A Guide to Robotic Process Automation in Patient Access & Revenue Cycle Management

Robotic Process Automation (RPA) has the potential to transform major industries by increasing their productivity and efficiency levels across the entire billing lifecycle. Businesses within the healthcare sector are now exploring the potential RPA has for patient access and revenue cycle management.

However, many healthcare organizations are still in the initial phase of understanding what exactly RPA is and how it can help their business be more efficient. This guide will help you understand this technology in greater depth and its potential for optimizing your revenue cycle workflow.

What is RPA?

Robotic Process Automation (RPA) is the use of software robots to carry out tasks that are repetitive and specialized for more efficiency. RPA helps streamline processes and reduce costs by eliminating the need for human intervention.

How Does It Work?

RPA works in a very simple manner. The robot is given the task of carrying out a particular process, and can learn to do this by mimicking the actions of a person performing that task. For example, this might look like automating the sequence of clicks and typing needed to log into an insurance company portal to submit a claim.

Unlike previous forms of workplace automation, some forms of RPA software can be implemented by non-technical users without coding knowledge. This means it has the potential to be easily adapted to meet new business requirements in non-IT departments such as finance and HR.

RPA helps businesses achieve their goals by improving employee productivity and efficiency across various departments effectively. It eliminates errors by providing consistent results every time and has been proven to increase accuracy by a factor of 10.

In order to see how effective this kind of automation could be for your company, you may want to consider undertaking an RPA assessment . This is where experts will assess your current processes and suggest ways in which they can be improved for greater efficiency.

RPA vs. AI: The Difference Explained

While RPA is a form of automation, it differs from artificial intelligence (AI). Robotic process automation uses programming and repetition to automate specialized repetitive tasks, while artificial intelligence relies on machine learning and pattern detection to carry out more complex work such as analyzing data to find patterns or making decisions based on information received.

Many researchers believe that these two systems can work synergistically because AI and RPA together can automate the full spectrum of tasks, from simple to complex.

The Modern RCM Technology Stack

Every business that has a collections function requires RCM. RCM is the process of filing claims, receiving payments, policy issuance, customer service support, claims management, and collections throughout the entire billing lifecycle.

RPA can help businesses by automating manual revenue cycle processes such as form creation and processing for authorization, eligibility checking and adjudication. It allows users to complete these tasks in a fraction of the time and avoids the possibility of human error or delays due to resource constraints. This increases processing speed which in turn increases revenue collections while allowing people to focus on higher-level strategic tasks.

With RPA, users are able to acquire solutions efficiently at an affordable cost with a minimal risk involved without having to deploy large teams of IT experts or developers onsite. Since RPA does not require any special type of platform or environment, it can be set up and implemented on existing revenue cycle workflows systems with little to no downtime.

Additionally, RPA can solve persistent bottlenecks such as:

1. Revenue leakage is one of the main issues in RCM. Due to the complexities of the healthcare third-party payer system, not all revenue is collected from clients and hence statements may not be accurate. This problem can be solved with RPA because it will ensure that every single transaction is recorded accurately.
2. A disconnect between the client-facing and service delivery teams resulting in non-standardized processes that affect adoption by both internal staff as well as clients/prospects.
3. The lack of visibility into goals across departments makes it hard to determine what needs to be done when new business opportunities or financial issues with existing customers arise and there is no automated system available.

How Healthcare Companies Are Adopting RPA

Rapid adoption of RPA eliminates staff errors and increases accuracy in workflows. It is capable of automating revenue cycle management processes by working with a diverse range of applications that companies need to handle revenues such as Oracle EBS, Medisoft (MHS), Vision(TM), EpicCare(TM) etc., which are also used for other areas of healthcare, making it easier to deploy quickly.

RPA makes automation more effective by augmenting the manual process with intelligent and dynamic software that can rapidly improve the way you handle transactions in your business. It is an effective solution that helps eliminate repetitive tasks and reduce ‘button pushing’ and wasted effort.

Where RPA Benefits Patient Access & RCM

Whether you are addressing the patient access functions of prior authorization or insurance discovery, or you are tackling RCM processes like AR Optimization and denials management, RPA lends itself to the electronic automation in these three ways:

1. Automating Manual Processes

RPA can automate manual tasks making them more accurate and reducing the risk of human errors. This allows users to focus on more strategic tasks while increasing productivity and revenues due to a faster turnaround time. For example, RPA can automate checking the status of prior authorization requests and insurance claims, potentially saving hours of staff time spent on phone calls that can be redirected to higher value patient care. Conversely, managing denials is one of the most mis-aligned functions in RCM. However, with RPA, the process becomes automatic and no longer at the risk of being put aside for more pressing or timely matters.

2. Processing Data At Higher Speeds And Greater Accuracy

Machines are able to execute tasks much faster than human workers. Furthermore, when workers are involved in manual processes, there is an increased chance of errors being made due to lack of consistency when compared with using automated software or machines.

These are valuable assets, for example, when it comes to processing accounts receivable. Many providers find processing accounts receivable without the use of automation to be very difficult because it involves the use of several different processes and systems. Manual processing can lead to errors, multiple workarounds and delays in getting reports for leadership.

Prior authorizations and accounts receivable use significant resources, so it’s important to have a system that will not only keep costs down but also save time and effort on the part of staff who are tasked with these responsibilities. RPA can assist in reducing hands-on work in this area such as filing claims, processing paper invoices and data entry.

3. Faster Deployment

RPA increases efficiency by enabling quick implementations without needing any additional hardware or software modules. It does not require any budget for future upgrades, saving costs and increasing efficiency.

RPA is a good fit for RCM processes as it can be used with any type of system which helps in freeing up internal resources so that they can focus on more strategic tasks. It allows you to reallocate your existing IT assets and infrastructure towards the expansion of your business rather than investing in new technology or architecture improvements.

As RPA doesn’t require any specialized skills, the implementation process is quick. Furthermore, since RPA does not require any modification to underlying systems such as databases, companies can switch back to their previous processes without issues if required.

Making the Most of RPA in Your Organization

Domain specific intelligence is key to making the most of RPA in revenue cycle management. A good RCM software should be able to identify transactions that are similar in nature and break them down into a range of activities which have been performed before. This will help you reduce costs by minimizing errors, cutting time spent on approvals and eliminating unnecessary work.

RPA for accounts receivable is an important step towards increasing efficiency, improving cash flow and reducing costs. These processes can be handled much faster when you let automation take care of them rather than relying only on human labor which may not be available at all times.

What to Expect In the Future

In the future, RPA has the potential to have an even greater impact on the revenue cycle since RPA can also be used to detect errors in back-end systems and communicate these to supervisors. This is because RPA will be able to monitor and analyze financial transactions more effectively than humans.

RPA has been designed to work with an existing system but with better efficiency. In the future, RPA could be further enhanced so as to integrate into back-end applications like claims management or revenue cycle management platforms. With further development of this technology, we expect it will see greater adoption within RCM processes.

Many large organizations are positioning to adopt robotic process automation across sectors. Gartner predicts that in 2021, the value added by robotics process automation will reach $1.9 trillion.

Key Takeaways

With consistent RPA implementation within your internal systems, you can maximize efficiency and improve operational performance while also ensuring reduced costs in the long run.

Although there is an initial learning period when developing an understanding of how RPA works and integrates into your prior authorization and RCM systems, this investment can produce a significant return on investment due to saved employee hours. Moreover, with the speed at which technology has developed over the past few years, expect artificial intelligence and machine learning to play an even more important role in business software in the future.

An Intelligent Prior Authorization & RCM Platform by Infinx

Infinx offers the ideal, modern-day AI and RPA powered RCM solution which can integrate directly with your existing billing systems. Providers can predict, prioritize, and recover accounts receivable using cutting-edge machine learning, advanced automation, and our extensive databases, coupled with our state-of-the-art, real-time analytics that keeps you informed 24/7.

If you want to automate the process of getting quick reimbursements, streamlined denials, timely appeals, and intelligent insights to accelerate accounts recovery, schedule a demo today.