Robotic process automation implementation in RCM and significant time-saving.

Revenue cycle management processes are time-consuming regardless of how efficient your manual workforces are. Healthcare systems and hospitals serve hundreds of patients every day and processing that amount of data through the RCM workflow is time-consuming. Manual workforces can only achieve so much in a day and burnout is at its highest when it comes to repetitive tasks and complex processes like obtaining prior authorizations. Robotic process automation helps in resolving this problem by functioning as your manual workforce in just a fraction of the time and costs compared to manual workforces, with the implementation of RPA your staff can focus on more core functions of the revenue cycle management rather than verifying, entering and validating thousands of patient data. 

Let’s dive deeper and discuss the time-saving capabilities of RPA when implemented in RCM processes. 

According to surveys conducted in Baylor Scott & White Health (BSWH), being a health system containing 52 hospitals across the nation calculated that manual workforce billing takes 5-7 minutes depending upon the complexity of the services rendered. If the services provided are in the ER and the patient needs surgery after the surgery is completed the inpatient billing takes more time than that of the outpatient visits and its accuracy is in question and usually, it is not 100%. That’s why huge health systems like BSWH implemented RPA in their RCM workflow. After the implementation of RPA, hospitals and health systems can handle these time-consuming RCM billing tasks with 70% without creating staff burnout and human error.  

Time studies conducted by the county and state healthcare organizations provided real insights on how mass covid testing, screening, and vaccination billing was significantly reduced by implementing RPA for certain data verification processes in RCM. These government healthcare organizations actually informed in news articles that robotic process automation technology has quicker and more accurate billing for COVID-19 testing by 90% or more, RPA bots make the initial diagnosis by checking the data with the specimens collected and then collate this data with the COVID test results and their medical charts in the hospital’s EHR. 

While a significant reduction in time for all of these RCM processes, robotic process automation can perform complex tasks and get them done in seconds, along with maximum productivity and 0% margin of error, and being able to run 24/7 365 days round the clock throughout the year, RPA technology can increase the productivity of your billing staff, letting them focus on tasks that matter and core functions of your healthcare organization.

There are numerous RCM processes that are very time-consuming and will take even days for the process to be completed and the claims are paid. Most of these processes come with certain complications where the billing staff will need to navigate between multiple platforms and verify patient data on those platforms. Using RPA the bots will take care of these tedious processes and allow you to oversee the work done. Some of the processes and RPA uses are as follows:

Yes, prior authorization is the most painful RCM process and it takes most of the manual hours and reduces productivity by 10%. A prior authorization request needs verification of patient benefits, patient history, and whether a particular service needs authorization or not, this process takes around 1-2 hours per patient. Imagine a healthcare system or hospital with 100 patients a day of which 50 patients need authorization for the services to be paid. It takes 50-100 manual hours to file authorization applications. RPA bots will complete this task in 8 minutes flat and will complete the application and automatically submit it to the payer web portals leaving your staff to monitor only the correspondence or letter received from the insurance companies.

The next most time-consuming RCM process there is. It’s not only verification of eligibility and benefits, but it’s also identifying any TPA, IPA, Workers comp, or auto liability for the injury or illness the patient has visited the doctor. But, also verifying covered services, limitations of any, and other plan coverages like secondary or HMOs. It takes almost 30 minutes to an hour to completely check the patient information, sometimes it gets even more difficult when the patient’s insurance information is incorrect. Incorporating robotic process automation  for eligibility and benefits verification will eliminate the burden of manually searching various resources and insurance web portals. RPA bots will take 1-2 minutes to obtain the necessary information required for your provider and keep the eligibility status up to date in your EHR, so when a patient returns for another visit there is no hassle in educating the patient about their benefits.

Patients nowadays like the appointment scheduling and registration processes to be automated as they are fed up with long call hold times and paperwork that takes at least 45 minutes per patient. RPA bots will do it in just 5 minutes to complete the entire process and the data obtained from the patient is 100% accurate leaving the front office staff to assist patients who are physically present in the doctor’s office during the visit creating a patient-friendly environment. 

Most of the RCM errors occur during the charge capture and entry process, having an RPA bot perform these tasks will create fewer errors. RPA bots are capable of capturing charges, entering, and filing the claim to the respective insurance companies in a matter of 2 minutes, compared to manual charge capture and entry which takes around 20-30 minutes per claim. Given the fact the RPA bots cross verify each and every piece of information including charts and patient history before submission of the claims ensuring that the same services are not provided to patients in the following visits reducing duplicate denials.

Although most insurance companies use ERA as payment data through EDI. Most payers still use correspondence, letters, and denial EOBs through mail as paper documents. If these documents are to be entered manually it takes more than 1 hour. OCR engines in RPA bots will automatically extract the data from these scanned documents and automatically posts the payment and then logs each manual document for future review, reconciliation, and audits. Robotic process automation implementation for payment posting and reconciliation only takes 30 seconds to read every document and then use that data to post payment saving your staff time and allowing them to identify the reimbursement and other important tasks.

Claim denials are hard to track according to denials and the responsive actions need to be taken for reimbursement. All denials have time limits to rebuttal or dispute ranging from 30-120 days. Most appeal time limits range from 90-120 days. Corrected claims and reconsideration time limits are around 30-90 days which exceeded the denied claims reimbursement time reduction resulting in late submission and no payment. RPA bots will analyze denials creating  appeal forms and submit them in the designated payer portals within 8 minutes, compared to manual denials and the appeal process it takes 45 mins for a claim to be completely reviewed, corrected, or appealed. Robotic process automation creates timely denial analysis and segregates the denials by categories, time limits, and again to set your priorities.  

Robotic process automation creates an environment where your manual workforce does not look at the clock every 5 minutes to fasten the process. RPA bots are essential for many specialty practices such as radiology, labs, inpatient hospitals, and surgery centers where loads of paperwork are done. It allows practices to perform with less stress and be one step ahead of time for all activities. Besides, patients always love a hospital or clinic providing care in a timely manner, in return, they will refer more patients to your network for the speedy service and recovery they receive. BIllingParadise RPA experts are skilled in RCM and programming RPA, discuss more about implementation with our experts!