RPA for Revenue Cycle Management

Robotic Process Automation (RPA) is used to help employees streamline their workflows. There are a number of ways that this can be helpful to a healthcare organization.

RPA - The future of healthcare RCM

Robotics Process Automation (RPA) is a form of automation that uses bots, or robots, to complete tasks that would traditionally be handled manually. This type of technology has been evolving for a long time. It streamlines efficiency in manufacturing and other industries. For healthcare, RPA offers exceptional benefits, especially in terms of revenue cycle management (RCM).

RPA ensures that the billing and claims process is precise and there is no room for errors. Human error can cost an organization in wasted man-hours to fix the problem and may even lead to a lack of payment for services. Heightened efficiency is one of the reasons that RPA is an excellent fit for many areas of healthcare, from billing and coding to scheduling and charting.

                      Why Clinic Switch to Prognocis RCM?

Table of Contents

What Is Robotic Process Automation

RPA uses bots to do standard processes that a person would have to do manually. By definition, someone oversees these processes to a degree. The computer program doesn’t think for you or use a workflow to follow the process through various solutions. This is the difference between RPA and artificial intelligence (AI). AI does use machine learning which allows the program to learn from previous scenarios and continuously evolve. Occasionally people will use these two technologies interchangeably, but they are different types of solutions.

RPA is used to help employees streamline their workflows. There are a number of ways that this can be helpful to a healthcare organization. Using RPA to handle repetitive tasks frees employees to work at a higher level that benefits patients and the organization.

The Benefits of RPA for Revenue Cycle Management

RPA offers excellent benefits for RCM because there are so many intricate parts of the process and they all need to be handled precisely. With this in mind, human error can be exceptionally detrimental to your organization’s billing and claims cycle. RPA eliminates errors caused by miss-keyed data and simple human mistakes. RPA also allows these processes to move faster. Tasks that would take an employee several hours can be achieved through RPM within a matter of minutes.

Insurance VerificationHere are some of the RCM tasks that can be streamlined using RPA:

  • Preauthorization.
  • Insurance Verification.
  • Claims Submission.
  • Patient Billing.
  • Account Segmentation.

RPA allows you to automate tasks that are repetitive and pull information from multiple data sources. The program checks information and moves data from one source to another so that no manual input is required.

Why Clinics Are Moving to Make RPA an Integral Part of RCM

Clinics and healthcare organizations are moving to use RPA because it reduces errors and increasing profits. Those are some of the main reasons. Organizations using this technology see a decrease in errors, which also means a decrease in the number of hours that employees spend trying to remedy errors. They also benefit from better efficiency. Employees are freed from repetitive tasks so that other, higher priority responsibilities can be managed more effectively.

Another benefit of using RPA is in an increase in employee job satisfaction. Streamlining the workflow and removing mundane tasks means that employees are less burdened and more engaged in activities that allow them to contribute more fully to the organization. Well executed RPA solutions also allow organizations to handle these administrative tasks continuously, rather than only during office hours when staff is available.

What Is the Cost of Not Using RPA?

Medical Billing and RCMRPA is more accurate than other solutions. It uses robots that are programmed to complete set tasks in the same way that an employee would. For companies not using these solutions, the job of comparing data across different platforms, filing claims, and completing billing and administrative tasks will fall to employees to oversee. While some EHR programs do include various automation tools, there are still many tasks left to the employee to oversee and complete. This means that there is a higher probability of error and tasks will take more time to finalize.

How Is PrognoCIS Utilizing RPA Processes for its Current RCM Clients

At PrognoCIS, we have developed RPA technology to help our clients use their staff more efficiently and cut costs from their RCM. RPA automated repetitive, high-volume, rule-based processes. This allows your organization the ability to decrease your revenue cycle time, improve efficiency, reduce errors, streamline operations, lower overhead, and increase profits.

Billing-AnalyticsWe understand the importance of accurate reporting and analytics. This is the best way to effectively measure success. That’s why we offer the ability to use RPA to create custom dashboards that reflect your organization’s most important metrics – KPIs.

At PrognoCIS, we offer Claims Monitoring with Waystar. When your organization uses these tools, you can set a time frame for your claim submissions. For example, if you set the time frame at 15 days, the system will automatically ping the payer for status 15 days after the claim is submitted. The payer will then send the status back to PrognoCIS to let your office know where in the cycle this claim is – ie In Process, Pad, or Denied. With this technology, an employee does not need to be tasked with the follow up on claims. They occur automatically and can be easily checked and overseen by staff. The accounts receivable team can see the status of claims at a glance and determine when one needs their direct attention. This technology allows organizations that use PrognoCIS to file claims more efficiently and speed up the payment process.

PrognoCIS automates coding with the templates. The doctor picks the correct template for the procedure and the system automatically codes the claim. You can get specific with units, medication, and services or tests, as well. With the templating ability, the coding process is automated for the provider so that he or she can focus on patient care and documentation, rather than coding or billing.

PrognoCIS also offers batch insurance verification and pre-auth crawlers. With batch insurance verification, PrognoCIS can set the process to automatically check patient benefits at a set time. This might be the day before a procedure or the morning of a patient appointment. Batch insurance verification reduces your staff’s workload and allows them more time to prepare the office and handle other aspects of patient care. The task is simplified from a solely manual process to a simple matter of running the daily batch report and noting any incoming patient who may need to update their insurance information.

Pre-auth crawlers allow your organization to send out batch PAs to all payers at the same time. The process is automated so that your staff can easily see which patients need pre-authorization.

These are some of the ways that PrognoCIS has added robotics process automation technology to our software in order to help our clients improve efficiency in their revenue cycle management. Please feel free to contact us if you’d like more information about these features.

You will be pleasantly surprised at just how good PrognoCIS is. Connect with us via Calendly or the web form.

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