The document outlines 7 priorities for healthcare CFOs to consider when automating revenue cycle management (RCM) operations with robotic process automation (RPA). The priorities are: 1) properly placing RPA within the RCM workflow; 2) upgrading the RCM workflow to integrate both human staff and RPA bots; 3) surveying staff population and objectives; 4) prioritizing pre-billing RCM processes for RPA; 5) automating repetitive RCM tasks; 6) using RPA for clinical data management; and 7) ensuring RPA keeps up with changing guidelines and regulations. Addressing these priorities is important to prevent underutilizing RPA bots and maximize returns on investment in RCM automation.

1. 7 RCM OPERATIONAL
AUTOMATION PRIORITIES
HOSPITAL CFOS NEED TO GET
RIGHT
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2. Implementation of robotic process automation is a form of major change in any healthcare organization’s
RCM operations structure, where only about 54 percent of all the healthcare CFOs in the entire nation’s
hospitals, health systems, and group medical practices have documented in the past 3 years that they do not
have sufficient manual workforce, increase in patient volumes and piling up outstanding balances and are
trying to incorporate RPA to their RCM processes so that they can reduce operational costs, improve
productivity and quality.
However, they tend to miss out on certain important areas where robotic process automation is to be
implemented as a priority and there are processes that need full human intervention, using RPA bots for the
processes which clearly need human support needs to be identified and assigned accordingly for a very
smooth and round the clock RCM operations.
INTRODUCTION
The goal of healthcare organization CFOs is to implement RPA in their RCM processes in the
right way so that the operational efficiency is at its maximum, here are 7 RCM operational
automation priorities any hospital CFOs need to get right:
PROPER PLACEMENT OF RPA IN RCM OPERATIONS
As soon as the term robotic process automation is brought up in any major changes
implementation in hospital’s RCM operations, it is understood that all RCM processes
can be automatically performed without any human staff overseeing, well that’s a
false notion.
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3. UPGRADING THE RCM WORKFLOW
RPA bots are intelligent and are sometimes self-learning; however, prioritizing only the areas where 95% staff burnout is
experienced within the organization must be deployed with robotic process automation. Data segregation processes are
where RPA gets the maximum output of your ROI and operational success.
Data segregation and entry processes with the RCM operations are where RPA bots find their true calling and can
outperform a human. Terms of the volume of data captured, entered, and Or consolidated. Healthcare CFOs who are
looking to get the best bang for the buck with RPA are only when they identify or conduct regular staff feedback sessions on
the RCM operations that make them burn out or stressed.
These manual data capturing processes can be very tedious and the repetition itself is a burden, unlike
living in the time when the industrial revolution was at its peak and people preferred doing repetitive tasks
in factories, modern-day human staff are more prone to the loop of repetitive tasks and eventually leave
the organization as their productivity and quality levels decrease over time. Having only 2 areas such as
monitoring the volume of data and division of that data among the RCM departments with regular human
intervention can do wonders with RPA allowing speedy post-data entry and consolidation audit processes
by your human staff.
RCM is an assembly line process regardless of how much RPA technology is being implemented. An astonishing 80% of all
RCM processes are conducted in this assembly line workflow.
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4. Productivity and quality are up to the mark as CFOs are tied to RCM operations related to revenue generation and
expenditure. Around 1-2 million dollars are spent every month just for the hospital’s RCM operations staff. CFOs looking to
cut down costs eventually implement robotic process automation for faster and more efficient RCM performance.
Although considering the RPA requirements from the inquiries we receive, most CFOs relied on RCM directors or billing
managers as they set up the RCM workflow suitable only for human billing and coding staff.
They tend to leave the RPA implemented RCM workflow which is adaptive to both RPA bots and
human billing staff. CFOs need to have a complete understanding of their current RCM workflow set
up by some hospitals only have one role which is biller, not all billers are certified in various processes
in RCM, take prior authorization coding and credentialing for example they need certified human
resources to identify the faulty areas according to the state and federal guidelines.
If your hospital is only going to have a few RCM processes with human resources having a lack of knowledge of
these guidelines then there is an immediate need to change these RCM processes as implementing RPA bots will
need certified RCM staff to assist them in certain areas only a certified human expert can. So upgrading an RCM
workflow that will be suitable for both your human staff and RPA bots will provide 100% efficiency and
performance.
STAFF POPULATION AND OBJECTIVES
Utilizing robotic process automation for RCM operations isn’t just about eliminating the manual workforce, it is about how
efficiently you can use your manual workforce to evaluate and oversee the RPA operations.
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5. It is true that 98% of the time these RPA bots do not need any IT support once programmed and implemented, but
overseeing the RCM specific performance is essential which is the reason why surveying your RCM staff population and their
objectives is a key responsibility of any CFO.
Prioritizing the objectives of the staff population is a must after implementing robotic process
automation in your RCM operations. You may have multiple resources with the same expertise and
objectives in the RCM workflow that they would have been assisting in one single process over the
course of many years. Providing them training to work alongside RPA bots in various RCM processes will
amplify the rate of reimbursement to 87% because major errors obtained by manual staff before the
patient visit will be rectified with a combination of both RPA and human staff ensuring twice the quality
and guarantee of reimbursement after 7-14 days according to CMS reimbursement time periods.
Additional staff, who tend to fail in diversifying themselves are opted out because if bots have the adaptability to diversify
why can’t human staff? The decision of prioritizing staff is in your hands as CFOs.
PRE-BILLING RCM PROCESSES
Pre-billing RCM processes are the best place to start robotic process automation implementation. Pre-billing processes like
patient access, registration, scheduling, eligibility, and benefits verification, and prior authorization are the main areas
where hospital CFOs need to prioritize and implement RPA. The reason why these RCM processes require automation is that
data obtained from the patient during the scheduling, registration, and patient access process might be incorrect and
causes 55% of all missing or incorrect information claim denials.
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6. Other pre-billing areas like prior authorization require robotic process automation because this is a lengthy and
time-consuming process and human staff tends to miss capturing in the prior authorization request applications
and insurance companies always revert it back to incorrect information captured. Patient eligibility and benefits
verification is also time-consuming because of the large patient volumes you receive and the amount of
information that needs to be verified and recorded in the patient account on your EHRs for the doctor to educate the
patient on their benefits. Healthcare decision-makers like CFOs and CTOs should prioritize RPA in these areas first
before moving into billing and post-billing RCM processes.
REPETITIVE RCM PROCESSES
Similar to the ones we discussed earlier, repetitive RCM process tasks are the
best way to prioritize your robotic process automation implementation.
Understanding that RCM is a big cycle and it takes at least on an average 10
days for this cycle to end depending upon the time taken by the insurance
companies for reimbursement Or denial. Repetitive RCM processes like charge
capture/entry, patient demographics entry, coding, payment posting, and
reconciliation are some of the repetitive processes which only involve capturing,
evaluating, and entering data, these processes are handled with absolute
accuracy and precise timely deliverance by the RPA bots.
They surpass human staff capabilities which take 15-20 mins per patient to complete this task whereas RPA bots only take
2 minutes at the maximum to complete this task for a patient. This clever implementation of RPA in repetitive processes will
easily help CFOs to boost their operational productivity and quality while reducing operational costs simultaneously.
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7. CLINICAL DATA-ORIENTED RCM OPERATIONS
The term clinical data does not only refer to CDI but also to the recording of clinical data and the
management of that data inside your hospital. Many hospitals have in-house labs, radiology,
and other screening services that require precise documentation. Robotic processes automation
specifically created for this type of clinical data creation and management will significantly
increase your hospital’s reputation but also allows you to produce awards like HFMA MAP for
performance in terms of high-quality clinical data maintenance and management. CFOs
prioritizing RPA for this particular process will increase revenue and avoid documentation-
related audits by CMS and other external entities.
GUIDELINES AND REGULATORY CHANGES
Lastly but not least, the ever-changing guidelines and regulatory changes implemented on reimbursement policies, ICD10
codes, reimbursement rates and billing methodologies are hard to keep track of, because RPA is built in such a way that it
always upgrades the guidelines and regulatory changes every month it is important for CFOs and RCM directors to
prioritize robotic process automation for this particular RCM operation. It allows a hospital to abide by all state and federal
guidelines and rules and get reimbursed in a legal way, as there are various hospitals out there who fail to abide by
regulatory compliance and lose confidential clinical data to hackers and ransomware. Robotic process automation not
only keeps this information subject to guidelines but also alerts any staff who tries to evade such regulator compliance
and guidelines.
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8. CONCLUSION
RCM operations priorities in hospitals are incorrectly
perceived and investments are made in the wrong
areas of operations leaving a half-baked RPA
implementation.
Identifying these factors before implementing robotic
process automation in a hospital is the golden rule.
This prevents the lack of utilization of the RPA bots and
prioritizes your investment in the RCM processes which
in turn gives you a faster ROI.
As healthcare financial decision-makers it is your
responsibility to inquire about these priorities with
experienced RPA and healthcare IT solutions
companies that can provide you a complete analysis
of which RCM processes you should implement RPA
and reap the benefits of increasing overall revenue.
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9. CONTACT US THANK YOU
PHONE NUMBER
+1 888-571-9069
EMAIL ADDRESS
inquiries@billingparadise.com
WEBSITE
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10. Question ?