Strategic Capability

Declining reimbursements and the transition to value-based care has altered the way health systems provide care, document services and report on patient outcomes. As a result, healthcare executives today are under tremendous pressure to capture every dollar by demonstrating positive clinical outcomes and patient experiences.

To accomplish this, health systems need to build robust revenue cycle management (RCM) capabilities that go beyond billing and collection. It requires effective patient communication, capturing patient encounters, service codes, and charges from multiple systems (that likely do not talk to each other) at scheduling and admission, the bedside, discharge, and even patient engagement outside the walls of the hospital. These capabilities need to be excellent at:

• Accurate documentation and coding
• Effective patient engagement and education
• Delivering data and reporting requirements
• Integrating operational, clinical, and technical expertise

How RPA Fits In

The end-to-end RCM process is complex and consists of multiple activities that include patient pre-registration, insurance verification, billing, collections, denials resolution, claims status and accounting. Unfortunately, a vast majority of these activities remain time-consuming, resource-intensive, manual and error prone tasks. With RPA, health systems can:

• Automate the benefits retrieval process to generate cost estimates
• Aggregate data from disparate systems and enter it into a central patient accounting system
• Automate data entry and reduce errors that lead to claims denials
• Gather prior authorization data from insurance portals and integrate data into medical record systems
• Automate standard denial resolutions and focus staff on more complex denial management
• Improve the patient experience through chatbot response capabilities
• Establish an audit-enabled trail of activities for regulatory compliance and reporting

Take-Away Thoughts

As you look to RPA, and other technologies such as machine learning and artificial intelligence, to reach greater levels of revenue cycle performance, do not expect these technologies to be able to automate the entire process. In fact, do not start with the technology itself. Start by identifying the problem you want to solve and what gaps you need to fill to provide the most value. Then determine which technology can best fill those gaps. When automation is applied appropriately, health systems can realize fewer errors and reduced costs — both of which will lead to higher quality, more cost-effective care.

If you are building out and improving your revenue cycle performance capabilities, contact us at rpa@oneleapconsulting.com.