5 Reasons to Use RPA in the Healthcare Revenue Cycle

The impact of COVID-19 is still being felt in healthcare. Coupled with the Great Resignation, hospitals and healthcare organizations are stretched thinner than ever. The American Hospital Association (AHA) stated in a recent analysis that there will be a shortage of up to 3.2 million healthcare workers by 2026. Technologies like Robotic Process Automation (RPA) allow healthcare workers to “do more with less.” In this blog post, we will explore the top 5 benefits of adding RPA to the revenue cycle.

1. Managing Tasks with Fewer People

Workforce shortages have reached a crisis in this country. Resources are a challenge, especially with fewer team members. Governors have addressed dire healthcare shortages in over 20 states. Having the right technology in place allows your teams to work smarter. By adding automation to the revenue cycle, manual data entry tasks can be offloaded to machines. People are free to deal with tasks that require human skills like empathy and creative communication. With 100% accuracy, no additional staffing, and no days off, this “digital workforce” removes the burden from people, allowing them to work smarter, at the “top of their license,” instead of wasting time on duplicative, tedious tasking.

2. Claims Status Checks

When a provider contacts a payer to check a claim status, it takes an average of 14 minutes and costs the provider roughly $7.12. By the time a claim reaches a denied status, the provider has lost at least two weeks. Considering that the time between claims submission and payment can be as long as four weeks, these delays are costly. At Northwestern Medicine, automating claims status checks revealed a 330% ROI within the first year, and this will continue to grow into perpetuity. They were able to offset 25 full-time employees (FTEs) worth of work on an annual basis. That did not mean reducing their workforce by 25 people, that means they were able to double in size (from 1,500 to 3,000 providers), without adding one additional team member, all due to automating claims status checks.

3. Reducing Claim Denials

The complexity of revenue cycle management tasks makes it difficult for providers and healthcare organizations to identify the root causes of claim denials before submission. Unfortunately, a denied claim costs roughly $118 to rework. It’s a costly, time-consuming administrative burden that is made easier with RPA automation. RPA identifies any gaps in the claims and corrects mistakes before they even hit the submission queue. Providers gain better control over denials to prevent chronic revenue losses. The RPA “digital employee” becomes a valuable resource to the claims management team, clocking in and working like an FTE, reducing the number of denials, which makes the entire process easier for human workers.

4. Prior Authorization Management

The prior authorization process gives health insurance companies a chance to review how necessary certain medications or procedures may be in treating a patient’s condition. It is an important process, but very labor -intensive, costly, and time-consuming for insurance payers to triage the enormous number of incoming requests. Review processes typically require significant human assets to examine incoming materials and often involve multiple iterations with physicians. Delays and errors in the prior authorization process have a huge impact on both patients and providers, reducing the timeliness and quality of patient care. These delays often lead to costly appeals and grievances. RPA significantly minimizes eligibility processing time by as much as 83%.

5. Payment and Collection Activities

By automating payment processing, productivity is improved and the manual, time-consuming process of posting insurance payments is streamlined, resulting in reduced operating costs and increased time management. This includes other activities like automated invoice capture, coding, and vendor contract approvals as well. Boston WorkStation has been keeping hospitals on track with payment and collections automations since 1985. On a daily basis, Boston WorkStation queries databases, looks for transactions, and then posts them through multiple EHR modules on the proper account. By automating multiple touch points within the revenue cycle, errors are reduced or prevented, collections avoided, and payments expedited.

Why Boston Software Systems?

We’ve been automating healthcare tasks for 30+ years, adding value to the organizations we serve and empowering people to get more accomplished using less resources. Boston WorkStation receives a 100% rating in two critical areas: “working as promoted” and providing a “money’s worth return on investment.” When the path isn’t clear, you’ll want a team you can count on to lead the way. Give us 30 minutes. We’ll answer every question you have about adding automation to the revenue cycle, and have a Scope of Work (SOW) ready for you within 7 days.

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