervention.
- Improves the consumer experience: website chatbots automated by RPA provide instant answers to simple questions.
- Human error is often to blame for aging receivables. Payers commonly reject claims for insufficient or improper documentation, delaying payment with each denial. RPA accelerates payment-collection by eliminating human error and improving the accuracy of data entered. Furthermore, unlike with humans—who may all process claims differently—you can immediately implement a change across your entire organization by revising the rules for automated tasks.
- RPA can be used to address missing/incorrect National Provider Identifier (NPI) numbers for referring physicians. Such errors often impact coding, but RPA can be used to identify all errors by querying the NPI database and scrubbing referring-provider data to submit more accurate information that will improve collections.
- In addition to keeping claims flowing, RPA also frees providers from hours of administrative work, allowing them to see more patients, thereby generating additional revenue.
RPA also facilitates connectivity and continuity of patient care outside the hospital, which improves clinical outcomes. As a stand-alone technology, RPA is just the beginning. The technology can be integrated with patients’ electronic health records so, when providers need to substantiate the medical necessity of a procedure or treatment, they can easily attach a portion of a patient’s medical record—including structured and unstructured data (e.g., physician’s notes). Further down the line, RPA can be integrated with machine learning, data and analytics, and cognitive technologies. Working together, these technologies will likely extend the impact of automation from claims and financial administration to diagnoses, population health management, utilization management, care coordination, and remote monitoring.
There’s no doubt this is a challenging time for healthcare organizations. However, many of the changes of the past years point in a positive direction: healthier patients, an increase in access to care, satisfaction with the healthcare experience, better use of data to inform clinical decisions, and an industry-wide commitment to value and quality. RPA and other intelligent automation technologies are invaluable innovations that help organizations rise above the current uncertainty and enable the continued protection of their patients as well as their organization’s solvency. To learn more about how RPA can benefit your organization, please don’t hesitate to reach out to Anexinet for more detail. We’d love to help you get started.
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