From telecom to transport, IT to insurance—transforming one industry after another, automation shows no signs of stopping. The automation market is growing steadily, expected to increase its total size twofold to almost $400 billion in 2029. But how does this remarkable trend impact healthcare services?
Due to its human-centered nature, healthcare may not be the obvious target when considering automation candidates. However, behind every medical procedure and patient-doctor interaction, there are umpteen non-medical background processes like insurance billing and coding, pre-authorization, or claims processing. All of them are well-suited for automation, and Robotic Process Automation (RPA), in particular, is a great way to start small and take it from there.
Are you keen to learn about automation’s opportunities for medical providers? Read on and discover the most pressing challenges for healthcare workflow automation and how your office or practice can address them using RPA.
Main challenges facing today’s healthcare industry
In addition to some global factors that affect every business sector (think COVID or skyrocketing gas prices), each industry has its pains to face. When it comes to healthcare, the following few are particularly prominent.
This is a problem that hospital managers and healthcare HR specialists know all too well. The lack of professionals is nothing new (already in the early 1990s, analysts raised concerns over the imminent nursing and hospital bed shortages). Still, the issue has only been exacerbated by the great resignation, pandemic, and ever-growing hiring expenses.
Unfortunately, things aren’t expected to take a turn for the better anytime soon. For example, the American Association of Medical Colleges projects a shortage of up to 124,000 physicians by 2033. At the same time, 28% of nursing facilities remain understaffed.
That trend applies to non-medical personnel as well. Time and resources necessary to train revenue cycle professionals are some of the main reasons why 60% of healthcare finance leaders report having at least 100 vacancies. Note that we’re looking at leaders here, which means that shortages may be even more severe in the case of smaller providers.
High operational costs
With all the processes, resources, and specialists involved in each treatment, it’s hardly shocking that healthcare doesn’t come cheap. However, in recent years, operational costs have gone through the roof. A report by American Hospital Association points at four main culprits:
- Workforce expenses — at the peak of the Omicron upsurge, per-patient labor expenses were 57% higher than before the pandemic.
- Drug prices — expenses on drugs and medical supplies for each patient increased by 36% between 2019 and 2021.
- Supplies and PPE costs — some crucial resources, e.g., energy, resins, and cotton, went up by over 30% between 2020 and 2022.
- Inflation — higher prices affect costs and discourage patients from seeking treatment.
Denied and overdue claims
Is $25 a lot? That’s how much reworking a denied insurance claim costs on average. Even if this amount seems peanuts to you, multiply it by the monthly number of claims denied or overdue in your practice, and the sum of money leaking out may pile up real fast. That’s where healthcare workflow automation comes.
Preventing denied claim losses isn’t easy since the exact reason for claims issues may be tricky to pin down. Here are some of the most common ones:
- medical coding errors,
- improper pre-authorization,
- missing information,
- duplicate claims,
- medical necessity requirements not met,
- missed deadlines.
The transition to EHR has ended many documentation challenges in healthcare. However, some issues have persisted in plaguing the industry still today. Do any of these sound familiar to you?
- Missing or incomplete documentation, may negatively affect treatment, lead to negligence, legal action, and even result in patient death.
- Miscommunication between providers influences the quality and speed of healthcare delivery and damages the providers’ reputation.
- Privacy breaches and leaks due to insufficient and amateur protection against cyberattacks. In the USA alone, 2021 brought a record high in cybersecurity issues, resulting in 45 million patients compromising their private information.
- The mass use of copy-paste when handling medical documentation that may contribute to the dissemination of incorrect and misleading information.
As you can see, handling data is one thing. But the sheer volume of data to process is a challenge of its own for healthcare facilities and professionals.
Too many tedious back-office tasks are still handled manually, leaving room for human error and putting additional strain on your already busy personnel. Take medical insurance billing and coding, for example. These tasks involve working with huge volumes of data and repetitive procedures while putting your practice at risk of denial if done without due diligence.
Ensuring compliance with HIPAA and other regulations is one of the most error-prone areas of healthcare finances. Even the most conscious professionals can blunder between hundreds of claims to process each day. And, given that fees for non-compliance can reach $1.5 million per year, that mistake can be costly.
Meeting audit and regulatory requirements can be particularly challenging for providers running their operations in multiple countries, each with different compliance regulations.
Five Unlikely Candidates for Healthcare Workflow Automation
Luckily, RPA solutions for improving healthcare automation workflow such as medical coding automation tools can help providers resolve all the above issues—however daunting they may seem. There’s no limit to the use cases that can be supported by adopting robotic-enhanced automation. However, as we will see, certain processes are more likely candidates for automation.
1. Onboarding, scheduling, and profile creation
The back-office work begins right after a new patient sets foot in your practice. The repetitive nature of onboarding tasks makes RPA and other automation methods shine here. While workflows like setting up an account, verifying history, or submitting patient data to the system can be extremely monotonous, scripts can be easily pre-programmed to run these tasks precisely, no matter the volume. By automating data collection and entry, medical and non-medical staff can prevent mistakes they would normally spot further down the road.
Once a patient’s data and account are ready, automation tools can assist your staff in scheduling appointments. Pulling the necessary information from various systems, finding the right time, and confirming the visit with the patient has never been easier.
2. Claims processing
Preparing claims and submitting them to the insurer is notoriously tedious and just as crucial. Fortunately, in many cases, both processes can be completed entirely without the involvement of a human worker.
A bot is capable of handling every step of the procedure. After logging in, it starts searching for claims to process and respective insurers based on pre-existing databases. Next, medical coding automation algorithms assign the ICD codes to each claim, enabling relevant medical procedures and insurance charges. Since the bot checks, if all information is in place and pulls it from all available sources, no empty text field goes unnoticed. Lastly, it scans the claim for unnecessary ICD codes and deletes them. With cleanup done, the claim gets sent to the insurer. All in just about half a minute!
Read claims processing automation in action!
The problem with medical data isn’t just that it’s sensitive—it also comes in huge volumes and tends to move a lot between clinics, physicians, insurers, laboratories, research facilities, and other institutions. Keeping all records secure and complete while preventing them from ending up in siloes and ensuring they reach the right recipient can be overwhelming.
Just like with medical coding automation, RPA solutions guarantee the safety and accuracy of data transfer. Data is structured automatically, allowing for easier access and file traffic monitoring. Records are only forwarded after the algorithm has ensured that they are complete and properly encrypted.
4. Compliance monitoring
Another challenge that stems from massive bulks of health records is staying compliant with HIPAA and other data regulations. Verifying every single file transfer is a job that cannot be completed without proper tools.
Algorithms act in line with the compliance policies established by your administrators. Based on defined roles and authorization rules, RPA bots automatically transfer and process the data only when the process is verified and free from errors. Script-run workflows limit human interference, too, reducing the likelihood of a breach.
5. Dynamic provisioning
We’ve already established that resources are pricier than ever. Moreover, these costs grow further as healthcare organizations increasingly rely on virtual and cloud-based systems. The answer to that problem lies in dynamic provisioning.
Automated provisioning bots monitor load conditions and adjust throughput to the current needs. By turning off machines, not in use, dynamic provisioning helps healthcare organizations save money and resources. On the other hand, it also scales up computing power when needed, guaranteeing adequate performance.
Healthcare workflow automation — what are the benefits?
Automating all the processes mentioned above aims to mitigate the main pain points in healthcare automation workflow and help your practice deliver even better services. Here’s what’s in it for all stakeholders—including the medical and management professionals:
- Less time spent on dull tasks — your personnel is now free to do what they do best: providing excellent treatment and patient experience. Another important benefit is higher work satisfaction.
- Lower operational costs — money saved thanks to the automation can be invested elsewhere, e.g., in infrastructure or salaries.
- Faster revenue cycle — all processes that make up the revenue cycle, from registration to claim submission, are faster, leading to no missed deadlines.
- Centralized data — automation helps you harness all the data, no matter how massive.
- Higher patient satisfaction — the overall efficiency improvements won’t go unnoticed by patients who’ll love to return to your practice.
- Fewer errors, full compliance — bots take care of repetitive tasks, preventing mistakes and ensuring data security.
Conclusion – what’s next?
Virtually no tasks and workflows are unfit for automation in healthcare. Ultimately, their proper implementation and optimization boil down to choosing the right strategy—and an experienced implementation partner.
As a UiPath-certified company with ample expertise in the medical coding business, here at Flobotics, we have everything needed to get your practice started with RPA-assisted workflows. Our experienced consultants can’t wait to hear about your vision and see how they can get your healthcare workflow automation efforts underway. So reach out and tell us more!