Even with the best platforms and solutions, healthcare revenue cycle management (RCM) still requires some manual effort. However, many of those manual tasks can be completed with robotic process automation (RPA). RPA works with a host of systems, including electronic health record (EHR), to complete tasks quickly and more consistently with less expense than human staff. Organizations that rely on EHR systems for RCM can optimize their resources while enhancing their EHR investment by adding RPA.

Do it yourself?

So, you want to enhance your EHR with RPA. Many companies are tempted to build their RPA in house. As building technology solutions is not one of the core competencies of a healthcare RCM organization, this task would be overwhelming. After all, your staff likely doesn’t consist of experts in RPA scripting languages, bot development and testing, bot security, and more. And you likely don’t have the manhours to spend months learning these skills, then hoping everything goes smoothly.

Do you have the time and expertise to maintain these bots? Can your staff ensuring they are working properly or have the ability to repair them if issues arise? And can you continue to build new bots to take advantage of new opportunities or deploy new projects?

Plus, many organizations fall into the trap of turning to automation to solve problems that can’t be solved with automation. After all, automating a bad process just makes a bad process faster!

As with other tools, it is best to partner with a trusted vendor with RPA experience. These experts can guide you as to the best fit for RPA within your EHR. They can even advise what the steps to automate should be when the vendor also has expertise in healthcare RCM.

But exactly where can RPA help? Here are some of the key areas where RPA can boost the performance of your EHR.

Denial management (Medical record requests)

RPA provides greater security over what information is shared with payers when they deny your claims and request records. This way, payers can’t search for additional reasons to not pay or to deny a claim. RPA can also help you control the timing of the denial process. For example, it can monitor the claim to determine if a payer moves your claim from received status to a pending status. And, instead of waiting for a denial, RPA can monitor and work that claim immediately, getting the records and necessary information to the payer so that your adjudication timeframe is as short as possible.

Lockbox correspondence

Healthcare RCM organizations often face difficulties when they receive paper correspondence in the mail. These documents usually end up in the mailroom, where they get scanned into a database so someone can attempt to link it to a patient’s medical records. And there they sit, until a claim is denied. Instead of waiting for that denial, RPA can manage your lockbox correspondence and even download these digital correspondences. Organizations can better manage them, using AI to read, index, and route them accordingly. And, in some cases, these correspondences can automatically trigger the appropriate work that needs to be done on the claim, leading to an overall reduction in AR days.

Eligibility research

Determining insurance eligibility can be complicated. For example, a provider checks to see if a patient has Medicare for coverage. The result may show that the patient is covered by Medicare, leading the provider to process the claim. But, if the patient has a Medicare replacement plan, also known as Medicare Advantage plans, the claim will be rejected as it should be sent to the owner of the replacement plan, such as Humana. Now you must update the coverages in your system and re-bill the claim to the right payer. Yet, if the managed care plan requires a prior authorization that Medicare didn’t (and you don’t have it), this leads to even more work. RPA can be programmed to scour your data to discover and fix these types of issues.

Some EHR systems have a feature known as Query Chaining, which can automatically catch these types of errors. However, this feature is quite often underutilized by clients. A trusted provider with an expertise in RPA can teach EHR users how to correctly set up query chaining.

Billing edits

With many current systems, organizations generate the claim which then flows into a claim scrubber, which is tied to your clearing house. The claim scrubber is where your billers can see what edits are needed to get through the scrubber. While this can take place from your EHR, humans are still needed to clear those edits, including LCDs, NCDs, and more. This usually requires a person to look in various places for certain data elements to either validate them or put them back on the claim. This person must also look for data that would indicate what condition codes, value codes, and more, must be put on the claim to pass the billing edits. This manual work can be handled with automation.

Submission and tracking

After you’ve taken care of any eligibility issues, it’s time to submit the claim and track its progress. The best way is with an electronic data interchange (EDI), which can be built into many EHR systems. However, this can take quite a bit of time and effort. If your EHR can’t handle an EDI or if you are slowly working toward building one, RPA can serve as a great solution.

A beneficial partnership

RPA is a valuable tool for automating repetitive and manual tasks, offering healthcare RCM organizations increased efficiency and cost savings. And an experienced vendor with a background in RPA and healthcare RCM can analyze your tasks, identify any potential challenges or complexities, and implement automation quickly.

You’ve already made a considerable investment in your EHR. Don’t you want it to work at its peak to get the most out of your investment? Then it makes sense to partner with a trusted vendor who can help enhance your systems with RPA.