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RPA and AI: Revolutionizing RCM Operations

Amanda Parada
October 4, 2023
RPA and AI

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“The two areas that are changing… are information technology and medical technology. Those are the things that the world will be very different 20 years from now than it is today.”

Bill Gates said this in 2019. And was he ever correct!

Hospitals and healthcare organizations have been adopting technology to improve diagnoses and treatment for years. Now these organizations are incorporating innovative technologies in their back-office operations.

When it comes to revenue cycle management (RCM) departments, technological advances can help overcome workforce shortages and overburdened staff. And the technologies best suited for the job are robotic process automation (RPA) and artificial intelligence (AI).

Let’s look at how these technologies are changing RCM organizations.

RPA today

Hospitals and healthcare systems continue to face staffing issues, including in their RCM organizations. Shortages of these critical staff members can lead to delayed insurance follow-up efforts, increased patient responsibilities, and dissatisfaction. This might influence patient loyalty and their willingness to return for future services.

As a result, RCM organizations are looking to innovative solutions, such as RPA. This technology can perform many simple tasks, automating specific activities that would normally be handled by what’s left of your overworked staff.

RPA has been used to configure computer software, or a “robot,” to emulate and integrate the actions of a human interacting within digital systems to execute a business process. RCM organizations have quickly embraced the value of RPA and have begun configuring it to handle more than just simple, humanized tasks.

RPA has become a valuable tool for RCM organizations to perform numerous activities, including:

  • Enabling patients to schedule appointments without intervention from hospital employees, freeing employees to focus on other assignments while improving the patient journey.
  • Automating time-intensive processes associated with manual and repetitive inputting, processing, and evaluating documents and data associated with claims management. Using RPA can automate many of these activities while also eliminating human errors during claims processing.
  • Tracking and documenting each process step in structured logs files so that the company can maintain regulatory compliance, comply with external audits, and improve data confidentiality.
  • Extracting data from legacy systems and entering it into digital systems. When there is a need for the migration of data for a different purpose, such as medical research, another RPA bot can handle this migration process.

RPA and denial management

With the growing number of denied claims, intelligent RPA solutions can be configured to handle some of the complex tasks associated with denial management. Since a claim can be denied for several reasons, automating the process of gathering the necessary information to analyze why the claim was denied would be a critical time-saver. Intelligent RPA can be configured to:

  • Scour various systems to find incorrect and missing demographic, insurance, or other data points, and automatically update the account.
  • Conduct automated eligibility checks through various systems to search for coverage options. If any additional coverage options are found, the bot automatically updates the account.
  • Gather all necessary material as directed by the insurance company, such as medical records, pre-authorization details, clinical notes, and more, then create a PDF of required documentation and submit it to the insurer.
  • Remove the manual efforts associated with adjustment posting by logging into the system of record, then creating an adjustment transaction. Once the balance is updated, the platform is automatically updated.

Implementing RPA in RCM can lead to increased efficiency, reduced operational costs, improved accuracy, and better utilization of human resources for tasks that require critical thinking and decision-making.

Welcome AI

Since AI is essentially a brain and RPA is, in essence, the hands, what if the “brain” and the “hands” were put together and used in RCM processes? AI could do the necessary “thinking” and then direct RPA to execute the task. In short, the artificial brain (AI) makes the decisions that activate the hands (RPA).

Some of the areas where the combination of AI and RPA can be effective include:

  • Patient registration and eligibility verification
  • Appointment scheduling
  • Claims processing
  • Coding and documentation assistance
  • Payment posting and reconciliation
  • Patient billing and invoicing
  • Pre-authorization and pre-certification
  • Follow-up and collections
  • Data analytics and reporting
  • Contract management
  • Compliance monitoring
  • Refund processing

Transforming RCM

Charles Darwin said: “It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.”

While change might be scary for some, it is, quite often, necessary for survival. This has never been more true than in the world of healthcare, especially in the back office. And RCM organizations are adopting RPA and AI as part of their transformation to becoming efficient parts of the healthcare system.

The use of AI in RCM is in its infancy. But as this technology continues to develop, the potential for how it can be used in RCM is nearly unlimited. Ultimately, the more tasks that can be automated, the better it is for RCM organizations, their employees, and patients. Employees can be freed from mundane tasks to focus on those requiring a human touch, specifically when connecting and reaching out to patients.

That sounds like a successful collaboration to me.

Want to learn more? Check out this white paper on automation in the healthcare industry.

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