Powering Digital Transformation in the  Revenue Cycle

Automation technologies in healthcare are changing the way people work, by powering completion of mundane, tedious tasks, allowing humans to focus on higher-priority items that require empathy, conversation, and communication. It’s not Artificial Intelligence (AI), but rather automation technologies like Robotic Process Automation (RPA), and Intelligent Automation (IA), that accelerate cash flow and positively impact net revenue for hospitals and health systems. Between $0.25 – $0.33 cents of every dollar you spend on medical care goes to pay for back office costs, like those in the healthcare revenue cycle. The pandemic kicked revenue cycle teams into “emergency preparedness mode.” How does automation continue to simplify the process and reduce administrative costs?

Claims Status Checks

A huge win for revenue cycle teams is automating the claims status process. In the past, a human staff member would need to log in to multiple payer websites, or call them, for updates to claims statuses. Because revenue cycle items can be found in multiple, disparate databases, “our staff was spending 50% of their time just making sure the payers received the claims,” said Brad Cox, Director of Patient Accounts at Northwestern Medicine. The average hospital processes tens of thousands of claims every month. Revenue cycle team members spend countless hours going out to multiple portals to see which claims require follow-up. This manual process pulls people away from higher value work. Instead of manually going through claims one by one, RPA can automate the workflow. One customer stated, “No response claims status checks revealed a 330% ROI in the first year. And that goes into perpetuity.” When a provider manually runs a claim status check, on average it takes 15-19 minutes per claim, and costs providers $7.00 – $10.00. By automating the process, there is an instant savings in time and labor.

Denial Management

Claim denials represent an operational speed bump for hospitals and health systems. Denial management costs hospitals roughly $262 billion (yes, billion), each year. By the time a claim reaches a denied status, the provider has lost at least two weeks in reimbursement. To minimize delays, hospitals and provider organizations can improve the process and #bridgethegaps that exist between system vendors, billing systems, and other data silos, areas that should work easily (but don’t), giving human workers back their time, and providing relief for some of the mind-numbing tasks in the revenue cycle. This shift allows staff to focus on higher priority items that require communication or a personal touch, improving productivity and employee satisfaction.

Before submission, automation can handle the tedious tasks of claims management including:

  • Eligibility verification
  • Prior authorizations
  • Analyzing or identifying missing information
  • Accessing other applications or 3rd-party sites for information

After submission, automation can handle additional tasks including:

  • Denial routing, resolution, and re-submission
  • Collections management
  • Payment processing
  • Crossover claims
  • Contractual allowables and analysis
  • Write-offs and adjustments

Eligibility Checks

Checking patient eligibility can require applying more than 250 complex business rules to data found in 30+ fields about co-pays, co-insurance, deductible amounts, etc. Automating the process saves over 80% of the processing time, sifting through volumes of data and applying rules-based processes to claims so that humans can spend time working on other tasks. Automation relieves the burden of data integrity by ensuring accuracy and increasing efficiency in the healthcare revenue cycle. The return on investment (ROI) can be upwards of 350% in the first six months. Here’s just a few of the savings our clients achieved:

  • Saved 180 hours per month and $20 million automating failed claims
  • Recovered $2 million per year automating ED billing
  • Saved 10 hours per day and $1.2 million per year by automating crossover claims processing
  • Saved 15 FTEs and $450,000 per year by automating claims submissions

Boston WorkStation has been reducing the “cost to collect” in hospitals, health systems, and provider organizations for over 30 years. In a world where problems are getting more complex, problem-solving skills say everything about a company. We built and retained a loyal customer base by treating our customers well, and giving them a reason to do business with us again (and again). We keep our promises, and remain true to the level of service our clients have come to expect from us. We’ve worked with all EHR vendors and applications, and provide automation services onsite or in the AWS cloud. Give us a call. We’d love to discuss our successes with you.

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