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Building Automation Bots? Let a Vendor Do It

Aruna Nadesan
November 29, 2023

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We’ve all taken on a project around the house instead of hiring a professional to do it for us. Doing it yourself can save some money and give you control over the process, ensuring that things are done the way you want. This might be a good idea when it comes to painting a room in your house or landscaping your backyard.

When it comes to technology, is doing it yourself better? That’s what many revenue cycle management (RCM) organizations are debating when it comes to the world of bots. Should you let your IT department build and manage these bots or should you choose a vendor?

In most cases, bringing in a vendor turns out to be the best choice.

Bring on the bots

RCM departments are adopting robotic process automation (RPA) to help with simple, mundane tasks. RPA uses bots to emulate and integrate the actions of a human interacting within digital systems to execute a business process. The healthcare industry saw a huge jump in the use of automation in revenue cycle operations, growing from 66% in 2020 to 78% in 2021. Another 2021 study revealed that 82% of RCM organizations were adopting automation.

Insurance providers are also employing more bots, especially to validate claims against policy terms and conditions. If the submitted claim doesn’t meet certain criteria, it is often automatically denied. Providers are also using bots for pre-authorization, medical necessity review, fraud detection, and more.

It’s becoming evident that automation and bots are becoming commonplace, and almost a necessity, in the world of healthcare RCM.

To DIY or not to DIY?

While not quite as elegant as Shakespeare’s famous phrase, this is the biggest question facing RCM organizations when it comes to bots. It’s tempting to manage this yourself with your current IT team and resources. However, just as with home DIY projects, it is often best to leave some things to a vendor with special expertise.

Building and managing bots in-house would place more burden on your current IT team. This indispensable group has already been tasked with launching and overseeing a host of new digital healthcare initiatives, including mobile health apps, patient access solutions, portals, patient engagement solutions, electronic health records (EHRs), and wearable devices, as well as telehealth and telemedicine services. The IT team is already stretched thin (just like every other group working in healthcare today). So, it is unlikely that they would have the time required to properly build and maintain these bots.

Even if they were able to find the time in their schedule to take on this task, it is highly unlikely that anyone on the IT team is an expert in bots. Of course, someone on the team can figure out how to build and maintain these bots. But is not their core expertise, and it would take additional time to get up to speed.

In addition, RCM organizations must evaluate their processes and operations to determine what bots they need to build when bringing in a vendor. Department leaders must take a closer look at how the organization operates to understand which processes are efficient and which ones are not. After all, simply automating a poorly executed process doesn’t improve the process. It only makes a bad process faster.

Need a specialist

On the clinical side, healthcare organizations have plenty of specialists. By bringing in a vendor to handle the bot, RCM departments will now have their own specialists because these bots are a bit different from the rest of your IT infrastructure.

Just like any other IT element, bots require maintenance. Some see this as a reason not to implement bots. However, as I mentioned earlier, automation is almost a necessity in the healthcare industry today, especially in the RCM realm. Therefore, not using RPA because it may require maintenance would be like not getting a car because you need to get a tune-up, change the oil, and fill the gas tank! Instead, RCM organizations must invest in a vendor that can build a robust and productive bot and quickly handle any necessary maintenance. Basically, that’s like buying a reliable car with a lifetime warranty.

In addition, some vendors can spread the cost and risk of maintenance across multiple clients. This actually reduces the overall maintenance cost for the healthcare industry to adopt bots. It also ensures high levels of up-time without worrying about when your IT team can fix a broken bot. This requires a carefully thought-out architecture to provide maintenance and operation at an industry scale.

Of course, in today’s digital world, security is a critical issue. This is another area where a vendor plays a critical role.

Often, these vendors have bots integrated into their solutions, providing a true all-in-one option for customers. This integration further reduces the burden on your IT team and increases the value for customers.

While some organizations might feel trepidation about the security around bots, they can actually help reduce your IT security risk. Vendors will fully encrypt all data managed by their bots – both at rest and in transit. Bots also reduce the risk of phishing attacks since bots never open suspicious emails or vulnerable hyperlinks. Bots can also have high-difficulty login credentials with passwords that can’t be guessed and are stored as secure credential tokens.  A do-it-yourself approach to bots, especially one that allows for “citizen developers,” is a significant security and HIPAA risk. You may already have staff using ChatGPT for processes that make their jobs easier, such as helping draft appeal letters or other content. However, that is not HIPAA compliant. A vendor can help ensure that only secure and compliant tools are used with your bots.

Leave it to the pros

RCM organizations in the healthcare industry are undergoing a transformation, adopting automation to help increase efficiencies, overcome workforce shortages, and improve the patient journey. Implementing bots is a critical element of RCM automation transformation.

But it’s a good guess that RCM organizations don’t have bot experts already on staff. And, IT teams are already inundated with other responsibilities. So it is incumbent on RCM leaders to bring in a trusted vendor to manage this process.

This will take some burden off your IT team. Bringing in a vendor to build and manage automation bots will also make your RCM operations more efficient in a shorter time than if you tried to do it yourself.

Maybe it is best to save the DIY enthusiasm for home projects.

Want to learn more? Download this white paper about automation in RCM organizations in the healthcare industry.


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