Creating a sustainable digital workforce for hospitals using RPA

 Erika Regulsky RCM, RPA
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Resource management and its funding are managed by RCM directors and CFOs is a complex endeavor. The running of smooth RCM operations defines the performance of the hospital, health system, and clinical group, however, there are certain drawbacks when it comes to hiring more staff for the same RCM process and maintaining them financially as most RCM experts do not have the right certification and experience to handle your particular specialty.

A combination of robotic process automation (RPA) and human staff can create a sustainable workforce. A few staff that are certified and well experienced can handle the entire RCM process. RCM directors and CFOs worrying about too much patient volume and whether or not RPA bots can fulfill these tasks successfully without no error are still skeptical among many healthcare leaders. We have done extensive research and identified a sustainable digital workforce for hospitals using robotic process automation (RPA).

Hybrid operations using RPA

RPA bots are a sustainable solution, as a digital workforce many hospitals, and health systems have implemented and reaped the endless benefits it has to offer. The reason why a hybrid model with few RCM human staff and RPA bots programmed to complete a respective task in RCM is needed is that RPA bots need to be monitored once a week or month depending upon the operational structure and data volumes. It is not because RPA bots can cause errors, it is because the tasks performed by the bots need to be reflected from the management standpoint to measure efficiency.

Creating space for high-value tasks

While RPA bots are suited to function on tiring, tedious, and time-consuming repetitive tasks it is only obvious that the utilization of human staff or FTEs will be reduced. This creates an environment for the human staff to concentrate on fixing operational gaps, unattended workflows, and other manual paper document consolidation. The reason to emphasize this is that many insurance companies do not send information through ERA. Correspondence, additional information letters, and provider-related issues all are documented and mailed out by insurance companies that reached your mailroom and are constantly forgotten to be worked. We have come across various surgical groups that have lost a minimum of $80K work surgical claims, just because the surgical notes or patient history was needed and was not provided in a timely manner. Robotic process automation (RPA) has covered all the repetitive data entry, verification, and filing tasks, and healthcare CFOs and RCM directors must utilize human staff in these areas so that higher percentages of unattended and unpaid claims can be paid.

Targeting successful patient care

Targeting successful patient care

Now that RPA has got the manual repetitive tasks, human staff can now have the upper hand to understand patient health plans, policies, and covered services. As robotic process automation (RPA) bot’s eligibility and benefits verification sort the patients according to their plan and the covered services and limitations human staff can now understand the medical necessity of the treatment to be provided to the patient if they do not have covered benefits for the particular service provided by your doctors. Your staff or FTEs can then inform the patient either during their visits or through electronic modes to request their health plan to change the coverage for a particular service rendered by your physician. Thus increasing return patient visits that will be payable by their health plan instead of moving to another provider that has more benefits due to network participation or incentive programs.

Non-stop RCM operations with RPA

There comes a time in a staff’s life they need to take time off from work or the holidays are right around the corner and these FTEs would like to extend their vacation time. It is in times like these that robotic process automation comes in handy. RPA bots can cover for human staff as long as they can. This eliminates unnecessary quarrels between staff of covering for each other’s work and planning their vacation that a few staff remain and some take off. Management staff such as CFOs and RCM directors can solely rely on RPA bots during these times and need not get stressed out to hire temporary staff.

Reporting and Analytics

Reporting and analytics are used constantly in healthcare organizations. Providing reports and analysis on a daily basis would be a hectic process, but RPA bots have simplified obtaining these data which has resulted in more clarity of RCM operations. 

Collection reports

Payments from insurance companies are received almost every day. Keeping track of payments VS write-offs is a crucial part when it comes to managing the revenue cycle. Robotic process automation(RPA) can provide daily collection reports from the data collected from both payment posting processes and manual EOBs. This reduces confusion in preparing monthly or yearly collection reports. 

Denial Reports

RPA denial management bots provide comprehensive denial reports which inform your clinic/ hospital on the dangers of crossing industry-standard denial percentages and allow you to rectify future and or major denials which affect constant revenue loss. Practice managers and CFOs can download or present these reports by the pictorial and graph representation of the denial data. 

Aging and AR report

Following up on AR is missed by most traditional follow-up methods. AR aging reports are derived by RPA bots on a daily basis according to the AR buckets 30,60,120+ are clearly available to target your priorities based upon days and dollar values. This will decrease uncollectible each month allowing your clinic/hospital to maintain revenue targets. 

Lost Revenue Analysis

Balances that are deemed as not collectibles are usually written off. To avoid this RPA bots can easily provide you with a detailed report of 6+ months of revenue loss which you can compare with the present month and previous year’s revenue to identify the potential leaks and revenue losses. Comparative analysis of these months will be delivered automatically to your billing manager every month. 

Management Reports

RPA bots have eased hospital administration and practice managers to generate resource-related reports on check-in times, utilization hours, and time study on a particular process. All these are available through robotic process automation bots, it allows your higher-level management to keep an eye on how smooth and efficient the virtual RCM process runs.

Having said all these sustainable digital workforces proven references at the end of the implementation robotic process automation is unique for every single healthcare organization and the difference lies in patient volumes, operational strategies, workflows, RCM teams, etc. To identify the best-suited RPA technology for your hospital or medical group, BillingParadise and our team of RPA and RCM experts strive to educative RCM directors and CFOs about the implications and the ways of implementing RPA. If you are one of the decision-making management professionals schedule a free consultation with our RCM and RPA experts to learn more!

 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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