How Healthcare Automation Builds Post-Pandemic Business Continuity

The COVID-19 pandemic placed additional pressure on CIOs to accelerate their digital transformation efforts. The unparalleled demand for services, facilities, staffing, and public health tracking created chaos in healthcare.

Critical areas of focus like telemedicine, lab testing, and revenue cycle management required efficient processes be implemented at warp speed. There were no longer continued discussions around the ‘possible’ benefit of digital health solutions, they were needed now. Hospitals and health systems were forced to take urgent action to reduce the negative impacts of COVID-19. A study by Ernst and Young found that during the early days of the pandemic, 43% of executives stated they would focus on prioritizing investments in digital and technology. CIOs and additional stakeholders realized that digital capabilities were key to not merely surviving, but thriving in a post-COVID world.

Maintaining business continuity during a public health crisis of this size was unprecedented. McKinsey noted in a recent study of more than 200 organizations across industries:

“More than 90 percent of executives said they expect the fallout from COVID-19 to fundamentally change the way they do business over the next five years, with almost as many asserting that the crisis will have a lasting impact on their customers’ needs.”

Healthcare was hit hard in 2020. 71 of the 200 executives stated that they “expect the COVID-19 crisis to be one of the biggest opportunities for growth” in their industry. As the world faces a new wave, with the variant numbers continuing to rise, healthcare resilience becomes a major concern. Automation can reduce manual interventions, thereby reducing disease transmission risks and empowering human staff to work from anywhere, rather than working alongside others who may be sick. We will continue to see these implementations increase as automation provides an affordable solution to maintaining business continuity post-COVID-19.

CIOs began turning to Robotic Process Automation (RPA) to keep business and service levels afloat during the crisis, allowing healthcare organizations to maintain pre-crisis productivity levels despite challenging work environments and reduced staffing. By automating one area of the revenue cycle, namely claims management tasks, Northwestern Medicine was able to transition to a work from home (WFH) environment without jeopardizing “dollars in the door.” In an interview with Brad Cox, Director of Patient Accounts at Northwestern, Matt Hawkins, SVP at Boston Software Systems, asked, “what impact has RPA had for you and the organization?” “We had two weeks to transition everyone to a WFH environment, many of whom had never worked remotely in their entire career. While the heavy lifting was going on (computers, desks, connectivity), automation took care of everything else. Once we got back to our new normal, we found that all of the tasks that kept money coming in the door had been taken care of by RPA.”

Not unlike the humorous (but true) New York Times article, “The Robots Are Coming for Phil in Accounting,” the kinds of repetitive, tedious tasks that were once left to manual data entry and days of reconciliation, are now being performed error-free and more efficiently, allowing humans like Phil to focus on tasks that require a human brain and eliminating the numbing activities that were once considered a key part of the job description.

Automation was also helpful in areas like telehealth. The number of telehealth visits increased by 50% in the first quarter of 2020, and 154% during March of 2020, according to the CDC. Because quality of care is dependent on the entire chain of data collection and processing, telehealth providers needed a way to keep up with increasing patient volumes with accuracy and completeness.The use of automation in telehealth allowed providers to order COVID-19 lab tests and receive results, without hiring additional FTEs to navigate web portals, requisitions, and claims. Automation replaces the robotic behavior of the human staff and offloads the copy/paste/tasking to the robot, which (unlike Phil) works tirelessly 24/7 and loves performing repetitive tasks.

The RPA market is forecast to grow at double-digit rates through 2021 despite the economic pressures of COVID-19, according to the latest forecast from Gartner, Inc. As we continue working toward this ‘new’ healthcare system, one in which we may fight even more public health crises down the road, let’s take the lessons learned from the pandemic to improve patient care and offload tasks that can be performed more efficiently by robots. By translating our new insights into actionable value propositions, we will be better prepared to weather the next storm.

Why Boston Software Systems?

At Boston Software Systems, we have been driving efficiency and productivity in healthcare solutions since 1985. You’ll see a wide selection of automation and machine learning vendors at #HIMSS21. While we won’t be in Las Vegas, we’re available at any time to explain why more organizations, vendors, and partner solutions turn to Boston WorkStation to bridge the gaps left by system vendors, and deliver on the promise to improve performance and reduce costs in healthcare. Boston WorkStation is a flexible, scalable solution that’s designed to work the way you do, aligning to existing business constraints and delivering exceptional results to clients worldwide.

Reducing The Barriers To Interoperability

Interoperability is certainly not a new topic. It is a predominant theme at #HIMSS21, and has been a term of engagement in healthcare for over 20 years. To better understand the impact of data interoperability, Google Cloud recently commissioned The Harris Poll to survey more than 300 physicians across the U.S. Nearly all (95%) of these physicians said that access to the right data, at the right time, in the right system, can save lives. And almost the same number added this can improve patient outcomes.

Pain Points for Physicians and Patients

According to the study, the majority of physicians (63%) said time-consuming, burdensome reporting systems (still) remain their biggest pain point. Critical information gaps may not make it from the physician office to the hospital in time for care coordination, medication reconciliation, or imaging. It’s even difficult for data to follow the patient from the Emergency Department to the inpatient area in the same hospital. When patient records and critical information doesn’t transfer with the patient, missing or inaccurate information introduces the opportunity for failure. Why is this so difficult for us to fix?

We have hundreds of government-certified EHR products in use across the country, each with different clinical terminologies, technical specifications, and functional capabilities. One in five hospitals reported using different vendors for their inpatient and ambulatory EHR systems.

These differences make it difficult to create one standard interoperability format for data sharing. HL7 interfaces bring over information from disparate systems, but many times “dump” the data in one area, without first comparing and contrasting the information, or sending it to a specific location in the medical record. Physicians spend way too much time searching or toggling between systems and files. CIOs are turning to Robotic Process Automation (RPA) to streamline enterprise operations and reduce costs in revenue cycle, data migrations, telehealth, and reporting. RPA reduces “type and click,” “copy and paste,” and other tedious tasks, making it the perfect digital ally during today’s challenging times.

COVID-19 Highlighted Shortcomings in Systems and Services

During the height of the COVID-19 pandemic, the attention of hospitals and providers was quickly diverted to fighting a rapidly evolving public health crisis. Because few EHRs were architected for information sharing, clinicians had difficulty finding the actionable information they needed for decision-making. They were busy setting up telehealth and connected care technologies nearly overnight, while converting a significant percentage of their administrative workforce to remote work.

RPA connected lab orders and results reporting, telehealth portals, and revenue cycle tasks, reducing the need for FTEs and eliminating an overwhelming administrative and clinical burden. As we transitioned to vaccine distribution, RPA improved the multi-portal process of filing HRSA claims for uninsured patients.

Automation Accelerates Data Access and Streamlines Efficiencies

Automation can speed data sharing requests and improve the interoperability effort between disparate systems by combing through volumes of data, automating the collection, reporting aspects, and ensuring that privacy protocols are in place when capturing and/or sharing health information. And that’s just the beginning. Automation helps to streamline the prior authorization process, claims management, payment processing, supply chain areas, and so much more.

Unfortunately, we cannot solve the quandary of interoperability overnight. We can, however, work together to create easier access, reduce barriers, and check for missing information in systems and web portals. RPA is a much more affordable solution when compared to AI, offering the same benefits, with far less cost, faster implementation times, and fewer resources.

Why Boston Software Systems?

At Boston Software Systems, we’ve worked with every EHR system. We have 30+ years of successful projects under our belt. KLAS gave Boston Software Systems solid A’s in company culture, loyalty, operations, and value. We keep our promises and state our truths as to what our services can and cannot accomplish. In the process, we create happy customers, 100% of whom would purchase from us again.

Executive Order Tackles Healthcare Price, Transparency, and Competition

Lack of competition is a key reason for President Biden’s executive order, “Promoting Competition in the American Economy.” The proposed order tackles four key areas where a lack of competition in healthcare increases prices and reduces access to quality care: prescription drug costs, hospital consolidation, health insurance choice, and hearing aid access. Among other things, the initiative will make it easier to change jobs and help raise wages by banning or limiting non-compete agreements.

Included in the order, the President:

  • Directs the Food and Drug Administration to work with states and tribes to safely import prescription drugs from Canada.
  • Directs the Health and Human Services Administration (HHS) to increase support for generic and biosimilar drugs.
  • Directs HHS to issue a comprehensive plan within 45 days to combat high prescription drug prices and price gouging.
  • Encourages the FTC to ban “pay for delay” and similar agreements.
  • Encourages the Justice Department and FTC to review and revise their merger guidelines to ensure patients are not harmed by hospital mergers and acquisitions.
  • Directs HHS to support existing hospital price transparency rules and to complete federal legislation to address surprise hospital billing.
  • Directs HHS to standardize plan options in the National Health Insurance Marketplace so people can compare costs.

Do Mergers and Acquisitions Challenge Healthcare Systems?

According to a 2021 Physician Sentiment Index by athenahealth, organizational disruptions, such as changes in technology platforms, staff layoffs, temporary furloughs, and/or mergers and acquisitions contributed to more than half of the feelings of exhaustion, overextension, and burnout by physicians. When consolidating systems for increased efficiency and agility, healthcare CIOs must get the cost, scale, and quality right. A compelling issue occurs when vendors are unwilling or unable to migrate all of the necessary components like appointments, schedules, medical histories, preferred pharmacies, and other data during an EHR migration. The result is an overwhelming burden on staff who must capture the data, manually copy/paste, or re-capture from patients at the point-of-care. This causes a backlog of tasks, taking away from the patient experience, adding to organizational burnout and introducing additional patient safety risks.

Robotic Process Automation (RPA) can help with this by bringing over clean data, eliminating duplicates and errors, and reducing hours of manual data manipulation and correction. Greater leverage of this technology can help to improve the efficiency and quality of mergers and acquisitions for all involved, helping healthcare accomplish more with less, which is a driving theme in reducing costs.

Planning is Key to Migrating Systems and Minimizing Disruption

Planning is key to migrating IT systems during a merger or acquisition. Migrating data from disparate systems, through the use of RPA, at night or on weekends, reduces the disruption to administrative practices, clinical care protocols, and the patient experience. 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 burden that can be lifted through automation. Some of the benefits include:

  • A reduction in the administrative data burden on staff
  • The ability to offload tasks that detract from the patient experience
  • Implementation across existing systems, reducing complexities
  • Ability to identify entry errors, duplicates, and omissions for increased patient safety and reduced burnout
  • Accurate and consistent documentation for records and reports

In Summary

The executive order includes 72 initiatives by more than a dozen federal agencies. The President states that these initiatives tackle some of the most pressing competition problems across our economy.

Whether you are viewing these recent initiatives as good or bad, one thing is certain: it’s imperative that we address areas of inefficiency, burnout, and transparency in healthcare. Ongoing challenges include constantly changing regulations, systems, and services. Automation helps to lift the burden of manual data entry, advance timelines, increase system performance, and reduce costs, which helps to improve bottom line revenue in hospitals and provider organizations.

Why Boston Software Systems?

At Boston Software Systems, we’ve been successful at automating the healthcare enterprise for 30 years. Our automations are running in thousands of hospital applications, partner solutions, and EHR systems, every day to minimize disruptions, improve performance, and reduce costs.

Streamlining the Process of Prior Authorizations in Healthcare

From the moment data is entered electronically into a patient chart, the prior authorization process begins. For care to be obtained, prior authorizations have to be identified and submitted with the right codes, approvals, and follow-up. The majority of health plan denials are attributable to prior authorizations, eligibility, and medical necessity rules. Currently, hospitals and health systems have a wide variety of policies regarding prior authorization. Add to that the need to search for data in multiple payer portals, PM systems, and EHR, and move the information manually to a single system, well, it’s easy to see how the process is broken. In addition, a manual process creates a higher risk for errors, which can result in downstream denials and resubmissions.

Why is the System Broken?

According to a study by the American Medical Association (AMA) in 2019, a significant majority of physicians (85%) said the burdens associated with prior authorization were extremely high, despite efforts from policymakers to streamline the process. The AMA went on to state that prior authorizations did not get better in 2020, but rather got worse:

  • Prior authorization issues are associated with 92% of care delays
  • Two out of five physicians (40%) have to employ staff members to work exclusively on tasks associated with prior authorization
  • Practices spent an average of two business days (16 hours) of physician and staff time

We see the same with our customers and, based on their experiences, think these numbers are even higher. With all of the technology advancements over the last decade, you would think that the prior authorization process could be less painful. Yet in 2021, the process feels more manual and labor intensive than ever. This is why automation is such a great fit.

Robotic Process Automation (RPA) helps to streamline the prior authorization process by adding efficiencies to a burdensome administrative workflow. RPA is able to:

  • Work between multiple systems seamlessly, accurately, and without the need for human involvement
  • Check for missing information in systems and web portals
  • Reduce payer barriers and system interoperability challenges
  • Enhance collectible revenue, and reduce the possibility of downstream claim denials

As payer rules become more complex and increased time and scrutiny is placed on accountability, simply getting paid has become a monumental feat. An automated solution for prior authorizations eliminates these barriers, reduces errors, and improves turnaround time, so that patient care and financial reimbursement are not delayed.

Why Should You Use An RPA Solution vs. AI or Outsourcing?

RPA is a much more affordable solution when compared to AI, offering the same benefits, with far less cost, faster implementation times, and fewer resources. It’s a less costly alternative to outsourcing, with the ability to enter data and perform updates 24/7. Using RPA in the prior authorization process allows you to retain more internal control with 100% accuracy, ensuring fewer claim denials and reducing delays in care.

The benefits are noticeable within the first 6 months:

  • 83% reduction in administrative tasks
  • 75-80% reduction in prior authorization timelines
  • 30% reduction in authorization-related write-offs

Why Boston WorkStation?

At Boston Software Systems, we’ve worked with every EHR system. We have 30+ years of successful revenue cycle management projects under our belt. KLAS gave Boston Software Systems solid A’s in company culture, loyalty, operations, and value.

We keep our promises and state our truths as to what our services can and cannot accomplish. In the process, we create happy customers, 100% of whom would purchase from us again.

  • Boston WorkStation was given high scores in overall product quality, and driving tangible outcomes
  • Boston WorkStation works as promoted, and delivers a ‘money’s worth’ return on investment
  • Boston WorkStation’s ease of use drives the value add
  • Boston WorkStation can be implemented quickly and is less expensive than alternative solutions

Why Boston Software Systems?

Don’t pay more for an “AI-powered” solution. Give us a call. We’re happy to demonstrate the value of RPA in the prior authorization process. With most solutions live in <45 days, savings are right around the corner!

Addressing Burnout by Optimizing Healthcare Processes

The Washington Post-Kaiser Family Foundation polled frontline workers in April 2021 and revealed, ”3 out of 10 healthcare workers are thinking of changing professions.” While this may sound surprising, it makes total sense. Nearly half (49%) of healthcare workers reported they had suffered burnout in 2020, while 43% reported feelings of work overload. And it’s not just the clinical staff. Since 2013, the average hospital has turned over 85.2% of its workforce! Healthcare employees often work long hours to keep up with administrative tasks. About a third of every dollar in healthcare is spent on administrative burdens such as logging into multiple systems, tedious manual documentation, and delays in reimbursement. Robotic Process Automation (RPA) can deliver substantial and sustainable value, by automating activities that are manual, rule-based, and repetitive.

Implementing an RPA initiative to ease healthcare workloads is easier than you might think and can assist in optimizing business processes.

Involve the Right Stakeholders

Having the right buy-in from external and internal stakeholders and leadership cannot be overstated. It’s important to share an aligned vision and performance expectation. Leadership is always impressed by the outcomes of a successful RPA initiative, turning many who were previously “on the fence,” into cheerleaders for applying automation to additional areas. PwC estimates that “45% of work activities could be automated, and this automation would save $2 trillion in global workforce costs.” Some of the greatest benefits of RPA are the ease of deployment, scalability and speed, and the positive impact on ROI, with immediate cost-saving results. Addressing upstream process improvements has a magnified impact on downstream steps.

Set Clear Objectives

Getting started with an RPA initiative involves identifying the right processes and use cases to result in clear benefits and a fast ROI. An RPA initiative can remove the manual data burden from revenue cycle management teams by adding a layer of efficiency to the revenue cycle process, ensuring accuracy and eliminating duplication in time, effort, and documentation. This empowers people, allowing them to focus on higher priority tasks that require a human skillset. An RPA initiative can move seamlessly from one tool to the next, streamlining processes, and eliminating multiple steps throughout the healthcare ecosystem.

Design, Test, and Deploy

The best results are achieved when the initiative is designed to work like the human staff, so it’s important to align workflows. At Boston Software Systems, we’ve been doing this successfully for 30+ years. We’ve worked with every EHR system and are completely healthcare-centric. Whether it’s a revenue cycle project, supply chain initiative, COVID-19 specific, or telehealth, we work with every client to strategize the right project and achieve the desired objectives. We’ll help you every step of the way to ensure that your projects are successful. Our healthcare experienced project teams will deliver a sound transition plan and faster use of these new tools.

COVID-19 Use Cases

Boston WorkStation helped #bridgethegaps for telehealth providers, staff, and work queues during COVID-19. A process that previously took 5 FTEs, working on three shifts, manually entering data from each patient into the system was automated, allowing the organization to re-allocate 4 of the FTEs to higher-value work, and only keep one in an oversight role. Every order entered was complete and the communication process loop closed. The automation was quickly scaled to over 200 providers, across mobile testing sites, throughout the city of Jacksonville and across Northeast Florida.

In addition, RPA removed the barriers to COVID-19 vaccine administration for multiple health systems by checking patient eligibility in the EHR, entering treatments and submitting accurate reimbursement information via the HRSA web portal, eliminating multiple manual steps, and speeding the reimbursement process for providers.

Why Boston Software Systems?

Healthcare workers are the greatest asset we have in the health system. To effectively support them, we must make it easier for them to focus on patients, not paperwork. RPA initiatives reduce the effects of burnout by optimizing healthcare efficiencies and reducing the barriers to productivity. In doing so, we can minimize some of the effects of burnout, so that everyone wins.

Give us a call, we won’t take up much of your time. Spend 30 minutes to find out what can go live in < 30 days. Manual processes can be quickly reduced, creating a happier staff and long-term transformational changes to healthcare processes.

Artificial Intelligence (AI) is Not Ready for Prime Time in Healthcare, Yet

Sometimes we read what others are saying and, because we want it to be true, we imagine it is true. It’s important to break down false promises and inaccurate information about Artificial Intelligence (AI). Healthcare has not even begun to realize the potential of AI, as we are merely at the infancy stages of applying it in healthcare. The current use case is very limited in scope and practice. AI requires massive amounts of specifically categorized data in order for it to learn the patterns and perform as expected. That’s why millions of us click on all the images that “contain busses” to confirm we’re human.

AI is the next “shiny object,” so naturally vendors want to use the terms and promises, instead of the facts. Like any good build-up of a story, this is one that we can’t wait to read. But before we go all “back to the future” in this tale, let’s tune in to the present day reality.

An AI Workforce Cannot Transform Healthcare Today

Some parents used to say, “choose your words wisely.” The same should also apply to AI in healthcare. AI has the potential to transform healthcare delivery, but it simply cannot be accomplished today. We don’t yet know enough about how AI in healthcare might work. We have ideas, and a limited scope of ways, in which it should work. Ultimately we hope to see AI as an integral part of the healthcare value chain, once there are standards for data quality, access, governance, security, and yes, even data sharing. AI does not currently “empower interoperability in healthcare by connecting disparate systems, or connecting humans to data.” It sounds great and the phrasing is fantastic, but it’s just not true, yet.

The scale of AI solutions remains small. We can’t shift from a “digital workforce” to an “AI workforce,” basically because there isn’t one. There’s Robotic Process Automation (RPA), Intelligent or HyperAutomation (the end-to-end automation of processes and data), and other ways of connecting data from disparate systems (APIs), but none of this is true AI.

AI is Not Currently Empowering Humans in Healthcare

AI is not performing tasks and completing processes. It’s not connecting disparate systems. It’s being used in small situations that may lend themselves well to AI in the future, like radiology, supply chain, and pharmacy operations. It’s not being used for Clinical Decision Support (CDS) because we don’t have the needed standards in place, yet.

Let’s take a look at claims status checks. It’s noted in multiple marketing materials that, “RPA is not able to do what AI can do in terms of actionable insights.” That’s simply just not true. RPA can indeed perform claims status checks, access information from multiple systems, and drive actionable insights, faster and less expensively. We’ve been driving value in healthcare-specific RPA for 30 years. This is why Boston Software Systems is different. We don’t lean on fancy words and phrases, we lean on our experience, our customer satisfaction, and our results.

Global Awareness Does Not Create Interoperability in Healthcare

Global awareness is a capacity that incorporates attitudes, knowledge, and skills necessary to promote the greater good; an ability to understand, respect, and work well with people from diverse cultures. Creating better people in an interconnected world. We should all aspire to be better global citizens. But that’s up to individuals. Global awareness cannot create interoperability in healthcare. These are inaccurate statements. Instead, be “self aware” before spending millions for an AI solution that just doesn’t deliver. Because it can’t do what it is marketed to do.

We care about accuracy because in healthcare that’s of utmost importance. And while we’re excited to embrace the FUTURE of healthcare, and AI, we care about our customers and their patients too much to take the risk of developing it using them as a test case (with their money).

What can we do in healthcare today?

  1. Automation can process most of the tasks in payment processing, inventory control and management, supply chain, lab, and payer processing.
  2. Automation can manage almost the entire revenue cycle claims operation without involvement from humans.
  3. Automation can turn insights into actionable information for providers, identifying potential problems, and in many cases, fixing the problems and closing the loop on the entire process.
  4. Automation can access information on 3rd-party websites, complete forms and portal requirements, and connect data from disparate EHR and legacy information systems, thereby reducing administrative “human” fatigue, and improving interoperability efforts.

It’s automation, and we’ve been doing this for 30 years.

Maybe you’ve had business cards printed in the past and the main piece of advice was “say what you do.” Not what you might do years from now, or what you aspire to do, but what you do presently. In our case, it’s keeping our promises, stating our truths as to what our services can/cannot accomplish and in the process, creating happy customers, 100% of whom would purchase from us again. We are first and foremost for our customers, not our shareholders, that’s why we score so high in customer satisfaction.

Why Boston Software Systems?

If you’re looking at “AI in healthcare,” just know that you’re paying for the words and the story. The words are good, don’t get us wrong. But the truth is better, and AI is just not available in the revenue cycle or in healthcare automation services today. Find out more about our automation solution, Boston WorkStation. With most solutions live in <30 days, savings and efficiencies are right around the corner.

Key Strategies to Improve Revenue Cycle Processes in 2021

2020 was an especially difficult year for most rural hospitals and health systems, who lost an estimated 70 percent of their income due to delayed and deferred visits and procedures. Although billing and claims might seem like a pretty linear process, there are detours and bumps that challenge even the best revenue cycle management teams.

You shouldn’t have to spend hours each day manually checking to be sure the payers respond to every claim. Here are the highest value strategies for RPA implementation in the revenue cycle, with a proven return on investment.

Implement an Automated Workflow

The average hospital processes tens of thousands of claims each month. Revenue cycle team members spend countless hours going out to multiple portals to see which claims require follow-up. This manual system pulls people away from higher value tasks. Manual claims status checks take up to 50% of each revenue cycle team’s time. Instead of manually going through claims one by one, you 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.” By automating claims status checks, FTEs are able to save up to fifteen minutes for each claims inquiry. By enabling employees to work at the top of their expertise, organizations increase productivity, save valuable time and resources, and boost job satisfaction scores and employee retention rates.

Automate Claims Management Tasks

Revenue cycle departments can have as many as 20 disparate data silos to navigate depending on the task. They still rely on manual data input from human workers, who navigate through the steps in payment processing. Automation removes this manual data burden, adding flexibility and adaptability. A recent example revolves around HRSA uninsured patient claims for COVID-19. The manual, lengthy process of researching coverage and entering data in multiple portals is replaced with automation, freeing up your most valuable resource (people) and recovering millions of dollars in claims in a matter of weeks. Leveraging RPA allows claims to be filed and payments to be posted, automatically updating patient accounts.

“CAMC was able to eliminate a very time consuming and costly process of manually entering data from and to disparate sources. Our workflow automation processes do exactly what we need them to do and with the added bonus of proper error checking.” – David Dickens, CAMC

Optimize Claim Denial Management

The Advisory Board states, “You’re probably leaving $22 million on the table,” by not following best practice guidelines in four key areas: denial write-offs, bad debt, cost to collect, and contract yield. Patient obligations are routinely being written off as bad debt, rather than spending the time to collect. Especially in areas like the Emergency Department (ED) where the ability of staff to keep up with increasing demands diminishes. What may seem like a few dollars here or there, can quickly add up to millions of dollars in unpaid, uncollected debt over time. Automation can sort through multiple databases and work queues, without an overwhelming manual burden on administrative staff. One of our clients saved 180 hours per month and $20 million in failed claims re-submissions, through the use of Boston WorkStation.

Here are just a few of our revenue cycle success stories:

  • Recovered $2 million per year in Emergency Department 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 in claims submissions.
  • Collected millions of dollars in HRSA uninsured patient claims within a matter of weeks.

Why Boston Software Systems?

With a solid “A” ranking in the “Best of KLAS 2021” RPA category, Boston Software Systems has a demonstrated history of results in revenue cycle performance – #bridgethegaps left by your current vendor or process. Boost revenue, increase productivity, and eliminate an administrative burden on human workers, with Boston Software Systems’ revenue cycle management solution.

A Decades-Long History in RPA

Robotic Process Automation (RPA) has a decades-long history. Screen scraping started during the early days of the Internet to help users extract data from the web. It referred to the practice of reading text data from a computer display terminal’s screen. Simple scenarios involved automation navigating through a series of steps in an application using keystrokes and coordinated clicks. These scenarios evolved to include more complex workflows, entering and managing data into interfaces and across applications, replicating manual steps only a person could originally complete.

Thom C. Blackwell, VP of Technical Services at Boston Software Systems, states, “In the beginning, it was also referred to as non-invasive interfacing. At the start of HL7 (and still now) there were data gaps, and excessive cost and time issues in translating one vendor’s version of HL7 to another’s, making automation a very cost and time-effective option to interface systems like labs, pathology, medications, and scheduling.” Also in the 1990s, financial data providers displayed data in 24×80 formats intended for a human reader. Applications were written to capture and convert this character data as numeric data for inclusion into calculations without rekeying the data. Line item and payment posting, parsing, etc., was a nightmare for most revenue cycle management teams (and continues to be) in many organizations.

Fast forward to 2004, most hospitals were using paper intake forms with documentation entered by a nurse on a laptop positioned on a mobile cart. Physician orders were most often written on paper, picked up by the pharmacist daily, and then entered manually into the medication order system.

Throughout the 2000’s, data was routinely entered into a stand-alone system used for just one area of the hospital. Laboratory results and radiology results were all printed for paper charts. A Medication Administration Record was generated from the EHR based on physician orders entered into the system manually, then transmitted electronically to all relevant departments.

Manual data entry, duplicate documentation, and tedious tasking was just part of “business as usual” in most hospitals and health systems. If you worked in healthcare or Health IT during this era, you may remember transcribing notes into the EHR, then printing and scanning them into multiple departmental systems.

Thom goes on to say, “There were also many unstructured notes in the EHR. We did, and still do, a lot of dictionary maintenance and test synchronization. Dictionaries would be built in a “test” environment, then you’d have to build the same thing again in a “live” environment, to keep the synchronization the same. Mass updates and targeted edits in one or more fields, for various reasons. Many downtime mitigation processes required an automatic generation of reports for things like a hospital census, medications, etc., which required a switch to paper. When RPA was used, we could connect the data points without the need to print to PCs located all over the hospital floor.”

Since then, RPA has evolved and advanced from a one-area data migration tool to a Swiss Army knife working across platforms, applications, and systems. Hospitals and health systems are using the speed and accuracy of RPA to merge, transfer, and share data across telehealth applications, lab reporting systems, vaccine administration management systems (VAMS), and HRSA reporting portals. Revenue cycle management teams are shifting to an entirely new work environment (WFH) without losing time in payment processing, due to the automation benefits of RPA in the revenue cycle. RPA has simplified the process between the EHR and multiple regulatory reporting portals or order entry systems. According to Gartner, RPA is the fastest-growing segment of the global enterprise software market, expected to grow at double digits through 2024, despite the economic pressures caused by the pandemic.

Why Boston Software Systems?

At Boston Software Systems we’ve harnessed the power of RPA over three decades and our focus has been to improve the end-user experience exclusively in healthcare.

We’ve worked with every EHR vendor. We deliver revenue cycle management services that speed dollars in the door and eliminate administrative burdens. We keep our promises, deliver what we say, and understand healthcare’s challenges, since that’s our main focus. Take a look at our KLAS rating for 2021, and you can read our customer insights here.

Uninsured Patients HRSA Claims Reimbursement for COVID-19 Testing, Treatment, and Vaccine Administration

As part of the Cares Act legislation, The Department of Health and Human Services (HHS), will provide claims reimbursement to health care providers for testing, treatment, and vaccine administration to the uninsured patient population. More than $5.6 billion dollars have been paid to date and over 238,000 health care providers have enrolled in the program.

In addition, the COVID-19 Coverage Assistance Fund (CAF), launched this week. The COVID-19 Coverage Assistance Fund (CAF) will cover the costs of administering COVID-19 vaccines to patients whose health insurance doesn’t cover vaccine administration fees, or does but typically has patient cost-sharing. Patients cannot be billed directly for COVID-19 vaccine fees, or for the cost to health care providers. Now, underinsured patients will be fully covered through the CAF funds, subject to availability.

How It Works

HHS intends for the two programs to incent providers to get more shots in arms. Providers have funding available to cover the cost for underinsured patients through the CAF funds, subject to availability. Eligible providers will be reimbursed at Medicare rates for vaccine administration fees, and for any patient cost-sharing related to vaccinations, including:

  • Co-pays
  • Deductibles
  • Co-insurance

To qualify for reimbursement, providers must adhere to the following steps:

  • Enroll as a provider participant
  • Check patient eligibility in the EHR
  • Submit accurate patient information via the HRSA web portal
  • Submit correct procedural and vaccination codes
  • Submit claims electronically
  • Set up a direct deposit / an ACH account with Optum Pay

What You Need

HRSA has contracted with UnitedHealth Group to be the sole administrator of the HRSA COVID-19 Uninsured Program. There are several steps in the process to get started. First, you must set up and validate a temporary identification number (TIN) with Optum Pay. If you are already registered as a provider with Optum Pay, use your existing One Healthcare ID to sign in. If you do not have a One Healthcare ID, you can register for one on the United Healthcare portal. You will be provided with a unique provider identifier for the HRSA COVID-19 Uninsured Program Portal.

Once registered, provider organizations will need to confirm that the patient was uninsured at the time the services were rendered. The steps in the claims reimbursement process include:

  • Provide accurate patient demographic information
  • Access the web portal to submit patient information
  • Obtain a temporary member ID
  • Manage and add patients individually, or as a batch
  • Submit claims for reimbursement
  • Receive electronic deposit within 30 days

Automation Simplifies the Process

Because all submitted claims must be complete and final, accuracy is an important detail. There will be no adjustments to payment once reimbursements are paid. Automation allows the hospital and/or provider organization to review the patient information, and ensure all of the information being added is accurate and complete before submitting via any of the web authorization portals. By using automation, or a “digital workforce,” to complete these steps, the burden of manual data entry between the EHR and the HRSA web portal is removed. Automation navigates through the following steps:

  • Review patient information for coverage and eligibility in the EHR
  • Capture the necessary information for claims submission
  • Navigate to the web portal via a web browser
  • Apply for the TIN (Temporary ID Number)
  • Wait for the approval process (24 hours)
  • Send any documentation and/or notes back to the EHR
  • Ensure timely filing and submit claims for filing

Automation eliminates 12-20 time consuming and manual steps between the EHR, payer authorization portals, and the HRSA program portals. Automation ensures accuracy, which is an important factor of the HRSA COVID-19 Uninsured Program. If a claim is submitted with a potential error, the claim is returned to the provider, delaying the reimbursement process and creating the need to repeat the claims processing steps.

Why Boston Software Systems?

Robotic Process Automation (RPA) has a pivotal role in helping these programs operate effectively and efficiently. If your hospital or provider organization is looking to optimize day-to-day operations, go with a global leader in healthcare-specific RPA.

At Boston Software Systems we have worked with multiple client hospitals on the COVID-19 claims reimbursement process. KLAS reviewed and customer validated, we can have this deployed quickly and without disruption to people or existing infrastructure.

Unlocking Patient Access: The Cures Act Information Blocking Provisions

On April 5th, 2021, the National Coordinator for Health Information Technology (ONC) finalized the Cures Act’s information blocking provisions. These new rules focus on data exchange and patient information blocking. The Department of Health and Human Services (HHS) states:

“Putting patients in charge of their health records is a key piece of patient control in health care, and patient control is at the center of HHS’ work toward a value-based health care system.”

Patients have long struggled to gain access to their medical records both in hospitals and outpatient facilities. This has been complicated by the proprietary nature of the Electronic Health Record (EHR) and the lack of interoperable standards for data sharing. The new data exchange and interoperability rules will have a profound effect on an individual’s ability to manage their health information. Application Programming Interfaces (APIs) and apps will provide patients with greater control over health data, images, and clinical documentation housed in the EHR.

What This Means for Patients

Patients will have greater access to their medical records at any point in their healthcare journey, regardless of the proprietary nature of the software system. For example, if a patient is discharged from the Emergency Department (ED) a notification must be transmitted to the patient’s primary care provider (PCP), established practice group, or covered entity (ACO), and a copy of the visit made available for care coordination. The Centers for Medicare & Medicaid Services (CMS) encourages hospitals to include the patient’s chief complaint, a medication profile, discharge instructions, and a diagnosis. The rules state that providers must:

  • Provide patients with access to their medical record
  • Limit information blocking by sharing patient data with insurance companies, employers, and consumer-facing apps
  • Release lab, radiology, and/or pathology results
  • Update information in federal databases and provider directories

What This Means for Providers

The rules require that vendors open up access to the information via an API. Providers will have to re-assess and revise longstanding information sharing practices.

From a technology standpoint, providers will need to:

  • Enable patient-facing technologies (patient portals, kiosks, and apps)
  • Measure and report performance improvement efforts
  • Maintain up-to-date information in provider directories
  • Support greater transparency efforts in clinical data sharing

How Automation is Streamlining These Efforts

The use of Robotic Process Automation (RPA) raises opportunities for health informatics and information management. By streamlining some of the requirements for the providers regarding unstructured data, automation can make it easier to find unsigned provider notes, see if there’s a diagnosis code, and notify the provider, portal, or patient of any changes or updates to the healthcare information record.

Automation can speed data sharing requests and improve the interoperability effort between disparate systems, by combing through volumes of data, automating the collection, and reporting and ensuring that privacy protocols are in place when capturing and/or sharing health information.

Why Boston Software Systems?

At Boston Software Systems, we’re excited to see these new patient-centric standards, but we understand the stress this places on vendors and providers during an already challenging year. BSS has been working across the continuum of healthcare, providers, vendors, payors, and patients for decades to make data sharing across disparate platforms easier for all. We continue to support a sustainable operating model, one that reduces the challenges associated with interoperability and access, and reflects the needs of end users.

We’re happy to discuss how these rules and regulations can be streamlined for efficiency in your business model. Give us a call. With most solutions live in <30 days, we can help you achieve your goals faster and with less disruption.