PathGroup:

Automating key processes for a pathology services provider and building an RPA infrastructure

Client:

PathGroup

Location:

Tennessee, USA

Industry:

Healthcare
Laboratories

Team:

RPA Developer, Automation Consultant

Technology:

Robocorp

Timeframe:

June 2023 – now

PathGroup_Automation Case Study

About the Client:

PathGroup is a premier provider of anatomic, clinical, and molecular pathology services and one of the largest providers of women’s health services in the United States. It serves more than 95 hospitals and thousands of physician groups nationwide.

The Challenge:

PathGroup executives had been considering automating their key and repetitive processes for some time before the engagement. They already had a fat backlog of ideas for automation and were looking for the right automation partner.

They had two main challenges:

  • They have an enormous volume of medical documents to be processed daily.
  • They rely on custom, legacy EHR software that is hard to integrate with other software solutions and systems

In order to start with automation, PathGroup contacted Robocorp, one of the new players in the RPA market.

The vendor recommended us as the only RPA consulting company in their Partner Ecosystem experienced in healthcare automation projects.

Solution:

As a first step, we reviewed PathGroup's backlog, calculated the expected ROI from the processes, and together with selected the most crucial processes for automation.

Since the start of the collaboration, we have delivered multiple automation solutions. Here are the most important ones:

  1. Automating Insurance Claim Denials Management and Resubmission

In many instances of the RCM process, submitted claims contain errors. Due to errors, they are denied and sent back to the issuer, which extends the submit-to-pay time and, in some cases, misses deadlines.
90% of denials are due to minor mistakes, such as missing data, that are easily fixed. Out of these 90%, a limited number of error types are very repetitive and easy to fix.
We built a bot that automatically processes the denied claim and checks if the error is one of the pre-defined cases (such as missing data). If it is, it fixes it automatically and resubmits the claim.

Now, only the remaining 10% of denied claims that are more complex and require human intervention are being processed by human workers.

Learn more about automating insurance claims denials in RCM.

2. CPT Codes Fixer

With dozens of clinics and hundreds of clinicians, PathGroup handles a lot of medical coding. To keep up with the volume, PathGroup uses its own claim generator to assign the right CPT codes.

Unfortunately, with this volume, errors happen. Sometimes codes are added incorrectly, or there are conflicts between two codes that cannot be used together.

For PathGroup, the usual CPT error rate is around 200/day. Before the engagement, each error had been corrected manually.

To streamline this process, we built an RPA bot that receives all the errors daily. In 50% of cases, the bot can fix the coding error by itself and resubmit the claim, cutting the error backlog in half.

Monthly volume: ~3000 errors/month corrected automatically

Time savings: ¼ FTE/monthly

Learn more about automating medical coding.

Automate processes in healthcare

3. Laboratory Tests Management Automation - Sending Denial Appeals Back to Providers

A laboratory branch process, similar to claim resubmission mentioned in 1.
In some cases, when PathGroup passes laboratory information to insurance providers, some crucial data is missing such as incomplete addresses, insufficient medical records, or invalid progress notes.
We have built an RPAQ bot that automatically manages denied appeals that have been sent back. The bot searches for the missing information in the PathGroup databases, fixes the appeals, and sends them to the providers for review.

4. Automating Patient Registration and Data Collection via Fax