High-Impact Robotic Process Automation Use Cases for the Revenue Cycle

With effective revenue cycle management hinging on the completion of repetitive tasks and processes in the face of workforce shortages due to the pandemic, healthcare organizations are increasingly turning to automation to increase net revenue, reduce costs, and improve the patient experience. Fortunately, a tried-and-true technology is available to shore up inefficiencies spanning from registration through coding to backend billing — robotic process automation (RPA).

RPA is an automation technology that mimics human behavior for rule-based tasks to complete transactional and repetitive processes. A set of scripted processes can access applications and data sources using structured data and logic to automate decisions according to predefined business rules and conditions. Programmed software robots run continuously in the background to ensure the completion of predictable, repetitive tasks without the need for human intervention, eliminating manual workflows across various clinical and administrative systems and data sets and creating new RCM efficiencies.

This is the first installment of a three-part series on the value of robotic process automation to effective revenue cycle management.

RPA ADOPTION AND BENEFITS

In 2021, a survey conducted by the Healthcare Financial Management Association (HFMA) found that one-third of hospitals and health systems do not use revenue cycle automation. Healthcare organizations with billions in net patient revenues reported the most use of revenue cycle automation, indicating a growing divide between large and small providers in their ability to become more efficient and improve cash flow.

RPA has caught the attention of healthcare organizations in particular. More than three-quarters of respondents (82%) to another 2021 survey revealed they are on their automation journey, though only less than one-fifth (19%) have achieved positive results. Achieving savings tied to improved revenue cycle management emerged as a top-three priority.

What’s more, Gartner anticipates that half of all provider organizations will invest in RPA technology over the next few years, mainly driven by payment reduction and the need to bolster the patient experience.

The benefits of RPA are legion. Financially, the Council for Affordable Quality Healthcare (CAQH) estimates that revenue cycle automation for administrative tasks could generate $17.6 billion in annual savings. Internally, healthcare organizations can improve data accuracy and integration as well as foster greater employee satisfaction by utilizing staff for strategic high-value initiatives rather than on routine tasks and manual processes. Finally — but perhaps most importantly — RPA can streamline the patient experience from appointment scheduling through collections during a time of increased healthcare consumerism and patient financial responsibility.

RPA USE CASES IN THE REVENUE CYCLE

Across the three major phases of revenue cycle management — registration, coding, backend billing — several high-impact use cases emerge where RPA technology can reduce friction and ensure that necessary processes are completed on time and correctly the first time.

Appointment scheduling, reminders, communication

Missed appointments in healthcare are costly, to the tune of $150 billion annually. When a pandemic continues to overwhelm healthcare staff and systems, RPA bots can streamline appointment scheduling, registration, and intake. These bots can schedule appointments based on diagnoses, provider availability, location, health coverage, and other considerations, providing front-end support to collect and process data.

While an EHR system largely dictates appointment scheduling, it is not responsible for sending appointment reminders and initiating changes to other appointments and orders in the event of a cancellation. RPA can ensure the EHR and reminder system are kept up to date.

Regulatory compliance

Healthcare represents one of the most highly regulated industries in the United States, and rules and regulations change frequently. Beginning on Jan. 1, 2022, healthcare organizations must provide certain patients with cost estimates as part of price transparency regulation. The accuracy, consistency, and security of records are necessary for remaining compliant, and RPA can provide just that.

Manual processes open the door to the potential for errors. With more data throughout the healthcare system, an organization faces increased risk. RPA can automate tasks that save providers time and money and reduce the risk of non-compliance.

Order and referral management

Patient visits lead to the generation of orders and referrals. Manually monitoring downstream encounters can easily create bottlenecks and slow a patient’s ability to access and receive care promptly. With the pandemic having created gaps in care between initial referrals and actual visits by months (if not longer), RPA bots can remove inefficiencies in the way of providing patient-centered care by communicating, scheduling, and confirming orders and referrals across departments, processes, and systems. Patients can then navigate a care journey that is streamlined and frictionless.

Prior authorization status

Healthcare reform aimed at improving the quality and cost of care has led to the increased use of prior authorizations among providers and payers to ensure that rendered medical services are necessary and lead to better health outcomes. However, prior authorizations can easily lead to delays due to poor communication and a lack of standardized information and processes.

For patients with complex diseases, Byzantine prior authorizations can easily disrupt care pathways, which is why providers are looking to leverage RPA in this area. Bots can check on authorization status as well as determine whether one is necessary at all.

Claims management

Tens of thousands of diagnostic and procedure codes are part of the claims management process, and inaccurate or improperly coded claims are responsible for creating denials requiring review, recoding, and refiling that wastes time and delays revenue collection. RPA technology can improve claim edit resolution, status checks for claims, payment posting and reconciliation, and denial appeals. Better management of accounts receivable allows organizations to speed cash flow and collect full payment. With the pandemic leaving many healthcare organizations cash-strapped, RPA bots can directly enable providers to collect revenue and keep their organizations in operation.

For healthcare organizations to weather the financial uncertainty caused by a pandemic, they must put their employees in a position to have the most significant impact on operations. By adopting RPA technology, providers can improve their revenue cycle and shift staff to focus on activities that contribute to improved patient experience and outcomes, hallmarks of leading organizations as the healthcare industry increasingly looks to reward the value rather than volume of services provided to individuals and communities.

__________________________

Cloudmed, a leading provider of Revenue Intelligence™ solutions, partners with over 3,100 healthcare providers in the United States and recovers over $1.7 billion of underpaid or unidentified revenue for its clients annually. We are unique in our ability to utilize industry-leading expertise and the powerful CloudmedAI™ Platform to help providers boost productivity and increase revenue. Cloudmed was awarded 2022/2021 Best In KLAS: Robotic Process Automation and 2021 Best in KLAS: Revenue Integrity/Underpayment Services. Our solution suites have HFMA Peer Review status and are HITRUST certified. For more information, visit www.cloudmed.com.