Customizable Healthcare Workflow Management Automation

 Erika Regulsky RCM, RPA
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Health systems,  hospitals and medical groups have internal RCM operations which need cooperation with multiple departments. However, many do not achieve this cooperation successfully due to lack of internal management miscommunication and operational conflicts. Implementing RPA managed internal workflow platforms will allow healthcare organizations of any large size to keep the consistency and smooth RCM operations across these various departments. 

RPA technology is not only customizable according to your current RCM operations and speciality. Some healthcare organizations have multi speciality providers in their groups and would need more complex interactions between the various departments to finalize a patient’s diagnosis. Using manual methods of documents sending and receiving communication will result in missing out on documentation and results in the billing to be denied or rejected. RPA has the capability to stop this and create a streamlined environment of transferring patients from one speciality to the other for better patient care. Doctors and other clinicians can also pay closer attention to patient care which is their core responsibility rather than reading medical records whether they have documented it right or not. 

Questions may arise as to how automated systems can change their RCM operations to the better. The answer is simple, RPA managed workflow systems can pinpoint the prioritized work assigned to each department. If they have any questions or concerts the RPA bits will guide them accordingly so that internal blame games or human mistakes can be avoided at a greater extent and deliver 100% productivity and quality. Leveraging the current RPA technology to increase operations and collection is the key objective of RPA implementation. Healthcare organizations frequently posed questions and answers about customization RCM workflow using RPA are discussed in more detail below. 

Why is workflow management essential in the RCM process? Why can’t each department of RCM function separately without any communication? What is the role of automation in workflow management? We ask ourselves these questions every time when the whole RCM process is on the verge of collapsing. Worry not fellow Healthcare management and administrative C suitors BillingParadise provides a hybrid workflow management with automation.

What is Automated Workflow?

  • Charge capture: Rendering medical services into billable charges.
  • Claim submission: Submitting claims of billable fees to insurance companies.
  • Coding: Properly coding diagnoses and procedures.
  • Patient collections: Determining patient balances and collecting payments.
  • Preregistration: Collecting pre registration information, such as insurance coverage, before a patient arrives for inpatient or outpatient procedures.
  • Registration: Collecting subsequent patient information during registration to establish a medical record number and meet various regulatory, financial and clinical requirements.
  • EOB processing: Applying or rejecting payments through remittance processing.
  • Insurance follow up: Collecting payments from third-party insurers.
  • Utilization review: Examining the necessity of medical services

Automation in workflow

Robotic Process Automation (RPA) is emerging as one of the most transformational technologies that can help healthcare providers by automating many of their labor intensive, costly, and error prone tasks. IPA has the potential to free up resources from mundane administrative tasks and unlock data that is buried in fragmented applications. Utilizing RPA in RCM also helps healthcare providers maintain compliance and increase collections rates. This, in turn, accelerates their cash flow, reduces their accounts receivables, and minimizes write-offs.

Simple process automation are becoming more mainstream for simple, rule-based, repeatable processes. But more complex processes, such as RCM, require smarter tools which can understand the complexities and high level of variation that is found in the end-to-end process of getting paid. RPA is currently being applied to processes like:

  • Out of Pocket Estimation
  • Prior Authorizations
  • Patient communication
  • Processes which require interfacing with many third-party applications and online portals
  • Process claim denials

Applying RPA enables healthcare providers to realize additional revenues, capture information for claims disputes, and gain insights into the efficiency and effectiveness of their revenue cycle. RPA has amazing potential to make revenue cycle management a strategic strength versus a cost and administrative burden.


BillingParadise has created various custom made RCM automation systems for hospitals and health systems. We like a challenge in automating complex RCM. operations in healthcare organizations and provide innovative automation methods which will allow you to manage your practice with less hassle

 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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