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Robotic Process Automation (RPA) is a term that refers to software that automates manual, rule-based, repetitive tasks normally done by a hospital’s staff. In healthcare, RPA is used to improve the efficiency, accuracy, and speed of billing and reimbursement (Revenue Cycle Management) and potentially many other functions. 

RPA easily manages data across the organization

RPA is not designed to replace existing systems. The digital workforce of software robots complements systems and addresses gaps in processes where work is done manually.

One of the challenges facing large healthcare organizations is managing data that is spread across a variety of sources: clinical applications, labs, insurance portals, ERPs and more. Integrating these systems is complex, and most healthcare organizations still rely on their staff to perform labor-intensive information processing tasks. 

RPA helps move and update data between these systems in the same areas where a staff member does. A digital workforce of intelligent software robots, RPA automates the flow of information 24/7 between a healthcare organization’s many systems. Among the many applications in which RPA can increase speed, accuracy, and efficiency are physician credentialing, enrollment, patient eligibility, prior authorization, denial management, clinical documentation, coding, medicare billing, regulatory compliance, security, patient self-pay, and more.

RPA is trained in repetitive, time-consuming tasks

RPA software robots are trainable. For instance, if a staff member needed to find the metadata in a document such as a file name, the date the file was created, or the ID numbers for a scanned EMR document, they would have to open the properties of a file to extract the information. RPA learns as the human does this and memorizes and scripts the process, reducing information retrieval to seconds or less. The robotic software follows the same clicks, keystrokes, open applications, and keyboard shortcuts the staff member performed on the desktop. 

RPA in RCM

Healthcare handles complex and varied patient information on an intricate scale. Mistakes have high costs, from unpaid claims to lawsuits. 

Denied claims cost hospitals an average of $262BN per year. The average insurance claim denial is estimated at 9% as of Summer 2019. This massive cost in uncaptured reimbursements creates disruption in the revenue cycle. These disruptions can compound other processes and cost hospitals even more money to resolve. 

Advantum Health is a leader in RPA revenue cycle management. When billing cycle functions are automated, the hospital does not need to hire more staff to compensate for the massive workloads. RPA shortens cycle times, reduces errors, improves efficiency, reduces labor costs, and streamlines billing operations. 

An RPA digital workforce uses scripted processes to access information in the same way humans do, but faster and without errors. Once taught, robots access data, API’s, payer portals, practice management systems, and medical records without password mistakes, user errors, misspellings or forgetting how to navigate a system. 

RPA offers dashboarding for quick analysis and status

Advantum’s RPA uses dashboarding to allow staff to manage processes. Functions of the dashboarding include denials management, payments, auditing, flagging claims for errors before submission, patient payment status, trends, and easy to understand analytics.

Rapid processing of claims keeps the hospital operations flowing. This allows the staff to focus on high-value tasks.

Read More:

Robotic process automation revolutionizes the healthcare revenue cycle

Automating RCM reporting with AI-RPA