Introduction
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 in healthcare helps resolve 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 in RCM allows your staff can focus on more core functions of the healthcare 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 Automation processes.
Time studies conducted by large healthcare organizations
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 RCM workflow. After the implementation of RPA, hospitals and health systems can handle these time-consuming RCM Automation 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, Robotic process automation in healthcare can boost the productivity of your billing staff, enabling them to focus on critical tasks and core functions of your healthcare organization.
RCM process-specific time-saving methods by RPA technology
Many RCM processes are highly time-consuming, often taking days to complete and resulting in delays in claim payments. These tasks can be further complicated as billing staff must navigate multiple platforms to verify patient data. With robotic process automation in healthcare, bots handle these tedious tasks, enabling you to oversee the completed work efficiently. Below are some processes and applications of RCM automation.
Prior authorization
Yes, prior authorization is one of the most challenging RCM processes, consuming significant manual hours and reducing productivity by 10%. It requires verifying patient benefits, reviewing patient history, and determining whether a service needs authorization, which typically takes 1-2 hours per patient. For a healthcare system or hospital handling 100 patients daily, with 50 requiring authorization, this process can demand 50-100 manual hours. With healthcare automation, RPA bots can complete this task in just 8 minutes, automatically filing and submitting applications to payer web portals, allowing your staff to focus solely on monitoring correspondence or letters from insurance companies.
Patient eligibility and benefits verification
The next highly time-consuming RCM process involves not only verifying eligibility and benefits but also identifying any TPA, IPA, workers’ compensation, or auto liability related to the patient’s injury or illness. RCM automation can streamline these tasks, saving significant time and effort. 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.
Patient appointment scheduling and registration
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.
Charge Capture and entry
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.
Payment posting and reconciliation
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.
Denial management and appeals
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.
Conclusion
Robotic process automation in healthcare fosters an environment where your staff no longer feels the need to watch the clock to speed up processes. RPA in RCM is particularly vital for specialty practices such as radiology, labs, inpatient hospitals, and surgery centers, where extensive paperwork is routine. It enables practices to operate with less stress, stay ahead of schedule, and handle all activities more efficiently. Moreover, patients appreciate hospitals or clinics that deliver timely care, leading to increased referrals to your network for the swift service and recovery they provide. BillingParadise’s RPA experts specialize in RCM automation and programming RPA. Connect with our experts to learn more about implementation!
Frequently Asked Questions
RPA in healthcare RCM refers to the use of software robots to automate repetitive and time-consuming tasks in revenue cycle management, such as claims processing, billing, and data entry. It helps streamline workflows and improve accuracy.
Yes, RPA systems are designed to comply with data security regulations like HIPAA, ensuring the secure handling of patient and financial data.
RPA enhances efficiency by automating tasks, reducing human errors, accelerating processes, and improving data accuracy. This leads to faster claim approvals, reduced administrative costs, and increased staff productivity.
By reducing manual labor, minimizing errors, and accelerating processes, RPA significantly lowers administrative costs, saving healthcare organizations time and money
