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The Role of Purposeful Automation in Healthcare

Aruna Nadesan
May 10, 2023
purposeful automation

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Revenue cycle management (RCM) leaders have been turning to automation to help overcome many of the troubles plaguing their organizations. With the plethora of innovative solutions available, this move to automation makes sense. However, executives must be wary of implementing automation for automation’s sake. Instead, they must engage in purposeful automation to achieve the desired outcomes. Let’s explore what purposeful automation is and how RCM leaders should implement it.

The automation bandwagon

RCM executives at hospitals and healthcare organizations are facing a host of difficulties — smaller budgets, workforce shortages, remote employees, and more. Many have looked to technology to solve these issues.

One report revealed that 45% of healthcare organizations increased their software investment during 2021. And workforce shortage was the impetus, cited by 80% of respondents.

That’s all well and good, but RCM leaders must beware. Automation isn’t a cure-all. Even if you automate a broken process, it’s still a broken process. For example, if you are not gaining prior approval for medical procedures before submitting an insurance claim, then no amount of automation is going to get that claim approved.

Thus, it’s imperative that RCM executives think strategically about what processes to automate.

Automating what?

It doesn’t make sense to automate the entire RCM process. Many steps in the process require a human touch that can help enhance the patient journey. But there are many time-consuming tasks that could benefit from automation, leaving your agents to focus on those human-centric tasks. These include repetitive tasks and simple data entry or data migration processes.

According to a recent survey of CFOs and RCM leaders, the top five most time-consuming tasks that are ideal for automation are:

  • Denials management (cited by 76% of respondents) ​
  • Prior authorization (60%) ​
  • Insurance follow-up (58.6%)​
  • Eligibility and medical necessity checks (26.6 %)​
  • Patient cost estimation and price transparency (26.4%).

By removing time-consuming tasks that can be accomplished via automation, organizations can uplift the value that their teams bring to the table while also improving the experience and results for patients and staff alike.

A closer look

Automation certainly isn’t a one-size-fits-all endeavor. Different automation processes are used for different tasks. Let’s look at a few and how they work in healthcare.

Robotic process automation (RPA)​

RPA is the technology that allows anyone today 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. ​

  • Patient scheduling: Allowing patients to schedule appointments without intervention from hospital employees frees up employees to focus on other tasks while improving the customer journey.
  • Claims management: The claims management process involves many manual and repetitive tasks, such as inputting, processing, and evaluating documents and data. Using RPA can automate many of these time-intensive tasks while also eliminating human errors during claims processing.
  • Regulatory compliance: RPA enables healthcare providers to track and document each process step in structured logs files so that the company can comply with external audits. It can also improve data confidentiality.
  • Data entry/migration/extraction: The mountain of patient information previously stored on paper is being digitized so it can be stored electronically and accessible online by other doctors, and even the patients themselves. RPA can automate the process of 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.

Strategic data exchange​

The current standard for strategic data exchange in the United States is known as X12 EDI. Formally known as Accredited Standards Committee X12, Electronic Data Interchange, this is the standard established to govern the electronic exchange of information between organizations. X12 EDI includes a set of standards and corresponding messages that define specific business documents widely used across industries today.

The X12 standard allows U.S. companies to communicate information and transfer documents from business to business without the hurdles of incompatible software or unsecured connections that leave proprietary data vulnerable to outsiders. X12 has been developed to provide a standardized data transfer system that creates efficiency in business communications.

In the healthcare world, X12 is used for transmitting data to maintain Health Insurance Portability and Accountability Act (HIPAA) compliance.

Workflow automation​

For RCM, workflow automation should support skills-based routing, allowing representatives to work at the top of their license and increase their contribution. It also promotes process adherence with up-to-date workflow protocols accessible within flexible workplace environments.

Automation should also prioritize accounts and activities configured to meet your unique financial procedures, while also ​reducing denials and write-offs by automating the optimized presentation of these accounts for follow-up.​ For example, like-account grouping presents similar accounts together, which can increase the number of accounts worked for every payer call.

Other features, such as workflow configurability, can give representatives a better understanding of payer behaviors to help optimize their time. For example, representatives can speed up connectivity to an insurance agent and improve the insurance follow-up experience by making calls outside of peak busy hours.

Now you know​

RCM in healthcare is a long, multistep process. Automation can be used to make the process more efficient, and RCM leaders can easily track metrics to ensure this. Workflows can be automated and made more efficient, while the transferring of data can be seamless. And by automating actions, RCM organizations can begin to predict and address payer behaviors.

In short, you can increase employee satisfaction and improve the overall patient journey through automation. Isn’t that something worth investing in?

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