Automate 5 RCM Processes to Reduce Cost and Repetitive Tasks

 Wayne Carter RCM
  • Home
  • RCM
  • Automate 5 RCM Processes to Reduce Cost and Repetitive Tasks

Social Shares

How RCM Automation Reduces Costs and Eliminates Repetitive Tasks in Healthcare

Introduction to RCM Automation

Revenue cycle management (RCM) technology comes in all shapes and sizes depending on a healthcare provider’s goals. One of the more popular forms of technology in RCM is Robotic Process Automation (RPA).

RPA is a technology that leverages bots or programs to imitate how a human would interact with software to complete high-volume, repeatable tasks, such as logging into applications, entering data, and copying data. For this reason, RPA has been a highly sought-after technology for optimizing revenue cycle management solutions.

RCM Processes

The Role of RPA in RCM

Revenue cycle management involves a series of administrative and financial processes to manage the healthcare organization’s revenue stream, from patient registration to final payment for services rendered. Many of these processes contain repetitive and rules-based tasks. For example, revenue cycle staff must enter patient information, insurance details, and billing codes in order to establish a patient visit and submit claims to payers for reimbursement. Typically, this process is done manually by revenue cycle staff.

Data entry is just one example of manual RCM work. The healthcare revenue cycle is full of these manual, repeatable tasks, from claims processing and eligibility verification to payment posting and denial management.

How RPA Optimizes RCM Processes

RPA can help providers optimize revenue cycle management by leveraging technology to complete some of the more straightforward tasks, leaving their staff to manage more complex, value-adding activities like tackling complicated denials and tailoring payment strategies to patient preferences.

What is RPA, and How Can RCM Benefit?

RPA is likened to a virtual assistant that can handle repetitive, time-consuming tasks in daily administrative processes. RPA technology mimics what in-house staff do on a daily basis to free them up for more mission-critical responsibilities around patient care.

The key to RPA is that it does not replace a staff member. The technology acts more like a digital helper to perform rules-based and repetitive tasks alongside a practice’s team of revenue cycle professionals. For example, it can help to verify a patient’s insurance eligibility, process billing information, and manage appointment scheduling to a certain extent.

Enhancing Efficiency with RCM Automation

Leveraging RPA technology can significantly enhance revenue cycle efficiency by taking away some of the manual tasks staff perform. The technology can perform routine tasks like claims processing much faster than the average human and reduce the likelihood of errors stemming from manual data entry. Together, the efficiencies gained from RPA technology can reduce the cost to collect, turn around faster reimbursements, and minimize claim denials.

Meanwhile, staff can focus on tackling more complex tasks that require critical thinking. For instance, some claim denials are complicated, requiring providers to revisit coding and clinical documentation to gather evidence to justify reimbursement for services rendered. Many practices do not have the capacity to take on many complex claim denials without the use of some automated technology, whether due to staffing shortages or the volume of claim denials. Yet, these denials may return a significant amount of money to the provider if reworked or appealed.

Appointment Scheduling

The adoption of Robotic Process Automation (RPA) technology in healthcare has proven to be highly effective in managing appointment scheduling and related patient access tasks. This is especially critical in the current healthcare landscape, where patient no-show rates have increased significantly following the COVID-19 pandemic. A 2022 MGMA poll indicated that about half of the medical groups reported an increase in no-show rates. The reasons for this rise include patients’ hesitancy to seek care due to costs, lack of transportation, long wait times, or simply forgetting or choosing not to attend scheduled appointments.

Repetitive tasks in appointment scheduling, such as patient data entry and appointment confirmations, are both time-consuming and error-prone. RPA technology within revenue cycle management solutions can significantly reduce these repetitive tasks, enhancing efficiency and accuracy.

Implementing RPA for appointment scheduling and patient access not only improves efficiency but also reduces operational costs. Manual scheduling processes are resource-intensive and prone to errors. By automating these processes, healthcare providers can achieve significant cost savings.

Claims Processing and Adjudication

Claims processing and adjudication is a complex, multi-step process that involves creating and submitting claims to payers for reimbursement. This critical stage in revenue cycle management solutions concludes with a payment determination, where healthcare providers must post the payments depending on the outcome of the claims. Accuracy in this process is essential; even a minor misstep can lead to significant delays in reimbursement or outright claim denials, affecting the financial stability of healthcare practices.

Repetitive tasks in claims processing are not only time-consuming but also prone to errors. Automation, particularly Robotic Process Automation (RPA) within RCM software, can significantly reduce these repetitive tasks. A 2023 survey of healthcare financial leaders revealed that eligibility issues, missing prior authorizations, insufficient documentation to support medical necessity, and incorrect patient information are common errors leading to claim denials. RPA offers a robust solution by automating crucial steps in the claims processing and adjudication sequence. This technology boosts accuracy and efficiency by automating data entry tasks—it extracts relevant information and fills out claim forms, thereby minimizing the errors typically associated with manual data entry.

The integration of RPA in revenue cycle management solutions is not only about reducing repetitive tasks but also about lowering operational costs. Manual claims processing is labor-intensive and costly. By adopting RCM automation, healthcare providers can reduce these costs significantly. For instance, automation can cut operational costs by up to 30%, a substantial saving for any healthcare practice.

Patient Eligibility Verification 

Ensuring patients are eligible for the medical services they are scheduled for is crucial for quick and accurate reimbursement. Traditionally, this has often been a manual process where staff verify a patient’s eligibility against payer rules and guidelines prior to the appointment. However, this manual verification is not only time-consuming but also prone to errors, which can delay the reimbursement process. Robotic Process Automation (RPA) technology can significantly reduce the manual workload by automating patient eligibility verification, thus speeding up both patient service and claims processing.

Repetitive tasks in eligibility verification, such as manual data entry and insurance checks, are labor-intensive and error-prone. RPA technology within revenue cycle management solutions can leverage real-time verification of a patient’s eligibility for specific services. By integrating with payer portals and electronic health records (EHR) or practice management systems, RPA can automatically pull data to check insurance status and eligibility.

Implementing RPA for eligibility verification not only improves accuracy but also reduces operational costs. Manual verification processes are resource-intensive and costly. By automating these processes, healthcare providers can achieve significant cost savings.

Prior Authorizations

Prior authorizations are recognized as one of the most significant pain points in healthcare. Providers not only identify prior authorizations as the most burdensome regulatory issue they face, but a majority also agree that these requirements often lead to care delays, abandoned treatment, and adverse clinical outcomes. As the demands for prior authorizations continue to rise despite their heavy burden on providers, many healthcare practices are seeking technological solutions to alleviate these challenges.

The prior authorization process traditionally requires substantial manual effort and is prone to errors. Robotic Process Automation (RPA) technology can significantly simplify the task of checking a prior authorization’s status, similar to how it improves patient eligibility verification. This technology enhances efficiency by automating the verification process.

Implementing RPA for prior authorizations not only improves accuracy but also reduces operational costs. Manual authorization processes are resource-intensive and costly. By automating these processes, healthcare providers can achieve significant cost savings.

Accounts Receivable and Denial Management 

Accounts Receivable Automation

Accounts receivable (AR) management in healthcare involves tracking amounts due from payers or patients for medical services rendered but not yet paid. Traditionally, this process has been fraught with challenges, including delayed payments and high administrative costs. However, with the advent of RCM automation, these challenges are being addressed more effectively. RCM software automates the invoicing and follow-up processes, ensuring that claims are submitted promptly and correctly, and payments are tracked and received on time. This automation not only speeds up the process but also reduces the likelihood of errors that can lead to delays and additional costs.

Automating repetitive tasks in AR management, such as invoicing and payment follow-up, significantly enhances efficiency and accuracy. Implementing RCM automation for AR management not only improves accuracy but also reduces operational costs. Manual AR processes are resource-intensive and prone to errors. By automating these processes, healthcare providers can achieve significant cost savings.

Denial Management with RCM Software

Denial management, another crucial aspect of revenue cycle management, involves identifying, researching, and appealing unpaid claims. Denials can severely impact the revenue of healthcare organizations if not managed effectively. With RCM automation, the denial management process is significantly enhanced. RCM software can automatically identify denied claims, categorize them by reason, and initiate standardized appeal processes. This level of automation reduces the time and labor typically required to handle denials, allowing staff to focus on more complex cases that require detailed attention.

Reducing repetitive tasks

  • Automated Denial Identification: Quickly identifies and categorizes denied claims.
  • Standardized Appeals: Initiates standardized appeal processes, reducing manual labor.
  • Data Integration: Ensures accurate and complete data in claims through integration with electronic health records (EHRs) and other healthcare IT systems.

Automating denial management processes not only improves efficiency but also reduces operational costs. Manual denial management is labor-intensive and error-prone. By automating these processes, healthcare providers can achieve significant cost savings.

Benefits of RCM Software

RPA can also improve accuracy and compliance across revenue cycle areas, such as claims processing. For example, the technology can check claims information against payer rules and regulations, minimizing the risk of claim denials due to common eligibility errors.

Practices can also scale RPA technology quickly to handle more transaction volume, a feature many organizations may value as they prioritize merger and acquisition activity.

Overall Benefits:

  • Cost Reduction: Automating repetitive tasks reduces the need for extensive manual labor, leading to significant savings on staffing costs.
  • Error Reduction: Automated processes minimize the risk of errors, which can lead to costly delays and rework.
  • Faster Reimbursements: With faster processing times, practices can accelerate their reimbursement cycles, improving cash flow.
  • Improved Compliance: Automation ensures that all processes adhere to regulatory standards, reducing the risk of non-compliance penalties.

Key Questions to Consider

Which Processes Need Automation?

Identifying repetitive, rules-based tasks that are ripe for automation is crucial. Providers should have clear goals for technology implementations. What processes need to improve for better financial performance? What processes within a revenue cycle area are manual and can benefit from automation? What are the specific goals a practice wishes to meet by automating processes?

Considerations for Identifying Automation Needs:

  • Repetitive Tasks: Look for tasks that are performed frequently and require significant manual effort, such as data entry, eligibility verification, and claims processing.
  • Error-Prone Processes: Identify areas where manual processes are prone to errors, leading to rework and delays, such as coding and billing.
  • Time-Consuming Activities: Focus on tasks that consume a lot of time and can be expedited through automation, such as appointment scheduling and payment posting.
  • Integration with Existing Systems: Ensuring compatibility with existing IT systems, such as EHRs and practice management systems, is essential for seamless operations. RPA solutions must be able to communicate effectively with these systems to extract and input data accurately.

Integration Considerations:

  • System Compatibility: Verify that the RPA solution can integrate with current EHR, practice management, and accounting systems.
  • Data Flow: Ensure that data can flow seamlessly between the RPA tool and other systems, maintaining accuracy and integrity.
  • Interoperability: Check if the RPA technology supports interoperability standards, allowing it to work with a variety of systems and software used in the practice.

Vendor Selection

Choosing a vendor with strong data security protocols, regulatory compliance, and a track record of ROI and scalability is critical for successful implementation. Providers should evaluate vendors based on their ability to meet these criteria.

Vendor Evaluation Criteria:

  • Security Protocols: Ensure the vendor adheres to strict data security measures to protect patient information and comply with regulations such as HIPAA.
  • Regulatory Compliance: Verify that the vendor’s solutions comply with all relevant healthcare regulations and standards.
  • Proven ROI: Look for evidence of the vendor’s ability to deliver a return on investment through cost savings, efficiency improvements, and error reduction.
  • Scalability: Assess whether the vendor’s solutions can scale with the practice’s growth and adapt to increasing transaction volumes.

Best Practices for RCM Automation

RPA is ideal for rules-based, repetitive tasks like prior authorization requests, eligibility verifications, and payment posting. These tasks are time-consuming and contain manual processes ripe for technological disruption.

Implementing RPA Successfully

Clear Objectives:

Establishing clear goals and outcomes for RPA implementation helps in measuring success and ensuring alignment with overall business objectives. Practices should define what they hope to achieve with RPA, such as reducing processing times, decreasing errors, or improving financial performance.

Steps to Define Clear Objectives:

  • Assess Current Processes: Evaluate existing workflows to identify inefficiencies and areas for improvement.
  • Set Specific Goals: Define measurable objectives, such as reducing claim denial rates by a certain percentage or cutting down processing times by a set amount.
  • Align with Business Goals: Ensure that the objectives of RPA implementation align with the broader strategic goals of the practice, such as enhancing patient satisfaction or improving revenue cycle performance.
  • Staff Training: Proper training ensures that staff can work effectively alongside RPA tools, maximizing the benefits of automation. Training programs should cover how to use RPA technology, best practices for interacting with automated systems and troubleshooting common issues.

Training Program Elements:

  • Initial Training: Provide comprehensive training sessions for all staff members who will interact with the RPA tools.
  • Ongoing Support: Offer continuous learning opportunities and support to address any challenges that arise during daily operations.
  • Feedback Mechanism: Implement a system for staff to provide feedback on the RPA tools, helping to identify areas for improvement and additional training needs.
  • Continuous Monitoring: Regularly assessing the performance of RPA solutions ensures they continue to meet the evolving needs of the practice. Monitoring should include tracking key performance indicators (KPIs), evaluating system performance, and making necessary adjustments to optimize efficiency.

Monitoring Practices:

  • Define KPIs: Establish metrics to measure the success of RPA implementation, such as reduction in processing times, error rates, and cost savings.
  • Regular Audits: Conduct periodic audits of the RPA processes to ensure they are functioning correctly and meeting the defined objectives.
  • Adjustments and Updates: Make necessary adjustments based on monitoring results and update the RPA tools to keep up with changes in practice needs and regulatory requirements.

Cost Reduction

RPA can significantly reduce operational costs by automating manual, labor-intensive tasks. This leads to savings on staffing costs and reduces the need for overtime or additional hires. For example, by automating claims processing, a practice can handle more claims with the same number of staff, thereby reducing the cost per claim processed.

Areas of Cost Reduction:

  • Staffing Costs: Reduced need for manual labor lowers staffing expenses.
  • Overtime Reduction: Automation reduces the need for staff to work overtime to manage high volumes of tasks.
  • Error Correction: Minimizing errors through automation reduces the costs associated with rework and corrections.

Error Reduction

Manual processes are prone to human errors, which can lead to costly delays and denials. RPA minimizes these errors by following predefined rules and guidelines, ensuring that tasks are completed accurately and consistently.

Benefits of Error Reduction:

  • Improved Accuracy: Automated processes adhere to set rules, reducing the likelihood of errors in data entry and processing.
  • Faster Reimbursement: Fewer errors lead to quicker claim approvals and faster reimbursement cycles.
  • Compliance Assurance: Automated checks ensure that all processes comply with regulatory requirements, reducing the risk of non-compliance penalties.
  • Faster Reimbursements: With faster processing times, practices can accelerate their reimbursement cycles. RPA can handle tasks like claims submission and payment posting much quicker than manual processes, leading to faster turnaround times for payments.

Advantages of Faster Reimbursements:

  • Improved Cash Flow: Quicker payments enhance the practice’s cash flow, allowing for better financial planning and management.
  • Reduced Accounts Receivable: Faster processing reduces the amount of time payments remain in accounts receivable, improving financial health.
  • Enhanced Financial Stability: Timely reimbursements contribute to the overall financial stability of the practice, enabling further investment in patient care and services.

Improved Compliance

RPA ensures that all processes adhere to regulatory standards, reducing the risk of non-compliance penalties. By automating tasks that require strict adherence to guidelines, RPA helps practices maintain compliance with healthcare regulations.

Compliance Benefits:

  • Regulatory Adherence: Automated processes ensure that all steps are compliant with healthcare regulations and standards.
  • Audit Trail: RPA provides a detailed audit trail, making it easier to demonstrate compliance during audits.
  • Risk Mitigation: By reducing the risk of non-compliance, RPA helps avoid costly penalties and reputational damage.

Scalability

Practices can scale RPA technology quickly to handle more transaction volume, a feature many organizations may value as they prioritize merger and acquisition activity. RPA can adapt to increasing demands without the need for proportional increases in staffing.

Scalability Benefits:

  • Adaptability: RPA systems can easily adapt to handle higher volumes of tasks as the practice grows.
  • Resource Efficiency: Scaling RPA does not require significant additional resources, making it a cost-effective solution for growing practices.
  • Future-Proofing: Investing in scalable RPA solutions ensures that the practice is prepared for future growth and increased transaction volumes.

Conclusion

RPA technology has found a happy home in revenue cycle management, and many providers are reaping the rewards from implementations. The technology is setting the foundation for increased automation within a very manual space in healthcare. Practices should leverage RPA to realize cost and time savings, as well as increased productivity, as they set themselves up for more sophisticated technology investments.

By automating repetitive and rules-based tasks, RPA technology within revenue cycle management solutions can significantly enhance efficiency, reduce costs, and improve the overall patient experience. As the healthcare industry continues to evolve, the strategic use of RPA and RCM software will be crucial for improving operational efficiencies and financial outcomes. Practices that embrace RCM automation will be better positioned to meet the challenges of the modern healthcare landscape and deliver higher-quality care to their patients.

 

 Appointment Scheduling using Robotic Process Automation

Subscribe to Billing Paradise Newsletter


Social Shares

Wayne Carter

I've been working in healthcare industry of the United States in various types of departments since 2013. Started my career from the bottom as a Accounts Receivable executive, Practice management team handler, Entire Practice Management and now I'm employed at BillingParadise as a Content Lead. Areas of Expertise: End-to-End Revenue Cycle Management, Content Writing, Digital Marketing, RCM applications and Software, Healthcare Business Development, Healthcare Sales, and Healthcare Automation.


Get paid Three times faster with our 24/7 medical billing services.

Work with medical billers who understand your EHR's billing process backwards and forwards

Avail Free RCM Audit Worth $2,000! Check out 19 different KPI reports that stops your cash flow.