Effective Revenue Cycle Management is key to sustainability and profitability of healthcare organizations. Billing companies bear the most brunt on revenue cycle leakages. Billing service providers do not have the process to prevent denials from falling through the cracks. Not just billing companies, even hospitals suffer revenue losses because of poor follow-up process, communication gaps amongst various departments, and lack of root cause analysis to eliminate payment denials. Today, technology platforms play a role in assisting providers, payers, and consumers communicate and interact more efficiently.
Information Technology is expected to remove data losses, eliminate errors and provide a seamless integration across the complete revenue cycle supply chain. With the availability of information across devices, applications, and platforms, service providers can carry out insightful analytics. Root cause analytics of denials, causes and codes can help providers improve revenue recognition and manage their margins.
Amongst the gamut of technology solutions available for RCM improvement and effectiveness, Robotic process automation (RPA) has a lot of promise. RPA is the application of technology that allows configuration of computer software or a “robot” to handle high volume, highly repetitive, SOP led activities so that losses due to human errors and attrition challenges could be eliminated. RPA offers dramatic improvements in accuracy, cycle time and productivity gains in transaction-heavy processes like RCM, while elevating the nature of work of people by removing them from repetitive tasks. RPA tools mimic the steps of a rule-based, objective driven process without compromising the existing IT infrastructure. RPA allows easy scaling up or down of IT infrastructure to meet the demand.
Some areas where healthcare providers that can employ RPA to gain process standardization, elasticity of demand and improve the quality of employees include:
Data entry and migration: Instead of being dependent on paper charts, providers are digitizing patient information so that it can be stored electronically accessed online by other doctors and the patients themselves. In order to accelerate the process and not be reliant on employees to transfer these records manually, RPA can be used to automate this transfer of data between paper files and legacy structures to the new system. This will also substitute enhanced levels of customer service to the patient through transparency and ease of access to their medical histories.
Billing and claims processing: Billing and claims processing is of particular prominence for the healthcare sector. A patient visits the doctor, an insurance claim is filed, a patient is billed for the remaining amount, and accounts receivables are monitored to confirm the patient makes the payment. These tasks can be very time-consuming and prone to errors. Deployment of RPA decreases human error, increases efficiency and time-management and improved control or custody of billings and claims as these tasks progress across the value chain.
Automated monitoring of accounts payable/receivable: By careful monitoring of accounts payable and receivable, software robots are able to lead to an enhancement of billing efficiency and a reduction in write-offs. Payments will be made and received in a faster and more effective manner than if monitored by a human employee. As a result of debt decline, this utilization of RPA is another improvement to the financial performance of healthcare providers.
Decrease of errors in digitization of patient records: RPA software robots radically decrease the amount of error in data migration and replication tasks and the digitization of paper documents is no exclusion. The augmented accuracy from the use of RPA will allow healthcare providers to maintain up-to-date and accurate records, which is particularly important when considering a patient’s medical information and history consulted during the course of treatment.
Improvement in patient experience: A positive patient experience is vital to the success of healthcare providers. By automating long and repetitive processes, such as appointment scheduling, data digitization, and inventory tracking, doctors will have more time to offer value-based care for their patients. In addition, patients will benefit from having a shorter wait time for appointments and will have the capability to easily access their health records and bills online.
While considering partners for RPA, healthcare organizations must not only consider their expertise and experience but also how tool agnostic are their applications and the depth of their solution framework. Healthcare organizations benefit most by partnering with organizations that not only provide advice and consulting to select the right tool but also in deployment and scaling of their RCM capabilities. Partners with deep domain expertise, strong process modeling expertise and bring a repository of best practices help healthcare organizations gain a competitive advantage not just for short term but long term too.