Many industries are implementing robotic processing automation (RPA) in repetitive, transactional, and rule-based processes to help streamline operations, reduce task completion time, improve customer experience, and reduce labor costs. RPA automates transactional and repetitive processes, mimicking human behavior for rule-based tasks. Healthcare’s revenue cycle can also benefit from its transactional and repetitive processes.
While hospitals employ administrative teams to manage the process, several bottlenecks exist, including:
- Diverse systems.
- A lot of information.
- A large number of medical codes.
- Errors in billing.
- IT-related stumbling blocks.
- Inadequate financial policies.
- Failure to monitor the claims process throughout the entire claims cycle.
What Role Does RPA Play in Healthcare Workflows?
Healthcare is a prime industry that can benefit from robotic process automation due to two factors. RPA is highly versatile; it can automate a wide range of work processes that humans currently perform. Second, the healthcare industry is rife with administrative tasks and manual workflows.
Many hospitals and health systems are investing in some form of process automation. Approximately 70%, according to a recent HFMA study, only about 26% have invested explicitly in RPA. Nonetheless, Gartner predicts that RPA will be used in roughly half of all hospitals in the United States. RPA’s versatility, flexibility, and efficiency are some of the characteristics driving its rapid adoption. The more user tasks RPA bots can manage, the more efficient processes become and the more time RCM staff has for value-added, more strategic activities. Once built and deployed, a software robot is a model of efficiency, working tirelessly in the background 24 hours a day, seven days a week.
RPA – Healthcare’s Future RCM
RPA performs routine tasks in a fraction of the time it would take a human, around-the-clock, and without the risk of human error. This is accomplished by employing scripted processes with access to applications and data sources such as end-user health information systems (HIS), data input screens, online application programming interfaces (APIs), and structured and unstructured data repositories.
The global revenue cycle management market was worth USD 261.8 billion in 2020 and is expected to grow at a compound annual growth rate (CAGR) of 11.5 percent between 2021 and 2028.
Rising technological advancements and increased adoption of revenue cycle management (RCM) tools by various healthcare providers and others have resulted in the development and enhancement of solutions provided by key players.
The presence of numerous physician’s offices across the United States is responsible for this region’s large market share. Furthermore, regulatory changes, such as the addition of ICD-10 in 2015, increased demand for HIT systems, including revenue cycle management systems, to improve the efficiency of healthcare delivery. Furthermore, large established hospitals and healthcare infrastructures, favorable regulations, and a growing need to reduce healthcare costs present lucrative growth opportunities for the North American market.
Here are a few examples of RCM tasks that can be automated with RPA:
- Insurance Verification
- Claims Submission
- Preauthorization
- Segmentation of Patient Billing Accounts
RPA enables you to automate repetitive tasks and pull data from multiple data sources.
Why are Clinics Making RPA an Integral Part of RCM?
Hospitals and health systems are about more than just treating patients; in fact, what happens behind the scenes from the time a patient arrives at the hospital until they leave is the real deal. RCM encompasses a wide range of non-medical tasks such as document management, eligibility verification, demographic entry, billing and coding, and the filing of medical claims, all of which occur in large numbers daily.
According to McKinsey Quarterly data, 36% of healthcare tasks — primarily managerial and back-office can be automated. Revenue Cycle Management is the administration of essential financial processes in healthcare, such as identifying patients’ personal information, collecting payments, insurer name and treatment codes, financial billing information, and managing the revenue generated from payers based on the services provided.
Clinics and healthcare organizations adopt RPA because it reduces errors and increases profits. These are some of the most important reasons. Organizations that use this technology see a reduction in errors, reducing the number of hours employees spend trying to correct mistakes. They also gain from increased efficiency. Employees are relieved of repetitive tasks, allowing them to focus on other, higher-priority responsibilities.
A Few RPA Use Cases in Revenue Cycle Management
- Benefits Process Validation
Through RPA, an otherwise time-consuming process of validating each patient’s benefits by extracting reports from EHR, logging into each insurance provider’s portal, checking benefits eligibility, and preparing documents for further processing can be made seamless.
- Scheduling Appointments
When a pandemic like COVID-19 overwhelms staff and systems with demand for treatment, vaccines, and information, one of the more common hospital administrative tasks, appointment scheduling, can quickly become a mission-critical process.
Appointment scheduling is typically handled by the electronic health record (EHR) system, but appointment reminders are taken care of by separate systems with limited integration with the EHR. When an appointment is canceled through the reminder system, it necessitates manual steps in the EHR to ensure that other appointments and related orders are adjusted appropriately. RPA can automate that process, allowing the EHR and reminder system to remain in sync without the need for manual intervention or an application programming interface.
3.Compliance with Regulations
Revenue optimization and regulatory compliance have one thing in common: they require accurate data to be successful. Because healthcare is one of the most heavily regulated industries, providers devote a disproportionate amount of time and resources to documentation and compliance processes. These processes are typically manual, time-consuming, and expensive, but the cost of noncompliance can be significantly higher. There is always the possibility of human error when manually moving data from one system to another. The more data that people move around, the greater the risk. Automating government-mandated tasks saves hospitals time and money and reduces significant compliance risk.
- Management of Orders and Referrals
Among the many RPA applications in healthcare, order and referral management offers numerous opportunities for automation to streamline processes, eliminate redundancy, and improve the patient experience. An initial patient encounter usually starts a chain reaction of doctor’s orders and referrals for follow-up appointments with the laboratory, radiology/imaging, pharmacy, and specialists. Making sure that all of those downstream encounters are communicated, scheduled, and confirmed across the various departments, providers, and IT systems involved can be a tricky balancing act.
- Status of Prior Authorization
While most RCM processes can affect the bottom line, prior authorization can have an impact on patient care if treatment is delayed due to bureaucratic red tape. For the most part, Insurers have not standardized the information or processes needed to obtain prior authorization for procedures, tests, and admissions. This places a significant burden on providers in determining when permissions are required and how to submit them. Allowing RPA to obtain authorization status frees up staff time to focus on submitting authorization requests as soon as services are ordered, reducing manual staff effort, improving slot utilization, and enabling more timely services.
- Reconciliation of Charges and Coding
Complex systems, such as medical coding and billing, with tens of thousands of diagnostic and procedure codes, will always have errors and disagreements between provider and payer. Incorrectly coded or inaccurately coded claims result in denials that must be reviewed, recorded, and refiled, slowing revenue collection and wasting valuable staff time. To reduce denied claims and improve cash flow, automating code and charge reviews across disparate healthcare IT systems can ensure that supporting information required by the payer is captured and posted to the claim.
Benefits of Employing RPA Process Robots in RCM
Robotic Process Automation (RPA) is a non-invasive technology that can automate repetitive, rule-based processes to improve transaction processing speed. It can also help with error-free, efficient coding. It reduces claim denials and allows for a faster claim-to-payment turnaround time by eliminating manual errors in payment processing. Here are some of the advantages of using RPA Process Robots in RCM:
- Creating a virtual workforce that is available 24 hours a day, seven days a week
- Increasing standardization and reducing human error
- accelerating the retrieval process and generating cost estimates
- Accelerating pre-authorization by gathering claim information and directly feeding it into the HIS (Health Information System).
- Improved patient communication
- Reduced reliance on manual data entry
- Possibilities for reviewing revenue shortfalls
- Providing information about why a claim was denied, as well as correcting and tracking unpaid claims
- Ensure proper patient reimbursement
- Identifying a patient’s insurance status and copay obligations
- Increasing efficiency through the incorporation of third-party tools
- Enhancing the customer experience
Justification of RPA Implementation Costs
While the cost of robotic process automation may be a concern for healthcare providers who have yet to implement the technology, the benefits can outweigh the costs, and most industry analysts predict a surge in RPA adoption in the coming years. Cost pressures exacerbated by the COVID pandemic, ongoing staffing issues, and quality-based care demands are not going away. Workloads on RCM teams are not getting any smaller or more accessible, which will continue to drive adoption. The only question is whether your hospital will benefit from RPA or remain on the sidelines.
