How to work smart and not hard using healthcare RCM Robotic process automation?

 Erika Regulsky RCM, RPA
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How to Work Smart using RCM Automation

Currently, staffing challenges are being faced by nearly all types of healthcare organizations. The Great Resignation and COVID-19 vaccine mandates have led to staffing shortages in various hospitals and health systems and increased competition for skilled clinical and healthcare RCM workers. Consequently, it is crucial to find ways to be efficient and productive with limited resources.

Why work smarter with Revenue cycle Automation? 

Revenue cycle leaders should take advantage of the current situation by discovering new methods to improve or eliminate outdated and ineffective procedures. By utilizing the appropriate technology, it is possible to:

  • Reduce the workload on staff by implementing optimized RCM processes and smart automation, allowing them to accomplish more in less time.
  • Implement automation for existing procedures, beginning with the most critical and time-consuming tasks.
  • Streamline the process of training and onboarding employees, enabling them to become proficient in a matter of hours instead of days or weeks.

RCM automation

It’s a lesser-known fact that a significant portion of healthcare spending goes toward administrative expenses. The Centers for Medicare and Medicaid Services (CMS) estimates that $372 billion is spent on administrative complexity in the US, with $39 billion of that being spent on administrative transactions. Automation in healthcare administration can reduce costs and ease the staffing crisis. The Council for Affordable Quality Healthcare suggests that by fully transitioning to electronic transactions, the spending on administrative transactions could be reduced by 42%.

Advantages of Automating your revenue cycle:

Robotic process automation is the utilization of technologies, such as AI, machine learning (ML), and RPA bots, to optimize and expand the decision-making process throughout the healthcare revenue cycle management. 

Robotic process automation can reduce administrative tasks and save costs while improving the care delivery process. Bots can work continuously 24/7/365 days, potentially doing 30 times the work of a full-time employee and with less chance of errors compared to humans.

Hospitals and health systems can improve efficiency by allowing RPA bots to handle repetitive and mundane tasks, freeing up their team members to focus on more valuable work and ensuring faster and error-free RCM processes. 

It is important to note that complete automation is not always necessary. By minimizing the need for human intervention to only the instances when problems arise, the workload and administrative costs are reduced, leading to a more efficient revenue cycle process. By focusing on the tasks that truly require their attention, staff members are more engaged and less prone to errors, which ultimately leads to a better patient financial experience and increased revenue.

Why do hospital CFOs need to adopt Automation in 2023? 

If you are a healthcare leader, especially a CFO, and would need to evaluate the suitability of intelligent automation for your hospital or health system, consider the following key points:

  1. What is the annual volume of calls related to patient eligibility and benefits?
  2. To what extent are staff resources wasted?
  3. What methods do staff use to obtain updates on claim status?
  4. How much time is spent on resubmitting or appealing claims?
  5. How much time is spent using the Medicare DDE system?
  6. What level of understanding do you have of your Medicare and commercial claims?

By thoroughly assessing these points, you will be able to pinpoint specific areas in your revenue cycle that would benefit from automation, whether it be partial or full automation. It may not be possible to address all areas immediately, but by creating a well-planned strategy, you can prioritize the key processes that will have the greatest impact on team workflows. Some examples of such processes include:

Automatic Pre-certification and Prior authorization process:

Utilizing machine learning and automation AI to anticipate services that necessitate authorization, and automating the requests and follow-up process.

Transparent patient financials:

Automation deploys predictive analytics to objectively and consistently evaluate patients for financial aid.

Correct coding using automation:

Medical coding RPA bot uses advanced OCR to review charts and medical records, identifying any necessary documentation corrections before codes are entered with its inbuilt ICD10 database and NCCI edits.

Simplify eligibility and benefits verification:

Automation bots verify patients’ eligibility once their data is entered into the system and automatically records in EHR thereby making it less time-consuming for front office staff. 

Predict successful claim denial resolution:

Directing staff efforts towards claim denials that have the greatest potential of being successfully appealed.

Continuous accounts receivable and claim status checks:

Utilizing predictive capabilities to anticipate when reimbursement from payers will be received, reducing the number of unnecessary staff interactions. 

Enhance patient experience:

By using predictive analytics, it is possible to personalize each patient’s financial experience, increasing collections and reducing overhead costs.

Not all of these areas may be relevant to your hospital or health system’s goals and priorities, however, they are generally considered by a vast number of CFOs, CEOs, practice owners, and RCM directors as the most promising areas where automation can be particularly beneficial. 

Strategies to implement Robotic Process Automation in your healthcare organization:

The administrative difficulties encountered by hospitals and health systems are formidable, which is made more complex by the current labor market. It is therefore imperative to make the most of the resources at your disposal by automating certain RCM processes and implementing a strategic approach to revenue cycle management.

Looking for a smart, simple way to implement automation? Billingparadise’s technology expertise simplifies and unifies the entire revenue cycle. We empower healthcare organizations to automate manual work, gain insight into processes and performance and collect more revenue. If you’re ready to make your rev cycle swifter, smarter, and stronger, BillingParadise can equip you with the tools you need to get there.

Here are some of our dedicated Robotic Process Automation RCM process technology:

RPA eliminates the need for manual staff to constantly monitor time, allowing them to focus on other tasks. It is particularly useful in specialty practices such as radiology, labs, hospitals, and surgery centers where large amounts of paperwork are required. This technology allows practices to operate more efficiently and effectively, providing faster service to patients, who will in turn refer others to the practice for its speedy service. Our RPA experts at BillingParadise are experienced in RCM and programming, contact us to learn more about how RCM Automation can benefit your practice.

 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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