RPA Streamlines Revenue Cycle Operations

There are many benefits to automating processes in the healthcare revenue cycle. According to industry numbers by HFMA and MGMA, failure to accurately capture claim charges can result in a 50% loss in revenue. As healthcare financial leaders focus on recovery in a post-pandemic world, they are adding automation technology to revenue cycle processes to optimize organizational efficiencies and lower the cost to collect. Gartner anticipates that half of all provider organizations will invest in RPA technology over the next few years, driven largely by payment reduction and the need to support the patient experience.

RPA Use Cases In The Revenue Cycle

The most important aspect of automating tasks in the revenue cycle is choosing the right projects for the greatest impact and ROI. RPA adds value across all four areas of revenue cycle management: registration, coding, backend claims management, and billing – connecting disparate data silos, reducing friction, and ensuring that processes are completed on time and without errors. Use cases include:

Appointment Scheduling, Reminders, Patient Communication
One of the main challenges of the pandemic was in getting the right information to the right person, via the right system, at the right time. Whether EHR data, portal information, telehealth visits, or additional patient communication, the need to integrate data from multiple, disparate systems was a high necessity during the pandemic. It’s estimated that the average healthcare enterprise runs hundreds of custom applications, whether hosted in the cloud, integrated via APIs, EHR, PM, CRM, etc. Each application may require input from multiple legacy systems and tools. RPA is able to “bridge the gaps” between these disparate systems without disruption to the larger healthcare system. Missed appointments cost healthcare as much as $150 billion annually. When the pandemic overwhelmed healthcare staff and systems, RPA bots streamlined the process, giving people back their time and making it easier to schedule visits.

Eligibility and Benefit Verification
Prior authorizations and eligibility checks can easily lead to care delays due to a lack of standardized information and processes. By automating the prior authorization process, we can reduce the time it takes to be approved for care, while providers and hospitals experience a significant reduction in operating costs and claim denials. The volume and complexity of prior authorization requests is overwhelming already overburdened physicians and clinicians with too much paperwork to effectively perform their primary role, treating patients. As a result, it’s leading to escalating levels of physician burnout, delays in treatment, and decreasing levels of patient satisfaction. By automating the process, patients are seen faster, physicians are relieved of this manual paperwork jungle, and costs are reduced by 20-30% from a manual prior authorization process.

Reducing and Managing Claim Denials
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 of valuable time. Considering that the time between claims submission and payment can be as long as four weeks, these delays become costly. At Northwestern Medicine, automating claims status checks revealed a 330% ROI within the first year, which 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.

Regaining Financial Footing Post COVID-19 And Beyond
Digital connectivity is more important now than ever. With more employees working remotely, tools, applications, and processes are critical to supporting business continuity in a healthcare system that has been severely challenged over the last three years. By offloading tedious manual tasks to machines, physicians and healthcare providers have more time to spend with patients, not paperwork. Revenue cycle processes can involve data in as many as 18 different portals and websites. 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. By simplifying the process and allowing “bots” to take over these manual tasks, people have more time to build and maintain relationships.

Planning For The Future With Boston Workstation

Boston WorkStation has been improving healthcare processes for over 30 years. Hundreds of BWS automations run every day in hospitals, health systems, provider organizations, and technology partner solutions. We are #1 in RPA product value, support, & ROI. 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.

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