RPA is an Important Aspect of Value-Based Healthcare

Centers for Medicare & Medicaid Services (CMS) states that value-based care is a healthcare delivery model in which healthcare payments are linked to improvements in patient outcomes. This methodology is supposed to increase patient satisfaction, lower costs, and improve healthcare delivery. But, the value-based care model has proven to be more difficult than originally thought. How can technology advances like Robotic Process Automation (RPA) help with this effort? Let’s explore:

RPA Improves the Collection of Meaningful Data

Significant data is generated in one prior authorization request, but not all of it is usable. There are multiple touch-points and various issues with data quality and accessibility. In fact, the cost of duplications, errors, and manual data input costs the U.S. economy more than $3 trillion a year. RPA reduces these costs by taking tedious, highly repetitive tasks out of human hands, and completing them with machines. This includes opening emails and attachments, logging into web apps, filling in forms, or pulling data from disparate internal and legacy systems. RPA follows through with rules (“if this happens, then do this”), and extracts meaningful data from documents and databases. By adding a digital worker to the team, hospitals, health systems, and providers can improve the quality of data, increase efficiency, reduce labor costs, and improve staff morale. RPA can collect, organize, and translate data into actionable formats, improving time to value while ensuring accuracy and compliance.

RPA Optimizes the Prior Authorization Process

According to the American Medical Association (AMA), 34% of physicians have reported that a prior authorization for services led to serious adverse events for patients. In addition, prior authorization issues are associated with 92% of care delays. Most physician practices spend an average of two business days (16 hours) of physician and staff time solely on this process, hiring additional staff to work just on prior authorizations. Simply by adding automation, work queues are optimized, barriers and errors reduced, and avoidable delays in both patient care and financial reimbursement avoided. The manual process can take as many as forty-five clicks on various screens. Automation searches for the treatment, applies the necessary codes, corrects inaccuracies or missing information, sends it to the payer, and lets staff know if the treatment needs further clarification. This nearly seamless process requires no manual intervention. By automating prior authorization transactions, providers and health plans could save $437 million each year.

RPA Standardizes Healthcare Operations

Aligning organizational goals and processes is an important part of working in healthcare. When the duplication of effort is reduced, people not only work smarter, they get more important work done. RPA allows people to focus on the important daily tasks of value-based care, while automation takes care of the repetitive ones. We are all too familiar with the challenges and barriers to data access in multiple disparate systems. What seems like a simple fix of manually entering demographics or legacy appointment data, literally turns into months of manual data entry and an overwhelming financial and administrative burden. Access to information in multiple, disparate systems can be improved by automating the data transfer, enabling providers to access the data in the right system, at the right time, reducing care delays.

RPA Increases the Speed and Accuracy of Revenue Cycle Tasks

Revenue cycle integrity and speed are paramount to operational sustainability. According to industry numbers by HFMA and MGMA, failure to accurately capture claim charges can result in a 50% loss in revenue. By infusing claims management, prior authorizations, denial management, and payment processing with RPA, health systems and providers are better able to secure a firm foundation for revenue cycle growth and future sustainability. Boston WorkStation allows health systems to automate remittance processing and track all data flowing into and out of the EHR. Instead of monumental delays, inaccuracies, and added stress, clients can streamline tasks and processes and re-define higher patient priorities.

Boston WorkStation Supports the Value-Based Care Model

Since our beginning 35 years ago, Boston Software Systems has taken on the toughest challenges in healthcare, solving problems for our partners, providers, and customers that others can’t. Together, we can customize our service offering to meet the needs of your practice, your plans, and your patient populations. If you’re not a customer yet, we invite you to check out our blog, our website, or give us a call to see how you can benefit from using the latest version of Boston WorkStation 20; because when the path isn’t clear, you’ll want a team that you can count on to lead the way.

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