Is RPA the Future of Revenue Sustainability?

2020 was a difficult year for hospitals. Losses due to the pandemic were projected to be at least $323.1 billion in the US. In addition, over three dozen hospitals closed their doors due to fluctuating volumes. And it’s not just hospitals that have been affected. Providers of all kinds — from primary care physicians and specialists, to dentists, chiropractors, and clinics — all have experienced sharp declines in patient volumes.

Of the 3,500 physicians surveyed by the American Medical Association (AMA) last summer, 81% reported that revenue was lower than pre-pandemic levels, with an average decline in revenue of 32%. While hospital and health system executives are pursuing a range of strategies to enable long-term success, revenue cycle integrity tops the list of priorities for the third straight year. One “bot” can save countless hours of repetitive tasks, resulting in greater organizational efficiency, increased productivity, increased revenue, and overall employee satisfaction.

RPA Holds Enormous Potential For The Healthcare Revenue Cycle

RPA holds enormous potential for the healthcare revenue cycle. RPA mimics the actions of revenue cycle staff during insurance verification, prior authorization, claims management, follow-up, and account reconciliation, eliminating human error and providing greater productivity from the revenue cycle department. Relying on a manual process to improve healthcare inefficiencies just isn’t an effective use of time or people. Automation solves productivity drains in the revenue cycle by checking for errors, completing manual tasks, addressing quality control gaps, working across multiple systems, and reducing the cost to collect.

RPA Supports Revenue Cycle Integrity

Healthcare organizations can automate entire end-to-end processes with greater accuracy and speed, letting humans manage only exceptions. RPA ensures revenue integrity by reducing or eliminating errors and completing work at as much as eight times faster than that of a human worker. With a cost of less than one-fifth the salary of a human employee, it only makes financial sense to employ “bots” to support a human workforce. RPA decreases providers’ cycle times, working 24/7 without breaks, improves accuracy, and increases employee morale by automating tedious, manual tasks.

Revenue Cycle Automation is perfectly suited for:

  • Benefit and Eligibility Checks
  • Prior Authorization Management
  • Claims / Denials Management
  • Vendor Contract Management / Contractual Analysis
  • Collections / Payment Processing / Write-offs / Adjustments

RPA Balances Time and Resources

One out of every five dollars of revenue cycle management expenses are attributed to denials-related issues and to top it off, 67% of denials are recoverable while 90% of denials are preventable, according to Becker’s Hospital Review. Becker’s analysis found registration and eligibility to be the leading causes (one in four) for denied claims, followed by missing or invalid documentation (14.6 percent). RPA enables the healthcare industry to better balance time and resources, by shifting the focus from an operational emphasis to a business emphasis. RPA does the job of human employees in a fraction of the time, eliminating the risk of errors. RPA can reduce an administrative burden by as much as 85%, and can easily be scaled up or down as needed.

CIOs Plan to Double Down on Software Bots

CIOs began turning to Robotic Process Automation (RPA) to keep business and service levels afloat during the crisis, allowing healthcare organizations to maintain pre-crisis productivity levels despite challenging work environments and reduced staffing. By automating one area of the revenue cycle, namely claims management tasks, Northwestern Medicine was able to transition to a work from home (WFH) environment without jeopardizing “dollars in the door.” In an interview with Brad Cox, Director of Patient Accounts at Northwestern, Matt Hawkins, SVP at Boston Software Systems, asked, “what impact has RPA had for you and the organization?” “We had two weeks to transition everyone to a WFH environment, many of whom had never worked remotely in their entire career. While the heavy lifting was going on (computers, desks, connectivity), automation took care of everything else.”

Where Do We Go From Here?

About one-third of hospitals and health systems do not use revenue cycle automation, according to a recent survey by AKASA. Adding RPA automation allows revenue cycle teams to concentrate on higher priority tasks like creating relationships with payers, diving into denial resolutions, and just getting stuff done in a WFH environment. At Boston Software Systems, we have implemented literally hundreds of revenue cycle RPA projects, which continue to run every day in hospitals, provider organizations, and partner technologies around the globe. Boston WorkStation is highly respected and reviewed, with 100% of customers stating they would purchase again. Give us a call. We won’t take up much of your time. With most solutions “live” in < 30 days, savings (and greater efficiencies) are right around the corner.

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