The use case for Robotic process automation enabled denial management for your hospital of health system.

1. RPA use cases in
Denial Management
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Introduction:
Denial management is key when it comes to navigating
a hospital or health system’s financial wellbeing. Robotic
process automation (RPA) technology used in managing
denials for your healthcare organization will significantly
reduce denials as these RPA denial bots use cases for
denial management are an intelligent data-driven
digital workforce that doesn’t allow room for error.
According to surveys, hospitals have increased by 11%
denial rates. Most of the denials, that is 80% of all denials
are resolvable and can receive payment. Robotic process
automation (RPA) use cases for denial management are
purely on the basis of analysis and to automatically
perform the next qualitative action. Unlike human staff who
take many hours to analyze and come up with a resolvable
action, RPA denial management bots will simply do all that
for your human resources and allow them to just monitor
the performance of these RPA bots.

3. Robotic process automation (RPA) use cases for healthcare claim denial
management
Denial management is an expensive process. Submitting
corrected claims, reconsiderations, redeterminations,
appeals and other documentation itself costs a hospital
anywhere between $10-$20k which includes EDI,
clearinghouse, and other charges.
Cost savings
Additionally, adding resources to perform a denial management
process will cost the hospital or health system around $50-$100k
depending upon the volume of denials your healthcare organization
faces.
RPA denial management technology’s best use case is the reduction of cost
by 96% as the investment for RPA bots is one time and the management costs
of these bots will reduce over time creating faster ROI compared to human
denial management staff.
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4. The reason for this much time consumption is because denials are categorized to patient, provider, and
payer as the denial management experts need to figure out the route cause of the denial to make sure the
same denials do not repeat over and over again.
Reduced manual work hours (time-saving)
The next best RPA use case for the denial management process is saving manual work hours. A typical
denial management expert with 3+ years of experience in denial management would analyze and
come up with the following resolution action that would take 30 mins to an hour.
A robotic process automation (RPA) bot would perform this task within 2-5 mins drastically reducing the time taken
for analysis and next action. A denial management RPA bot can easily perform 100+ denials resolution in human staff
work 6-8 hours per day.
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Productivity, Quality, and efficiency
As you can see from the above-mentioned time-saving robotic process automation (RPA) use case for denial
management the time taken for RPA bots can single-handedly solve the reason for a claim denial and perform
resolvable action in 5 minutes giving a greater advantage in productivity as the RPA bots run 24/7 365 days a week.
Hospitals can take this as an advantage and resolve more and more denial recovering thousands of dollars every day.
The reason why the quality of the RPA bots is impeccable is that the adaptive intelligence technology programmed
inside the AI which includes ICD 10, and CCI database is already accessible by the RPA bots which eliminates any
coding-related issues.

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Similar to the coding databases RPA bost have access to denial-specific
insurance CARC and RARC codes, Remark codes, clearinghouse reactions
codes, etc to quickly analyze the issue right there instead of waiting for
other senior level expertise human staff to resolve the frequently received
denial problems increasing quality and productivity simultaneously.
The rather proven RPA use case for denial management is efficiency
because RPA bots do not take holidays, do not get sick, or go on vacation,
the continuous efficiency of the denial management process will allow
hospital decision-making leaders to get more recovered revenue in a
month compared to their previous financial performance.
Interoperability between applications
Interoperability between various applications is the workflow of any denial
management process in hospitals and health systems. Navigating
through these applications by a human staff is repetitive, and tedious, and
chances for errors are possible. Some insurance companies would like to
submit any denial rebuttals through their web portal where manual claim
information needs to be entered.

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Automated denial management paperwork
All these interoperable processes can be carried forward by RPA bots
quickly and more efficiently than a human staff due to their OCR
(optical character recognition) reading and writing engines combined
with their NLP (natural language processing) engines can perform
these tasks more efficiently and without any data errors as appeal
and redeterminations process need precise information for the
insurance companies to evaluate.
The most time-consuming process of denial management is creating
paperwork to rebuttal the claim denials with proper documentation.
This RPA use case for denial management is highly important because
most appeal documents are incorrectly sent with the wrong health
plan appeal forms or sent to the incorrect insurance plan resulting in
further denial of the claim. RPA bots can automatically populate the
fields in the appeal forms by identifying the correct health plan
appeal form and filing information. This allows human staff to
concentrate on more manual processes like responding to
correspondence sent by the insurance companies through the mail
and seeking necessary actions using the RPA bots.

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We hope these use cases for RPA denial management were helpful to identify the aspects of your hospital or health
system problem areas and were beneficial in making key decisions for RPA implementation.
We also understand that you will have many questions after reading RPA use cases for denial management, worry
not! BillingParadise, as an expert in both healthcare revenue cycle management and Robotic process automation
(RPA), can provide you with expert consultation for your RPA requirements for denial management and other
processes as well.
Our certified RPA experts are more than capable of answering your complex questions and providing the necessary
insight for RPA-enabled RCM processes! Schedule a free consultation now!

8. Contact us
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