How RPA Can Improve Your Medical Billing Processes?

What is RPA for medical billing?

RPA is a buzzword that you might have heard about multiple times but what does it literally & practically stand for? RPA stands for Robotic Process Automation which by definition is simply creating a software robot (sometimes referred to as a bot) that can perform redundant or repetitive tasks instead of a human with minimal to no interaction with the user. After the robot is programmed using one of the RPA software platforms like UiPath or Blue Prism, it can be easily scheduled to perform a specific list of actions at a specific time or when another event takes place.

Numerous highly sensitive client encounters occur in the healthcare business, but there are also many time-consuming, repetitive procedures and administrative duties that do not require specialist knowledge. From front-office activities to operational operations to patient engagement and bill payment, RPA can automate jobs across small & medium enterprises as well as corporations.

According to Gartner, “50% of US healthcare providers will invest in RPA in the next three years.” Gartner continues, “Healthcare providers are caught in a perfect storm of shrinking payments, improving outcomes, enhancing experience, and bolstering credentials. Any technology implemented to help these providers improve delivery and streamline operations must also optimize costs.”

What are the benefits of automating your medical billing processes with RPA?

1. Reductions in processing costs

If we look into applying RPA at a hospital that, for instance, is required to boost its operational control, we can see that this actually can improve the patient’s experience. By automating revenue cycle tasks like claims and billing, for example, the cost and/or time needed per claim will be significantly reduced.

2. A more efficient billing cycle

RPA can automate accounts payable and data digitization operations, resulting in increased billing efficiency. Healthcare organizations may save considerable labor and financial resources by improving administrative operations.

3. Reductions in the cost of human labor

Healthcare practitioners save time by delegating labor-intensive activities to robots. They can put these extra time resources to better use, such as focusing on more fine-grained patient attendance rather than monotonous data input, allowing them to improve their clinical training.

4. Employee satisfaction improved

This is a side effect of the prior advantage. And the good effect causal chain doesn’t end there! Pioneers in the transformation of healthcare to a digital business claim that a higher degree of job satisfaction among healthcare professionals is strongly connected not just to better patient care, but also to higher corporate ROI.

5. High-quality healthcare

Perhaps the most important and all-encompassing benefit of using RPA in healthcare. Automation enhances patient satisfaction by reducing time, removing the possibility of human mistakes, and allowing staff to focus on more meaningful, patient-centered tasks.

Increased operational efficiency may also broaden the scope of healthcare’s usefulness. As a result, the healthcare system might better meet the requirements of a larger number of individuals. The prospect of sufficient treatment for an increasing number of individuals elevates RPA in healthcare beyond a simple option.

Payroll and time attendance, for example, are activities that may be automated to save up time for personnel in an HR department. You can see an RPA demonstration of automating these operations in the video below.

What can be automated with RPA to improve revenue management cycles?

Medical Billing Processing

Manually processing medical billing operations such as payment posting, Electronic Health Records (EHR), and claims administration takes time. Robotic Process Automation streamlines and automates these operations, enhancing revenue cycle management for medical billing companies’ bottom lines.

‍Payment Posting

Automated payment posting boosts productivity and eliminates the need for human insurance payment processing. Users may define as many bespoke and detailed rules as they like with this bot. Organizations may educate the bot to post payments in the same manner as they would a new employee. These bots may also highlight unpaid claims for more labor and appropriately submit refunds or takebacks.

Revenue cycle departments have been able to automate up to 70% of the back end of the medical billing process by integrating payment posting bots and even patient collecting bots, enhancing efficiency and lowering operational expenses.

EHR Automation

RPA bots fill in EHR forms and replicate essential data across multiple systems, decreasing human error and allowing doctors to spend more time with their patients. You can automate sending data between one EHR and another, as well as pull the data from your existing EHR to your CRM, etc.

Claims Administration & Submission Process

Human mistake is a common cause of first claim denials in claims administration. RPA bots automate a variety of claims administration operations, including charge entry in medical billing, payer rule checks, and submission.

Boost Patient Communication

RPA bots create an email that summarizes information about the pricing of a service or other consumer inquiries mentioned during a phone conversation. Reminders can also be triggered via bots (I.e., emails & SMSs).

Accelerate Cost Estimation

RPA bots help healthcare businesses automate benefit retrieval and cost estimation operations by simply linking the patient’s profile with the medical services provided and calculating the cost using the price list already available in the database.

Minimize Manual Data Entry

RPA bots aggregate data from many systems and send it into a single patient accounting system, reducing the need for manual data entry. OCR is also used to extract data from images & PDFs in an efficient and error-free method to be plugged into the system automatically.

Automate Claim Denials

Bots can automatically address any simple errors and then resubmit the claim. For more complex errors, the denial can be passed to a human but will provide detailed patient information and denial information, greatly speeding the rework time. As RPA bots take responsibility of denial management in a step-by-step procedure, staff may focus on more complicated denials.

Assist Pre-Authorizations

The revenue cycle of robotic process automation allows healthcare businesses to get data from different websites and systems and integrate it directly into the Hospital Information System (HIS). In some situations, it also applies to pre-approvals.

Integrate Third-Party Applications

RPA bots function as a middleman between disparate third-party tools, allowing data to be shared and processed without the need for human interaction.

Improve the Consumer Experience

Healthcare firms are increasing the consumer experience by utilizing RPA-driven internet chatbots to answer simple questions. Except for managing the chatbots, RPA is able to improve the speed and quality of response on other sources.

What are the steps of implementing RPA to improve medical billing?

1. Perform process audit and validate requirements

Businesses should devise a strategy for selecting the best processes and then prioritizing them based on factors such as complexity and return on investment. Consider how automating these activities will appear, what it will accomplish, the business context in which it will be used, and how it will fit into future business operations or the broader automation journeys. During this step, RPA consultants will map your processes, review your current tool stack and compare them with your business goals and requirements.

2. Perform Feasibility Assessment including process discovery & even legal compliance check

Perform a feasibility analysis for each process to see how much of it can be automated. This is a two-step procedure that involves examining the process and determining technical viability. This assessment should be carried out by the operation user, an SME (Subject Matter Specialist), and an RPA expert.

3. Readjust

Determine whether procedures are not organized, standardized, optimized, documented, or implemented as anticipated based on the feasibility assessment study. Attempt to reoptimize and reorganize the process at this point.

4. Gather User Stories

A user narrative defines the aspects of an application that will be constructed from the perspective of the end-user. It goes through all of the user needs in great depth. It’s also critical to have a thorough description of each operation that will be automated. Develop a process description document with defined RPA processes for the development team based on this information.

5. Start Development Process by setting up the environment

The development process begins at this step, depending on the RPA workflows that have been developed. Using RPA technologies such as UiPath, Blue Prism, and others, the developers generate automated scripts and program code. Because each RPA tool has its own set of capabilities, firms need to be very particular when selecting the right solution for their purposes.

6. Test RPA Process via a PoC before live deployment

Conduct extensive testing to examine performance in all conceivable circumstances and to identify faults when the procedure is run. Send any possible performance or bug concerns to the development team for resolution.

7. Reconfirm & Deploy

Once the development teams have rectified the first tests and problems, double-check the results, and deploy the entire RPA solution.

RPA in medical billing – what should you remember?

Are you in the process of implementing RPA in medical billing already? Here are 5 things you should keep in mind:

Select the right RPA technology vendor

There are different RPA technologies (such as UiPath, Blue Prism, Power Automate, Kofax, and more) available on the market, providing various levels of efficiency, licensing costs & features. Depending on your business requirements some technologies may be more suitable for your needs than others. Make sure to consult that before jumping straight to RPA development!

Bet on the right developers

Following the same approach above, recruiting skilled RPA developers is crucial. The developers must have the relevant technical skills and experience for being independently able to set upset-up the environment and actually create the automation workflows with the minimum downtime. This skilled personnel can finalize the project and keep the possibility of scaling up in the future when needed.

Ensure legal compliance

All created workflows & bots must be legally compliant with each local market (i.e., compliant with HIPAA’s 3 rules in the US)

Select the right process

Process Selection for automation requires the right skills to define what is actually needed and what tools and development/testing methodology is required to achieve the required business automation needs.

Follow the right KPIs

KPI Selection is based on the business needs which differ based on the required outcome from this project. An example here would be RPA KPIs Selection including but not limited to: increased productivity, ROI, reduction of downtime, and others.

Conclusion

What we really believe in is that each market/firm/entity has its own business needs which need to be tackled from a completely independent angle to identify the real requirements, KPIs, the environment needed & expected outcome from the RPA deployment. Full-scale assessment should be done by adequately qualified & experienced personnel to avoid any loss in time and/or money as well as keep a chance for expansion and scaling-up in the near future.

Looking for an RPA consulting services or RPA development partner to automate your medical billing? We are a team of industry-experienced experts, we are 100% HIPAA compliant, and we have delivered various RPA development for the healthcare sector. Reach out to us and get a free consultation for your medical billing processes.

Let’s check together what RPA can do for you!