Robotic Process Automation’s Role in Revenue Cycle Management: A Guide

When one healthcare organization reached its limit with the errors occurring during medical records processing, it decided to see if robotic processing automation (RPA) could be more accurate than staff. They had been accepting some staff errors given that their medical records often reached 100 pages full of complicated diagnostic and treatment information. Their rising workflow costs stemming from these errors, however, drove them to find a way to improve accuracy. 

In just months of implementing a robotic process automation solution, the organization reduced errors and sped their processing, improving workflow costs by 68 percent and medical record inquiry turnaround time by 72 percent. 

Another healthcare system knew they needed to cut costs and improve patient volume to succeed in the post-pandemic era. With an RPA solution, they automated pharmacy prescription lists, visit and diagnostic testing scheduling, data uploads to cancer registries, and backlogged case prioritization. 

Quickly, they increased their outpatient clinical fill level and new patient bookings to over 90%. With tedious tasks carried out by RPA, employee retention improved dramatically. They cut costs significantly as well. 

Every year, healthcare organizations are finding new points in the revenue cycle where robotic process automation can step in. Here, you’ll discover how you can either implement or expand your use of RPA in RCM to improve patient satisfaction, staff morale, workflow processes, and net revenue.  

Robotic process automation usage in the revenue cycle today

The above are just two of many examples of how robotic process automation enhances the finances and systems of all kinds of healthcare organizations. 

As one of the most heavily regulated and scrutinized industries, healthcare has lagged in the adoption of technology. With promising results like these, however, adoption of robotic process automation is speeding up. 

Increasing complexity means healthcare systems will need more resources rather than less to provide care. Healthcare data is exploding as is the back-and-forth of documents and invoices between specialists and primary care doctors, payers, laboratories, and other entities. As medicine advances, these interactions will only become more complex. Robotic process automation can shoulder much of this complexity at a fraction of the cost of human labor. 

More revenue cycle leaders are using RPA to reduce costs while also adding flexibility and resiliency to their operations. In one 2020 survey, 66 percent of the responding 587 health system chief financial officers and revenue cycle leaders reported their organizations were using automation in their revenue cycle. By 2021, that same survey revealed 78 percent were. 

How much can robotic process automation cut costs?

Consulting firm McKinsey & Co. asserts that US healthcare overall could cut $200 to $360 billion in (mostly) administrative costs, by using technologies such as automation and analytics. Echoing these findings, an Institute for Robotic Process Information and Artificial Intelligence study, quoted in a KPMG analysis estimates that RPA can create 25–50 percent savings in healthcare costs. These savings come via reduced errors which lead to lower denial rates as well as lower labor costs. 

While direct cost savings are the revenue cycle manager’s prime directive, RPA impacts revenue indirectly as well. 

For instance, a recent SalesForce survey of 773 automation users shares that 79% find automation tools help them be more productive. Eighty-nine percent are more satisfied with their jobs after automation implementation and 84 percent are more satisfied with their company in general. Higher productivity, reduction in staff turnover, and improvement in company morale are just a few of the proven indirect benefits automation can achieve. Simple to implement and able to deliver quick returns, RPA solutions complement your organization’s workforce, freeing employees for more interesting, patient-centered tasks. 

What is robotic process automation?

Called “the unseen cousin of Chat tools” by one healthcare leader, robotic process automation uses software "robots" or "bots" to automate repetitive, rules-based business processes. These virtual bots can interact with different systems and applications in the same way a human user would, facilitating the automation of tasks such as data entry, processing transactions, and responding to simple customer service inquiries. Typically, the RPA solution provider works with your team to understand your workflows and exactly what you need automated. 

In the healthcare setting, RPA integrates with various existing systems, including practice management (PM) and electronic health record (EHR) software. The integration with these systems is usually straightforward and often achieved via application programming interfaces (APIs). 

While RPA can automate many routine tasks, it doesn't replace the need for human oversight or the expertise of healthcare revenue cycle professionals. It frees up staff to oversee the RPA solution and focus on more patient-centric tasks.

Where robotic process automation optimizes the revenue cycle

Today healthcare organizations, physician groups, and management services organizations are using RPA for: 

1. Patient Scheduling: RPA can automate the patient scheduling process, making it more efficient and timely. This intervention reduces the manual effort required and minimizes scheduling errors, resulting in cost savings.  

First, RPA automates the data collection and processing involved with bringing on a new patient. With the data ingested, bots optimally schedule patient appointments according to doctor availability, diagnosis, location, and other criteria. It can scan patient data to create a report to send to a referral management representative to complete the appointment. By tracking a doctor’s schedule, RPA can also notify patients when doctors are unexpectedly delayed or unavailable. 

2. Prior Authorization: Manual pre-authorization processes are labor-intensive and prone to errors. Automating these processes can speed up procedures, reduce mistakes, and save valuable staff time.

Instead of relying on manual reviews and cumbersome paperwork, automation analyzes patients' medical records in real-time and makes precise clinical determinations. It then submits prior authorization requests electronically. As a result, prior authorizations can be completed faster, eliminating unnecessary delays which in turn improves patient care outcomes. Getting patients in faster always makes them happier. 

3. Patient Eligibility Verification: RPA validates patient coverage automatically by extracting data from payer portals and your EHR. This step minimizes denied claims due to eligibility issues, reducing the likelihood of delayed or missed revenues. 

By integrating directly with payer systems, this process ensures that the most accurate and up-to-date information is obtained for each patient. This approach can uncover coverage options that were previously unknown or overlooked.

4. Charge Capture: Traditionally, charge capture has been a manual and time-consuming process. With RPA, healthcare providers can automate the charge capture process, reducing the risk of missed or incorrect charges, and ensuring complete and accurate billing.

RPA bots can be trained to extract relevant information from various sources such as electronic health records (EHRs), physician notes, and clinical documentation. These bots process vast amounts of data quickly and accurately, reducing the chances of mis-keying and incorrect charge entries.

RPA also enables continuous monitoring and auditing of charge capture processes. Bots compare the charges captured against predefined rules and guidelines, ensuring compliance with coding and billing regulations. Any discrepancies or anomalies can be promptly identified, flagged, and rectified, preventing revenue leakage and potential compliance issues.

Another area where RPA excels in charge capture is ensuring completeness. With its ability to integrate with various systems and applications, RPA can capture charges across multiple departments and specialties. This ensures that no services provided by healthcare professionals go unnoticed or unbilled, ultimately maximizing revenue for the healthcare organization.

5. Claims Management: By checking for errors in claims submissions, RPA reduces administrative burden, as well as administrative errors and costs. 

One 33-hospital system based in Sioux Falls, South Dakota had staff spending too much time calling and checking on paid or pending accounts. The cost-savings involved in a technological solution versus another staff member prompted the vice president of central business office operations to sign with a software solution. The 2022 CAQH Index reveals that the medical community saved 13 billion that year by doing away with manual claims status processes.  

6. Account Settlement: RPA can automate the account settlement process, identifying overdue invoices and automatically following up, resulting in a more efficient collections process. It sends payment reminders and can administer payment plans. It flags outstanding balances for staff attention and follows up until these are addressed and resolved.

7. Payment Posting: Automating payment posting transacts the timely and accurate recording of all payments, cutting down the time and effort required to resolve errors and discrepancies. In addition to alleviating the burden on staff, automated payment posting mitigates the errors inevitable with human data entry. Automated solutions can automatically match payments to outstanding claims, flagging any discrepancies for review.

Because automated payment posting speeds the time it takes to process reimbursements from insurance companies and patients, it improves cash flow and helps create a more streamlined revenue cycle. This increased speed in payment posting also enhances patient satisfaction, as providers can promptly update account balances and thereby offer accurate financial information to patients.

When linked with claim management systems, automated posting solutions can also easily flag denials, enabling immediate follow-up and corrective actions.

8. Denial Management: RPA can help sort and prioritize denials by cause, urgency, or value, making denial management more efficient and improving the success rate of appeals.

The Change Healthcare Denials Index shows that year after year denials are triggered due to errors of lack of completeness during registration and eligibility. Missing or invalid claim data is the second most common. Because automation can cross-verify data from multiple sources, it reduces the risk of incorrect information and increases the likelihood of claims being processed correctly the first time. 

Timeliness is another critical aspect of claims management in healthcare. RPA can significantly speed up the claims processing timeline by automating time-consuming tasks, such as gathering patient information and verifying insurance coverage. With RPA, previously manual tasks that were susceptible to delays and human errors can be conducted efficiently round-the-clock, reducing processing times substantially.

9. Reporting and Analytics: RPA can automate the generation of revenue cycle reports, providing timely and accurate insights to drive financial and operational decision-making. These reports include: 

• Claims status 
• Denial management 
• Payment reconciliation
• Accounts receivable 
• Revenue cycle performance 
• Compliance 
• Coding accuracy 
• Patient financial
• Workload distribution 
• Process improvement 

10. Contract Management: By automating contract performance analysis, providers can ensure that they are being paid accurately and fairly, as per their contracts with payers, using software such as MD Clarity's RevFind.  

Using robotic process automation, a robust contract management solution regularly scans, extracts, and analyzes critical data from contracts. It goes on to validate this data against predetermined rules. By doing so, RPA eliminates the need for manual review, reducing errors and ensuring compliance.

The contract management solution central repository where all contracts are stored, eliminating the hassle of sifting through heaps of paperwork or multiple locations to find specific documents.  RPA categorizes and tags these contracts based on predefined criteria, making them easy to retrieve and reference. 

With contract details tagged, RPA identifies upcoming contract expirations, deadlines, and renewal opportunities. A robust contract management solution sends automated notifications to the relevant stakeholders, ensuring prompt follow-ups and avoiding missed deadlines. Additionally, RPA can streamline the process of contract amendments by automatically capturing changes made during negotiations and updating the contract records accordingly.

Finally, when RPA extracts and consolidates data from contract management systems, it can render comprehensive analytics and reporting. Customized reports reveal valuable performance insights. These reports help physician groups make informed decisions, identify trends, and optimize revenue and cost management.

How Robotic Process Automation Works

In the simplest terms, Robotic Process Automation (RPA) uses software "robots" or "bots" to automate repetitive, rules-based business processes. These virtual bots can interact with different systems and applications in the same way a human user would, facilitating the automation of tasks such as data entry, processing transactions, and responding to simple customer service inquiries.

One of the greatest advantages of RPA is that it doesn't require any coding abilities. Instead, the bots use a graphical user interface to perform tasks based on instructions provided by a user.

The software bots need access to relevant data for the tasks they're automating. This access could be facilitated through a data upload process, or the bots could potentially access the data directly where it's stored.

RPA v. AI

Today, AI is all the rage. Until we create nannies with emotional capacity, however, AI will remain in the realm of science fiction. 

What we do have is machine learning, a subset of AI. Machine learning examines historical data and uses carefully crafted algorithms to make predictions and suggestions based on this data. When its suggestions are successful, it “learns” and uses the same processes to make more predictions and suggestions, conceivably getting more and more accurate as it racks up more successful and even unsuccessful experiences. It does this without being precisely programmed by a human. 

RPA and machine learning serve different purposes. While RPA is generally programmed to follow set rules and perform high-volume, repeatable tasks, machine learning uses algorithms to produce new insights. RPA operates in the realm of structured data, handling tasks that follow predictable, rule-based workflows. On the other hand, machine learning technology excels at handling unstructured data and complex tasks, evolving over time.

From budget estimations to resource allocation, machine learning’s predictive analytics helps in forecasting revenue cycles based on historical financial data. Healthcare leaders use it to make strategic choices that consistently enhance the financial health of healthcare providers.

Both AI and RPA offer unique benefits, and when combined, they can provide a comprehensive solution for intensifying automation and intelligence in healthcare revenue cycle management. 

Precautions when evaluating and implementing RPA

While RPA can offer significant benefits in terms of efficiency and cost savings, it's also critical to consider the potential impact on patient safety and data security. Implementing robust controls and ongoing monitoring is crucial to ensuring the success of RPA initiatives in the healthcare setting. Make sure your legal team is involved to evaluate potential regulatory roadblocks.

Working with your solution providers, you may want to start with a pilot process to understand any areas of friction and the opportunities the tool provides.

Your RPA solutions must demonstrate how it encrypts, anonymizes, and securely stores data. Access must be restricted to authorized users only. RPA must also demonstrate accountability and transparency by complying with audit trails and reporting requirements.

Before implementation, revenue cycle managers need to establish clear roles and responsibilities for who on their team will manage which aspects of the RPA solution. They need to define ownership of maintenance, updates, performance evaluation, and risk mitigation.

A simple path to net-revenue-reinforcing automation

Healthcare organizations face significant challenges (staffing shortage and turnover, increasingly unfavorable legislation and reimbursement limitations) in an environment where they’re also pressured to reduce costs. RPA improves efficiency by limiting human labor needed for repetitive business processes, improving accuracy and staff productivity, and reducing costs. 

With MD Clarity’s ClarityFlow, you can automate critical aspects of patient eligibility, payment estimations, and upfront collections. Enable patients to make up-front deposits directly from an online estimate that reaches them automatically after scheduling. 

MD Clarity’s back-end product RevFind automatically scrutinizes every payment against contract terms, flagging discrepancies and potential underpayments.

Get a demo to see how these products help limit your labor costs, reduce denial-triggering errors, and improve net revenue.