Hospitals no longer waste time in performing tedious and repetitive RCM tasks. Robotic process automation has paved way for efficient time management.

1. ROBOTIC PROCESS AUTOMATION
IMPLEMENTATION IN RCM AND
SIGNIFICANT TIME-SAVING
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2. 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 helps in resolving 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 your staff can focus on more core functions of the revenue cycle management 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 processes.
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3. 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 their RCM workflow. After the implementation of RPA, hospitals and health systems
can handle these time-consuming RCM billing tasks with 70% without creating staff burnout and human
error.
Time studies conducted by large healthcare organizations
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4. 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,
RPA technology can increase the
productivity of your billing staff, letting
them focus on tasks that matter and
core functions of your healthcare
organization.
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5. RCM process-specific time-saving
methods by RPA technology
There are numerous RCM processes that are very time-
consuming and will take even days for the process to be
completed and the claims are paid. Most of these processes
come with certain complications where the billing staff will need
to navigate between multiple platforms and verify patient data
on those platforms. Using RPA the bots will take care of these
tedious processes and allow you to oversee the work done.
Some of the processes and RPA uses are as follows:
Prior authorization
Yes, prior authorization is the most painful RCM process and it
takes most of the manual hours and reduces productivity by
10%. A prior authorization request needs verification of patient
benefits, patient history, and whether a particular service needs
authorization or not, this process takes around 1-2 hours per
patient.
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6. Imagine a healthcare system or hospital with 100 patients a day of
which 50 patients need authorization for the services to be paid. It
takes 50-100 manual hours to file authorization applications. RPA bots
will complete this task in 8 minutes flat and will complete the
application and automatically submit it to the payer web portals
leaving your staff to monitor only the correspondence or letter
received from the insurance companies.
Patient eligibility and benefits verification
The next most time-consuming RCM process there is. It’s not only
verification of eligibility and benefits, but it’s also identifying any TPA,
IPA, Workers comp, or auto liability for the injury or illness the patient
has visited the doctor. 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.
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7. 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 eligibility and benefits verification
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.
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8. 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.
Payment posting and reconciliation
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.
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.
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9. 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.
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10. Conclusion
Robotic process automation creates an environment where
your manual workforce does not look at the clock every 5
minutes to fasten the process.
RPA bots are essential for many specialty practices such as
radiology, labs, inpatient hospitals, and surgery centers where
loads of paperwork are done.
It allows practices to perform with less stress and be one step
ahead of time for all activities.
Besides, patients always love a hospital or clinic providing care
in a timely manner, in return, they will refer more patients to your
network for the speedy service and recovery they receive.
BIllingParadise RPA experts are skilled in RCM and programming
RPA, discuss more about implementation with our experts!
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11. Contact Us
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PHONE NUMBER EMAIL ADDRESS
inquiries@billingparadise.com
WEBSITE
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