Provide transparent treatment costs, benefits and limitations by leveraging RPA bots verification process, giving access to doctors so that their patients can be educated during visits of upcoming costs according to no surprise act.

1. How to get speciality specific
benefits and limitations with one
Robotic Process automation?
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2. Introduction
According to a study conducted in November 2021, the study
surveyed 371 Hospitals and medical groups whether they are able
to determine specialty specific patients benefits, out of pocket
expense and plan limitations accurately these endeavors can be
solved using Robotic process automation.
These hospitals and medical groups were asked to estimate this
information every quarter of the year using the general and
manual methods using insurance sites and third party platforms
such as EDI, Availity etc.Their study revealed only 21% of the
surveyed Hospitals and medical groups were able to accurately
calculate and obtain this information after spending 1 -2 hours on
the insurance companies sites, contacting insurance companies
over the phone etc. instead of simplifying the process through
RPA bots.
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3. What are the major issues faced due to lack of
specialty specific patient benefits, out of pocket
expense and plan limitation information?
Benefits and limitations issues
CDC reported, roughly a ⅓ of Americans postpone medical services access due
to lack of speciality specific benefits and its limitation, on contrary to the
survey’s outcomes and numbers, most doctors taking an interest in the
exploring to accept it is important to have commitment to their patients and
provide useful observations in regards to the expense of care with their
patients, RPA bots will notify patients of this crucial clinical data.
Doctors giving predictions on the exact costs but obtaining accurate benefits and limitations information can allow patients to know
the level of care provided and get educated to make choices with regards to their overall health and finicalical wellbeing.
Out of pocket expenses too high
Out of pocket expenses have risen significantly in the US because of a mix of medical services costs and insurance cost-sharing.
Hence, 33% of patients experience difficulty spending doctor’s visit expenses (copay), even the insurance companies cover 80% of
the actual cost for the medical care services performed.
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4. GROWTH
145%
PERCENTAGE
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The survey states that patients who battle to manage the cost of
hospital expenses might want to reduce their medicine/pills by
half or take their medicine/pills rarely. RPA bots assisted patient
responsibility notifications will ease the struggle of patients not
knowing their out of pocket expenses.
Using RPA bots for obtaining specialty specific
patients benefits, out of pocket expense and
plan limitations
Doctors should incorporate robotic process automation as
obtaining this information is very time consuming and their in-
house staff will barely have time to bill the existing claim
volumes, using RPA bots to obtain benefits, limitations including
cost sharing and out of pocket expense and extracting it into
patient friendly documents will provide education to patients
using accurately obtained out the prices and be transparent if the
medical care services are ongoing for the patient. So that they will
be aware of cost and make necessary arrangements with the
insurance companies to pay for non-covered services.

5. Why is transparency of costs important?
CMS issues price transparency protocols to doctors that US medical clinics/hospitals give
transparent data about care plans and services. In any case, a consistency report assessed
94% of studied medical clinics as rebellious with guidelines a half year after CMS carried out
it.RPA assisted cost determination will assure 100% cost transparency to patients.
The transparency rule is expected in emergency clinics to show data on their site with respect
to overall charges, payer-related arranged charges, limited out-of -pocket costs, and identified
least and greatest arranged prices.
The level of care was planned to permit patients to get a clear picture to evaluate data and
make them aware of the expense of their medical services, therapy or prescription before
proceeding.
As non-compliance proceeds, CMS will charge a penalty for emergency clinics under the 2022
Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center
(ASC) Payment System Final Rule. Emergency clinics who do not follow these protocols
provided by CMS, with north of 30 beds, will be fined a punishment of $10 per bed.
This new guideline can require non-compliance medical clinics to be liable for paying a limit of
$2 million
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6. Reason to incorporate Robotic process automation in
obtaining plan benefits, out of pocket expenses and
limitations However, given all the guidelines by CMS and other insurance companies,
physicians have a hard time going through all the guidelines line by line or payer
by payer. BillingParadise’s Eligibility and benefits verification robotic process
automation can provide detailed eligibility and benefit information, which can be
provided to the patient during the time for service, so that they will be aware of
their out-of -pocket expenses and covered benefits.
The question may arise how hospitals and clinics can obtain particular benefits
according to specialty. For instance if the clinic is an ER or ASC and they have
already provided the patient the services and wondering if the patient’s plan has
ER/ASC coverages, whether they have any limitations in the plan, all the front
office needs to do is log in to our eligibility and benefits verification robotic
process automation system and key in the patient name, DOB, insurance member
ID and select the speciality as ER/ASC and only these benefits will be visible.
Third party applications like Availity will provide you the basic information on the
patient plan, but fail to deliver the specific information required for that particular
speciality and services which the clinic or hospital wants to know.
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7. BillingParadise’s Eligibility and benefits verification RPA bots can provide the
clinic/hospital staff exactly what they are searching for. We all know that saying the
benefits to the patient will eventually let them forget, which is why BillingParadise’s
Eligibility and benefits verification RPA technology provides a PDF copy of the
specific benefits through email or to their phone number which is mentioned in the
EHR which enables patients to go back and check the benefits and make necessary
arrangements like payment plans, if they do not have benefits for that particular
speciality or services.
Obtaining a huge volume of
patient benefit information at
one go using RPA
Regardless of whether the hospital or group practice receives hundreds of patients visiting per day, BillingParadise’s Eligibility and
benefits verification robotic process automation can run bulk eligibility reports. Front office staff just have to upload the patient
appointment report from the EHR system, within 10 mins you will be able to obtain complete benefit and eligibility information in a
spreadsheet which is downloadable and kept in clinical records so that physicians and clinical staff can go back and review the
benefits in the past.This will not only allow to streamline their patient population, but also able to educate patients on the out of
pocket expenses and how they can device a accurate care plan which will benefit both patient and provider respectively.
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8. www.billingparadise.com
Going back to outstanding patient balances, keeping records of previously checked eligibility data will be
very useful for patient services staff in the hospital and clinical group when they are sending statements
to the patient. Along with the patient statement, billing and patient services staff can actually attach the
previous records of eligibility for the patient to identify the actual out-of -pocket expenses they need to
pay up front during the time for a visit such as copay, this process is carried forward automatically by the
RPA bots.
Other out-of-pocket expenses such as deductibles must be notified to the patient every calendar year for
them to recognize how much family and individual deductibles they have, which will make patients
aware of the current out-of -pocket expenses rather than insurance premiums existing in their plan.
Identifying non covered services through
RPA
Speaking of non-covered services; they do not come under traditional out of pocket expenses like copay or deductibles. Non-covered
services are purely dependent upon the network of providers, plan categories and benefit limitations. Routine services are sometimes
denied as non-covered services because they have benefit limitations, identifying these limitations is the key function of RPA bots.
Say for example I have a basic BCBS plan and this BCBS plan only covers according to the patient history and treatment trends of the
individual or family, uncertainty is the more accurate term to describe for these kinds of non covered services.

9. Conclusion:
Using BillingParadise’s Eligibility and benefits verification robotic
process automation in hospital and clinical group staff can
automatically obtain the non covered services of your particular
speciality so that doctors and clinical staff can keep patients
appraised on the covered and non covered services which will
eventually assist them to change the plan or the benefits covered in
their plan.
BillingParadise’s Eligibility and benefits verification robotic process
automation which has capabilities of importing and exporting large
volumes of eligibility and benefits check adn has the ability to
simplify any time consuming verification processes. Time to
experience the advantage of RPA , are you ready for the change?

10. Thank You
+1 888-571-9069
PHONE NUMBER EMAIL ADDRESS
inquiries@billingparadise.com
WEBSITE
www.bIllingparadise.com