7 RCM Operational Automation Priorities Hospital CFOs Need to get right.

 Erika Regulsky RCM, RPA
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Implementation of robotic process automation is a form of major change in any healthcare organization’s RCM operations structure, where only about 54 percent of all the healthcare CFOs in the entire nation’s hospitals, health systems, and group medical practices have documented in the past 3 years that they do not have sufficient manual workforce, increase in patient volumes and piling up outstanding balances and are trying to incorporate RPA to their RCM processes so that they can reduce operational costs, improve productivity and quality. However, they tend to miss out on certain important areas where robotic process automation is to be implemented as a priority and there are processes that need full human intervention, using RPA bots for the processes which clearly need human support needs to be identified and assigned accordingly for a very smooth and round the clock RCM operations. 

The goal of healthcare organization CFOs is to implement RPA in their RCM processes in the right way so that the operational efficiency is at its maximum, here are 7 RCM operational automation priorities any hospital CFOs need to get right:

Proper placement of RPA in RCM operations

RPA in RCM operations

As soon as the term robotic process automation is brought up in any major changes implementation in hospital’s RCM operations, it is understood that all RCM processes can be automatically performed without any human staff overseeing, well that’s a false notion. RPA bots are intelligent and are sometimes self-learning; however, prioritizing only the areas where 95% staff burnout is experienced within the organization must be deployed with robotic process automation. Data segregation processes are where RPA gets the maximum output of your ROI and operational success. Data segregation and entry processes with the RCM operations are where RPA bots find their true calling and can outperform a human. Terms of the volume of data captured, entered, and Or consolidated. Healthcare CFOs who are looking to get the best bang for the buck with RPA are only when they identify or conduct regular staff feedback sessions on the RCM operations that make them burn out or stressed. These manual data capturing processes can be very tedious and the repetition itself is a burden, unlike living in the time when the industrial revolution was at its peak and people preferred doing repetitive tasks in factories, modern-day human staff are more prone to the loop of repetitive tasks and eventually leave the organization as their productivity and quality levels decrease over time. Having only 2 areas such as monitoring the volume of data and division of that data among the RCM departments with regular human intervention can do wonders with RPA allowing speedy post-data entry and consolidation audit processes by your human staff. 

Upgrading the RCM workflow

RCM is an assembly line process regardless of how much RPA technology is being implemented. An astonishing 80% of all RCM processes are conducted in this assembly line workflow. Productivity and quality are up to the mark as CFOs are tied to RCM operations related to revenue generation and expenditure. Around 1-2 million dollars are spent every month just for the hospital’s RCM operations staff. CFOs looking to cut down costs eventually implement robotic process automation for faster and more efficient RCM performance. Although considering the RPA requirements from the inquiries we receive, most CFOs relied on RCM directors or billing managers as they set up the RCM workflow suitable only for human billing and coding staff. They tend to leave the RPA implemented RCM workflow which is adaptive to both RPA bots and human billing staff. CFOs need to have a complete understanding of their current RCM workflow set up by some hospitals only have one role which is biller, not all billers are certified in various processes in RCM, take prior authorization coding and credentialing for example they need certified human resources to identify the faulty areas according to the state and federal guidelines. If your hospital is only going to have a few RCM processes with human resources having a lack of knowledge of these guidelines then there is an immediate need to change these RCM processes as implementing RPA bots will need certified RCM staff to assist them in certain areas only a certified human expert can. So upgrading an RCM workflow that will be suitable for both your human staff and RPA bots will provide 100% efficiency and performance. 

Staff population and objectives

staff population

Utilizing robotic process automation for RCM operations isn’t just about eliminating the manual workforce, it is about how efficiently you can use your manual workforce to evaluate and oversee the RPA operations. It is true that 98% of the time these RPA bots do not need any IT support once programmed and implemented, but overseeing the RCM specific performance is essential which is the reason why surveying your RCM staff population and their objectives is a key responsibility of any CFO. Prioritizing the objectives of the staff population is a must after implementing robotic process automation in your RCM operations. You may have multiple resources with the same expertise and objectives in the RCM workflow that they would have been assisting in one single process over the course of many years. Providing them training to work alongside RPA bots in various RCM processes will amplify the rate of reimbursement to 87% because major errors obtained by manual staff before the patient visit will be rectified with a combination of both RPA and human staff ensuring twice the quality and guarantee of reimbursement after 7-14 days according to CMS reimbursement time periods. Additional staff, who tend to fail in diversifying themselves are opted out because if bots have the adaptability to diversify why can’t human staff? The decision of prioritizing staff is in your hands as CFOs.

Pre-Billing RCM Processes

Pre-billing RCM processes are the best place to start robotic process automation implementation. Pre-billing processes like patient access, registration, scheduling, eligibility, and benefits verification, and prior authorization are the main areas where hospital CFOs need to prioritize and implement RPA. The reason why these RCM processes require automation is that data obtained from the patient during the scheduling, registration, and patient access process might be incorrect and causes 55% of all missing or incorrect information claim denials. Other pre-billing areas like prior authorization require robotic process automation because this is a lengthy and time-consuming process and human staff tends to miss capturing in the prior authorization request applications and insurance companies always revert it back to incorrect information captured. Patient eligibility and benefits verification is also time-consuming because of the large patient volumes you receive and the amount of information that needs to be verified and recorded in the patient account on your EHRs for the doctor to educate the patient on their benefits. Healthcare decision-makers like CFOs and CTOs should prioritize RPA in these areas first before moving into billing and post-billing RCM processes. 

Repetitive RCM Processes

Similar to the ones we discussed earlier, repetitive RCM process tasks are the best way to prioritize your robotic process automation implementation. Understanding that RCM is a big cycle and it takes at least on an average 10 days for this cycle to end depending upon the time taken by the insurance companies for reimbursement Or denial. Repetitive RCM processes like charge capture/entry, patient demographics entry, coding, payment posting, and reconciliation are some of the repetitive processes which only involve capturing, evaluating, and entering data, these processes are handled with absolute accuracy and precise timely deliverance by the RPA bots. They surpass human staff capabilities which take 15-20 mins per patient to complete this task whereas RPA bots only take 2 minutes at the maximum to complete this task for a patient. This clever implementation of RPA in repetitive processes will easily help CFOs to boost their operational productivity and quality while reducing operational costs simultaneously.

Clinical data-oriented RCM operations

The term clinical data does not only refer to CDI but also to the recording of clinical data and the management of that data inside your hospital. Many hospitals have in-house labs, radiology, and other screening services that require precise documentation. Robotic processes automation specifically created for this type of clinical data creation and management will significantly increase your hospital’s reputation but also allows you to produce awards like HFMA MAP for performance in terms of high-quality clinical data maintenance and management. CFOs prioritizing RPA for this particular process will increase revenue and avoid documentation-related audits by CMS and other external entities.

Guidelines and regulatory changes

Lastly but not least, the ever-changing guidelines and regulatory changes implemented on reimbursement policies, ICD10 codes, reimbursement rates and billing methodologies are hard to keep track of, because RPA is built in such a way that it always upgrades the guidelines and regulatory changes every month it is important for CFOs and RCM directors to prioritize robotic process automation for this particular RCM operation. It allows a hospital to abide by all state and federal guidelines and rules and get reimbursed in a legal way, as there are various hospitals out there who fail to abide by regulatory compliance and lose confidential clinical data to hackers and ransomware. Robotic process automation not only keeps this information subject to guidelines but also alerts any staff who tries to evade such regulator compliance and guidelines.


RCM operations priorities in hospitals are incorrectly perceived and investments are made in the wrong areas of operations leaving a half-baked RPA implementation. Identifying these factors before implementing robotic process automation in a hospital is the golden rule. This prevents the lack of utilization of the RPA bots and prioritizes your investment in the RCM processes which in turn gives you a faster ROI. As healthcare financial decision-makers it is your responsibility to inquire about these priorities with experienced RPA and healthcare IT solutions companies that can provide you a complete analysis of which RCM processes you should implement RPA and reap the benefits of increasing overall revenue. 

 Appointment Scheduling using Robotic Process Automation

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I’m a multi-certified revenue cycle management professional and compliance officer with 20+ years of experience. I contribute articles to leading healthcare publications and journals. I am currently working as Senior Transition Manager, in BillingParadise headquartered at Diamond Bar, California. BillingParadise offers Medical Billing Services that intersect perfectly with the EMR/Practice management system you use.BillingParadise has offices in New Jersey, New York, Florida, Georgia, Minnesota, and Texas.

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