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Revolutionary Robots: How RPA Can Take RCM to a New Level


Robots and artificial intelligence (AI) have long been features of sci-fi lore that intrigued and engaged our imaginations. But while it might seem like a drastic leap to envision AI playing a critical role in health system operations, that day has already arrived.

Robotic process automation (RPA) challenges organizational leaders and stakeholders to think beyond the time-tested, human-centric approach to administrative processes. We’re now trusting robotics, augmented reality (AR), and AI in the operating rooms and to improve patient health outcomes. The time has come for health system leadership to embrace RPA as the future of revenue cycle management (RCM), too. 

That’s not to say that we should remove humans from the RCM equation, of course. Success in this area lies in understanding the strengths of a human touch versus the automated advantages provided by RPA, especially for rote, repetitive work.

Automation’s Potential in Healthcare System RCM

Detractors clamor that technology threatens the livelihood of many hard-working professionals. And while the function of RPA is to increase output with higher accuracy, thinking that it can eliminate the need for physical staff would be misguided. McKinsey reported that less than 5% of jobs can be 100% automated; the rest stand to benefit from the reduction of repetitive or demanding tasks high on potential human error and low on employee engagement.

One such area for health systems lies in medical billing and claims. The room for error here is jarring, with 80% of bills and 40% of insurance claims containing mistakes. While this makes for a frustrating patient – and payer – experience, the worst impact may be felt on the bottom line for healthcare providers. Up to 65% of denied claims go without resubmission, and much of that is preventable through proper RCM management.   

RCM starts with the patient intake process, collecting the proper insurance and patient details, and ends with the successful receipt of payment for services, which is then traceable in a robust reporting system. An end-to-end approach supplemented with the power of RPA can streamline claim submission timelines and reduce errors, bringing in more revenue in less time. It can also notify personnel regarding errors and inconsistencies, warn in advance if forecasting is dim, or create tasks for team member outreach and insight.

And while profit may be king when it’s time to recon for performance, the patient experience can be what drives that profit long-term. RPA can enhance customer service for patients not only in terms of correct data, but also to streamline appointments or automate follow-up reminders to ensure proper care with your provider network, not that of the competition.

How to Supercharge Healthcare RCM with RPA

Every leadership team should begin this process with an in-depth analysis of current processes and revenue integrity. With a clear understanding of where you might be able to recoup profits or stop losses in their tracks, you can isolate the best areas to apply RPA. Based on industry trends and best practices, here are some aspects of consideration.

Claims Processing

This is much more than submitting a request to payer for payment, as health system leadership know all too well. Efficient RCM requires proper processing of vendor applications, patient insurance information and eligibility, accurate forms, expedited benefits retrieval, and correct medical billing codes, to name a few. Automation can alleviate the strain that all these components place on staff with programming that verifies assets from start to finish, and in less time than ever before.

Data Entry

How does all of the information in your system actually make it into the system? The majority is likely entered by humans, and that makes it prone to error. Whether patients are filling out forms or office staff are entering in details scribbled onto papers attached to clipboards, there is too much room for inaccuracy. And with data entry error comes delays in processing and payment. RPA can introduce patient portals (eliminating illegible handwriting), identify errors (resulting from mismatched information), and cut staff time in half (removing manual data entry).

Error Mitigation

This may seem redundant to the above, but errors can be rampant beyond just payment processing. Consider preauthorization requests that go through incorrectly and the patients who never move forward with a prescribed test or procedure. Or perhaps you are looking to report on team performance or revenue integrity, but every staff member enters claims a little bit differently. The result can be haphazard data that slows progress, misleads decision-makers, and interrupts patient care outcomes.

Real-Time Analytics

Especially in the past year, with the rush to go digital and virtual brought on by the COVID-19 pandemic, more companies – and health networks – are juggling disparate technology systems than ever before. RPA can tie together these systems to streamline reporting. Not only does this reduce errors – from staff entering and reentering the same information in each place – but also it gives leadership real-time insight into revenue, claim denials, and overall business health.

Resource Allocation

With all the benefits of automation, healthcare administrative teams will have more time on their hands, and that is absolutely not a bad thing. These skilled workers, who already understand your business model and patient demographics, can be reallocated to more top-tier tasks that require a human touch. Rather than filing hundreds and hundreds of claims or keying in form data, they can connect with patients, resolve escalated issues, and make a larger impact with their true talents.

RPA Can Take RCM to a New Level

RPA, AI, automation, and all the other RCM tools available to health system administrators are just that: tools to be deployed with the utmost care and intent for the maximum value. GeBBS Healthcare Solutions understands the nuance needed to ensure revenue integrity and system implementation. That’s why we offer an end-to-end approach for revenue cycle workflow management.

GeBBS provides strategic outsourcing solutions to medical billing companies and healthcare providers. By leveraging our people, processes, and technology, we enable clients to reduce operating and capital costs, recover revenue, improve patient satisfaction, and increase productivity. Request a consultation to learn how GeBBS can help you put automation to work for your RCM processes.

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