Zeroing In On Claim Denials with RPA

Hospital leaders understand that it’s difficult to get claims out the door in the revenue cycle, but especially difficult to prevent claim denials. The complexity of revenue cycle management makes it hard for providers and healthcare organizations to identify the root causes beforehand. It’s a time consuming, administrative burden that is made easier with Robotic Process Automation (RPA). Sometimes referred to as Artificial Intelligence (AI), RPA is a trained digital employee, working 24/7 to identify gaps in claims management and correct mistakes before they are submitted. Gaining control over denials to reduce chronic revenue losses requires accurate information about where, when, and why the denials are occurring. This “digital employee” becomes a valuable resource to the claims management team, clocking in and working like an FTE, gaining more knowledge over time and making the process easier for the human workers.

Emergency Department Billing

Two-thirds of all inpatient admissions originate in the Emergency Department (ED), making it essential to capture the right information from insurance at the point-of-care. However, the hectic pace of the ED makes it easy to gather the wrong or missing information from the patient’s insurance. The patient may have been discharged or moved to inpatient (different billing). The nature of emergency care makes it difficult for patients and personnel to jump through insurance hoops that would otherwise be fairly straightforward. Some of the challenges with ED billing include contractual issues, like delays or underpayments for ED visits, labs, surgery, testing, or medication. Claims can be missing key identifiers for coding, not checked for crossovers between supplemental and primary insurance, or missing information from medical records. It’s easy to see how ED claims are denied. This makes the ED a great area for Robotic Process Automation (RPA). Bots can sort through mountains of claims, update statuses, check for missing information, access payor and third-party websites to check on crossover claims for Medicare and Medicaid, or verify eligibility and authorization codes. Boston WorkStation is a healthcare automation platform that eliminates the expense of manual data entry resources.

“Saved 10 hours a week and recovered $2 million per year,” the Manager of Business Information Services used Boston WorkStation to identify and load procedures done in the Emergency Room that were not being charged.

Eligibility Checking

Hospitals and other health systems just don’t have the bandwidth to solve claims management complexities. There are overly complicated systems, lack of interoperability, and simply a lack of resources. Boston WorkStation is a digital employee, working in real-time to validate, check, and correct claims. With a complete audit trail and the availability of daily reports, automation allows eligibility checking to work 4x faster and with 100% accuracy. Like a human employee, Boston WorkStation is able to estimate charges based on CPT codes, send information to multiple queues or facilities, look for crossover payment scenarios, and verify plan codes. This type of 24/7/365 workflow is even more important today, with administrative resources stretched, and revenue streams in jeopardy. Automating the workflow involved in processing claims and updating hundreds of providers could be difficult to track. But, Boston WorkStation’s logging capability enables managers to see the detailed steps of the workflow process, and review the information if a problem arises.

“Saved 10 hours a day and $1.2 million per year,” this particular automation takes patient Medicare billing information as provided by the patient and checks it against information that is in the Medicare screens to identify potential problems with Name, Gender, DOB, Secondary Insurance, etc. The automation also prints the differences to an exception report for manual intervention.

Sharing Data Across Systems

In the emergency, nursing, and lab departments, we developed two-part Boston WorkStation projects that share information between Meditech and McKesson systems. The first part creates a spreadsheet of accounts for the previous day’s discharges – then the discharge summary, nursing notes, and other information is pulled in by account from Meditech and into McKesson’s Horizon Performance Manager. The savings are significant. The CHRISTUS IM and nursing staff were previously required to manually input the information – a process that could take six people up to eight hours of data entry. This is the beauty of implementing an automation solution within healthcare, whether it’s build or buy, hospitals and health systems around the world use Boston WorkStation to accomplish error-free automation for every application and eliminate the expense of data entry resources. Boston WorkStation saves time, money, and improves data sharing across the healthcare ecosystem.

“I would say keep it simple. That’s one thing about Boston. It needs to be something that’s simple to use and simple to implement and simple to maintain, and that’s where Boston WorkStation has really shined for us.”

Why Boston Software Systems?
Boston Software Systems is the high performance standard in healthcare RPA. We exclusively focus on the hospital, health system, and healthcare provider organization industry sectors. No other RPA company possesses our 30 years of expertise, or level of experience in clinical, administrative, financial, and revenue cycle health.

Call us at 866-653-5105, or let’s hop on a 30-minute call. We’re also available to connect via Twitter, @bossoft. We’re happy to help you present revenue cycle optimization to your C-Suite. It’s a valuable resource to decrease days in A/R and increase bottom line revenue.

With over 95% of our healthcare automation projects being completed in under 30 days, savings are right around the corner.

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