Simplify Claims Complexities with Automation

There is a lot of buzz in the healthcare system about the benefits of Robotic Process Automation (RPA). Hospitals and healthcare organizations have a dizzying array of daily tasks to coordinate in order to get paid. The issue comes down to people, process, and technology. A lot of vendors are touting Artificial Intelligence (AI) as the perfect addition to the healthcare revenue cycle, but it’s really RPA that allows healthcare organizations to sift through required tasks without a human toll on people.

Revenue cycle departments become much more strategic when focusing on health system strengths rather than administrative burden. Costly, labor intensive, error prone tasks are exactly where this type of automation shines, transforming the business of healthcare and removing waste from the system. The benefits of automation include the ability to reduce bottlenecks, improve operating costs, and remove the administrative burden of claims management.

The Cost of Denials

90% of healthcare claim denials are avoidable, yet they happen every day on a massive scale at hospitals and healthcare organizations across the country. According to the Centers for Medicare & Medicaid Services (CMS), 20% of all claims are denied, 60% of lost or denied claims will never be resubmitted, and 18% of claims will never be collected. Many times these are the result of avoidable errors, like missing patient identifiers, coding errors, or spelling issues. According to The Healthcare Financial Management Association (HFMA), “Out of $3 trillion in total claims submitted by healthcare organizations, $262 billion (that’s billion) were denied, translating to nearly $5 million in denials, on average, per provider.” That’s a lot of revenue to lose or write off. Automation is the perfect partner for denial management.

The Impact of a Prevention Strategy

By utilizing an automated process, a virtual digital SWAT team drives efficiency and boosts bottom line revenue. Automation merges data from competing system silos, ensures there are no duplicates, gaps, or missing information, and corrects issues like incomplete data before the claim ever hits the queue. 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

Turn The Train Around

The Council for Affordable Quality Healthcare (CAQH) estimates that revenue cycle automation for administrative tasks can generate $17.6 billion in annual savings. The entire workflow relies on dozens of systems, hundreds of processes, and there are as many as eighteen silos of data to access, compare and contrast, none of which are interoperable. A competing mix of stakeholders across an already overwhelmed healthcare system complicates the revenue cycle process and makes everything more difficult.

Automation solves productivity drains in the revenue cycle by checking for errors, completing manual tasks, addressing quality control gaps, and reducing the cost to collect. An automated process drives efficiency and boosts bottom line revenue. Automation merges data from competing system silos, ensures there are no duplicates, gaps, or missing information, and improves clean claims rates. Most revenue cycle optimization projects provide a significant ROI within the first year, upwards of 300%. With a scalable, flexible RPA vendor, it’s easy to begin in one area, realize the benefits, then scale to additional areas throughout the healthcare organization.

Why Boston Software Systems?

With the average category score for KLAS-rated RPA services at 91.1, Boston WorkStation surpassed competitor rankings with a final score of 93.8. Boston Software Systems’ experience has been ensuring automation projects remain on track since 1985. Working across a wide-range of vendors and applications, we are experts on streamlining workflows, reducing costs, and improving usability for hospitals, health systems, provider organizations, and technology partners. We offer on-site, or cloud-based customized approaches to support your existing workflows and claims management challenges. Give us a call. With over 95% of our healthcare automation projects being completed in under 30 days, gains in efficiencies and cost are right around the corner.

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