Using RPA to Optimize Healthcare Revenue Cycle Operations

Many industries are applying robotic processing automation (RPA) to repetitive, transactional and rule-based processes to help streamline operations, reduce the time to complete tasks, improve the customer experience and lower labor costs. RPA automates processes that are transactional and repetitive, essentially mimicking human behavior for rule-based tasks. With its transactional and repetitive processes, healthcare’s revenue cycle can also benefit.

RPA executes routine tasks in a fraction of the time it takes a human, around-the-clock, and without the risk for human errors. This is accomplished through the use of scripted processes that have access to applications and data sources, including end-user health information system (HIS), data input screens, online application programming interfaces (APIs), and structured and unstructured data repositories.

Virtualization technologies and cloud computing power allow for scalable deployment of RPA software across departments and geographic locations of an organization. Unlike artificial intelligence, RPA technologies cannot modify processes without human intervention. However, RPA may serve as a stepping stone for incorporating more sophisticated cognitive technologies such as machine learning and artificial intelligence.

The successes and failures of RPA applications in other industries offer healthcare organizations a roadmap for effectively implementing the technology and identifying cases where it can deliver results. Financial institutions use automation to accelerate account reconciliations. Logistics providers are using RPA to facilitate shipment scheduling and tracking. RPA has improved retail and service-sector customer experiences using chatbots to provide real-time response to questions asked online.

The insurance industry is using RPA in combination with more sophisticated decision-making models across a range of business processes. For example, with access to a robust data repository, RPA can be used to quickly evaluate and issue low-risk insurance policies. Prospective customers benefit from timely service and underwriters are freed up to focus on more complex analytic and service work. The technology has also helped reduce claims payments administration from days to hours while eliminating human error during the process. Using RPA in similar scenarios in healthcare can deliver significant results.

RPA is not a solution for automating every revenue cycle process, nor will it eliminate all labor costs. But when implemented correctly, it’s an effective and efficient tool that generates cost savings and streamlines processes.

Apply RPA to revenue cycle processes to:

• Expedite cost estimate generation: Automate the benefits retrieval process and generate cost estimates.
• Assist pre-authorizations: Gather information from websites and other disparate systems and integrate the information directly into the HIS. In some cases, even submitting for pre-authorizations.
• Enhance patient communication opportunities: After a phone call to discuss the cost of a service or other customer service questions, automatically generate an email that recaps the information discussed.
• Reduce manual data entry: When information is stored across multiple systems, aggregate the data and enter it into a central patient accounting system.
• Increase efficiency by integrating third-party tools: Serve as the middleman between third-party tools that don’t “talk” to each other. This allows for data sharing and processing between the tools without human intervention.
• Automate simple claim denials: Takeover denial resolutions that follow a step-by-step process, allowing staff to focus on more complex denials.
• Improve the consumer experience: Provide instant answers to simple questions using a website chatbot automated by RPA.

As you seek to build a strong organizational foundation, driving out inefficiencies and streamlining processes is critical. Implementing RPA for certain revenue cycle activities is an effective way to do just that.