Emerging RPA use cases in healthcare RCM

 Erika Regulsky RCM, RPA
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Introduction about Emerging RPA use cases in healthcare RCM

Robotic process automation has emerged and has been the top trend in healthcare revenue cycle management. All hospitals and healthcare systems are checking for RPA healthcare use cases and are trying to identify the necessary information to implement in their hospitals RCM. Unlike other RPA providing companies, we have our RPA use cases in healthcare RCM crisp and easy to understand for we understand the busy schedule of hospital C level executives like CFOs and other high level management like RCM directors and practice managers. 

Without further adieu let’s dive into the RPA uses cases for healthcare RCM:

Enhanced patient data management and EHR operability

Traditional methods are gradually reducing as managing patient data and migrating them from various locations and departments has become less over the years due to ever threatening issues like HIPAA compliance, CDI and other federal guidelines. Using RPA in healthcare RCM in patient data management has increased the data verified and managed is upto the mark of the industry standards as most healthcare automation practices mentioned in surveys. RCM automation has created such a secure and regulatory compliant environment that it can operate between various insurance platforms EHRs, EMRs and PM systems, also data sharing to referred physicians or screening and imaging service providers for further treatment of their patients. 

Patient access, scheduling and registration

Every healthcare business model is now virtual and constantly uses online methods to promote, identify, schedule and register patient populations in the hospital or healthcare systems local region, likewise patients are also more into online shopping of their healthcare needs even for minor injuries or illnesses. Utilizing RCM robotic process automation not only attracts more business to a hospital or healthcare system but also elevates the burden of long hold times on call for appointments, identifying network participation etc. RPA use cases in RCM like this will create a wider perspective for you of achieving higher patient volume at the fraction of cost eventually leading to reduced front office staff burnout and time consumption. In the end the result would be efficient patient population management feasibility, scalability and sustainability.

Claim management and billing processes

Claim management and billing processes

All RCM processes include some form of bill, case, claim or invoice, regardless whether it is going to the patient’s insurance companies or to the patients themselves. Healthcare RCM automation has the ability to work huge volumes of charges, payment and other data oriented tasks where manual entries and analysis are needed the most. This RPA particular use case is the most significantly identifiable requirement for most hospitals with beds over 150+ and around 200+ outpatient visits a day. Billing staff get tired of over 30+ claim entries and tend to burn out more quickly than RPA bots. Hence, implementation of RPA bots will not solve entry and huge data analysis process complications and assist your CFOs or RCM directors to obtain precise data when needed at their fingertips.

Utilization, denials and medical records management

The next priority RPA use case in RCM is utilization, denials and medical records management. These are the processes which require more human staff than all the other processes combined. Utilization management or prior-authorization is the most time consuming processes there is with a rejection rate around 60%, claim denial management is the area where all hospital’s CFOs and RCM directors are looking to increase overall collections per month and medical records management comes in between these 2 processes as a linking agent. Robotic process automation in RCM will create an interoperable environment where it cross verifies various areas of the processes and provide effective measures according to insurance and federal regulations to provide rebuttal to these rejections and denials in a secure and regulatory abiding manner. 

RCM workflow, productivity and quality monitoring

Finally, implementation of RPA in healthcare RCM doesn’t only mean that RPA bots are performing tasks more accurately and faster than human resources, however it also follows the precise workflow you have created for a better RCM. Operations. It will not deviate from the current objectives as its data is constantly being updated. Productivity and quality are the other important RPA use cases in RCM where both these data kept on track for the RPA bots work and the human resources work as well preventing errors in regards to ICD10 codes, CCI edits, coverage determinations etc. And provides uptodate KPIs to your management like CFOs or RCM directors to have a much more streamlined RCM processes. RPA productivity and quality matches the data provided by Six sigma certified experts and  MGMA or HFMA standard productivity numbers. It also assists in case management for accident patients and remote patient monitoring for patients with chronic diseases making those data available for enclosing the complete RCM workflow.


Other RPA Healthcare Use cases are:

  • It decreases the time taken to complete an RCM task. 
  • When a process is created, it can be deployed at a later convenient time as numerous robots can be sent for the process. 
  • RPAs are versatile and adaptable. A RPA bot is equipped for playing out a rundown of in excess of 600 tasks in a given session or sequence.
  • Furthermore, accuracy and precision in light of the fact that RPA’s are rule-based and liberated from errors that human resources are inclined to make.
  • Human resources can focus on important and higher priority tasks which need constant human oversight.
  • Drastic reduction in cost. As indicated by the Institute for Robotic Process Automation, a RPA bot costs around 33% the cost of a full-time employee (FTE) of a human resource. 

As we have crossed all the beneficial robotic process automation use cases in healthcare RCM, it is also best to communicate with an expert once in a while and get a detailed overview about how robotic process automation (RPA) can help your hospital or healthcare system in terms or cost reduction, increased productivity, quality and effective data compliance. 

Now is the best time to learn more about RPA and implement it to reap the benefits. Don’t wait for tomorrow, schedule your session now!

 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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