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How Healthcare Can Tap Into RPA to Improve RCM Strategies

may blog 3 ready

As healthcare leaders evaluate multiple options to cope with the current workforce shortage and financial challenges and strengthen their long-term revenue-cycle management (RCM) strategies, many are turning to technology.

One healthcare tech niche worthy of increased attention is robotic process automation (RPA). RPA technology employs software-based bots and machine learning to automate repetitive business processes otherwise performed by staff whose time and skills are best devoted elsewhere.

More Health Executives Give RPA a Closer Look

Just a few years ago, RPA was not a concept that registered with most RCM leaders and health system executives.

A Healthcare Financial Management Association (HFMA) survey about RCM challenges and opportunities found that only 15 percent of health system executives considered or deployed RPA. Though relatively small, that number was zero in the HFMA’s 2018 survey of more than 100 health system chief financial officers and RCM leaders.

The number of providers who have adopted advanced healthcare IT — including RPA — has grown rapidly in the years since as leaders struggle to overcome the revenue disruptions –wrought by the pandemic, the Great Resignation and rising inflation. In 2021, approximately half of large hospitals and health systems utilized some form of RPA, according to a survey that formed the basis for a recent Becker’s Healthcare white paper about the state of RPA in the revenue cycle.

According to Becker’s survey, healthcare executives seek two key benefits from RPA: enhanced workforce efficiency and increased revenue. So how does RPA implementation help achieve these goals?

Current RPA Revenue Cycle Applications

RPA relies on algorithms and structured patient data sets to conduct repetitive duties that are often prone to human error.

When adopting an RPA solution, most health systems begin with basic patient eligibility, prior authorization and scheduling processes. RPA can also automate simple billing and claims management functions, optimize data collection and associated analytics, and elevate the patient experience through chatbots.

Chatbots alone, for instance, can aid with booking and modifying appointments, relaying insurance quotes, and capturing patient details at check-in. RPA chatbots can also interpret data from internal or external sources to trigger certain related administrative tasks.

RPA is also playing a role in the drive to meet interoperability guidelines and electronic medical record (EMR) standards. RPA can assist in data migration, including field-by-field mapping from one practice management system (PMS) to another and data transfer validation.

RPA can further facilitate streamlined workflow between payers and providers and help accelerate claims processes. For example, RPA can extract patient information and other crucial details from explanations of benefits (EOBs), as well as download and process electronic remittance advice (ERA) data directly from the clearinghouse. RPA can also administer multiple aspects of claims denial management.

A 2021 Forbes article examined how one hospital network leveraged artificial intelligence and RPA to lower administrative costs, reduce cost-to-collect and amplify net revenue. And the article points out that AI and RPA are still advancing technologies with substantial promise for additional automation opportunities in the near future.

RPA Offers Benefits to Revenue Cycle and Beyond

Though the term “robotic process automation” was coined in the early 2000s and the technology that would become RPA was developed in the 1990s, RPA’s benefits to healthcare have only become evident in recent years.

A 2018 study at Finland’s Tampere University about the role of business analytics in healthcare value was among the first to demonstrate that RPA technology could improve organizational efficiency and reduce costs by reducing human labor and human error in day-to-day processes. A new RPA white paper by the Healthcare Information and Management Systems Society (HIMSS) cites data indicating most RPA adopters report a return on investment within a year of integration. Additionally,  RPA utilization has improved claims quality and accuracy, compliance and productivity while reducing costs.

A recent Entrepreneur article about healthcare automation suggests that automation, including RPA implementation, at an industrywide level could save billions of dollars a year in wasteful spending. In turn, RPA-based automation could help save many individual providers fighting to survive the current healthcare hardships.

RPA’s benefits aren’t limited to the revenue cycle. A recent MedCity News article discussed how RPA can improve healthcare at scale, and noted the positive impacts on people, from reducing staff burnout to extending patient access to amplifying patient care.

What to Look for in an RPA Partner

As RPA technology progresses in accessibility, functionality and popularity, the number of companies offering RPA solutions is also expanding. But many RPA vendors’ services are tailored for general businesses and must be adapted to healthcare settings.

When evaluating potential RPA partners, it’s critical to work with a company that specializes in healthcare and possesses a deep understanding of revenue cycle processes, provider-payer relationships and patient-contact services. An RPA partner should focus on recognizing process gaps and enacting workflow upgrades through extensive automation solutions that are scalable to a provider’s unique needs and goals.

A reputable RPA partner should be able to provide proven results in cost savings and workflow improvement. However, it should be noted that not all RPA benefits are quantitative.

RevCycle Intelligence recently explored the qualitative and operational advantages of RPA. Beyond reducing costs and improving profitability, RPA can provide peace of mind and inherent value in the knowledge that a given task will be processed accurately and efficiently each time.

About GeBBS Healthcare Solutions

GeBBS Healthcare Solutions is a leader in RCM services and healthcare technology, including RPA.

GeBBS is dedicated to helping providers realize significant and measurable cost reduction and productivity improvements through end-to-end RCM platforms and custom RPA solutions that offer diverse data-entry and claims-processing automation opportunities, as well as real-time reporting and analytics. GeBBS is proud to be rated among Modern Healthcare’s Top 10 Largest RCM Firms, Black Book Market Research’s Top 20 RCM Outsourcing Services and Inc. 5000’s Fastest-Growing Private Companies in the United States. Connect with us today at gebbs.com to schedule a demonstration and learn how GeBBS can help your organization grow into the future.

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