RPA in Healthcare: Use Cases that Improve Revenue and Operations

January 21, 2022

RPA in Healthcare: Use Cases that Improve Revenue and Operations

A global pandemic is putting hospitals and health systems under cost and cash pressures never seen in our lifetimes. Persistent staffing shortages and skill deficits are creating consistent workflow bottlenecks and project backlogs. In addition, IT infrastructures often have essential revenue cycle management (RCM) data stored and managed in disparate systems across the enterprise.

These are just a few of the major challenges hospital revenue leaders face as the year 2022 gets underway. They are also problems that can be relieved to some degree with a tried-and-true technology solution that is easy to adopt, fast to implement and just as fast to deliver results — robotic process automation (RPA). From initial appointment scheduling to final payment and far and wide in between, RPA can turn mountains of administrative work into proverbial molehills of staff time and effort.

What is robotic process automation (RPA)?

Robotic process automation is software technology that replicates many actions of a human computer user to complete routine administrative and clerical tasks without user intervention. Programmed software robots (bots) run continuously in the background, ensuring predictable, repetitive tasks get performed without the need for human intervention. Because revenue cycle workflows cross over many different clinical and administrative systems and data stores, they tend to require a lot of manual workflows to move and manage data. Robotic process automation can perform those manual tasks to drive new efficiencies for the revenue team.

While many hospitals and health systems are investing in some type of process automation — about 70% according to a recent HFMA study — only about 26% have specifically invested in RPA. Yet Gartner predicts that by next year, about half of all US hospitals will be using RPA. Some characteristics of RPA driving this rapid adoption include versatility, flexibility and efficiency. The more user tasks that RPA bots can manage, the more efficient processes become and the more time RCM staff have for value-added, more strategic activities. Once built and deployed, a software robot is the model of efficiency, working tirelessly in the background 24 hours a day, 7 days a week.

Where does RPA fit into healthcare workflows?

There are two factors that position healthcare as a prime industry that can benefit from robotic process automation. First, RPA is incredibly versatile; it can be used to automate a wide variety of work processes currently done by humans. Second, healthcare is an industry absolutely awash in administrative tasks and manual workflows. Add the pressures of staff shortages and a disrupted, remote workforce due to COVID-19 and you begin to understand why visionary revenue cycle leaders are looking to improve efficiency and effectiveness through automation.

Appointment scheduling

One of the more common hospital administrative tasks, appointment scheduling can quickly become a mission-critical process when a pandemic like COVID-19 overwhelms staffs and systems with demand for treatment and vaccines and information. Indeed, R1 clients are already using our automation suite to streamline appointment scheduling, eliminate registration redundancies and improve the intake experience for patients and staff despite the pandemic.

Downstream scheduling changes are a good example of appointment process improvement using RPA. Appointment scheduling is typically the domain of the electronic health record (EHR) system, but appointment reminders usually come from separate systems with limited integration to the EHR. When an appointment is canceled within the reminder system, it creates the need for manual steps in the EHR to ensure other appointments and related orders are adjusted accordingly. RPA can automate that process to keep the EHR and the reminder system in sync without manual intervention or an application programming interface.

Regulatory compliance

Revenue optimization and regulatory compliance both come with a common requirement for success — accurate data. Because healthcare is among the most heavily regulated of industries, providers spend an outsized share of time and resources on documentation and compliance processes. These processes are generally manual, time-consuming and costly, but the cost of non-compliance can be much, much higher. Any time human staff manually moves data from one system to another, there’s potential for errors. The more data people move around, the greater the risk becomes. Automating tasks required by government regulation not only saves hospitals time and money — it also reduces considerable compliance risk.

Order and referral management

Among the various use cases for RPA in healthcare, order and referral management is ripe with opportunity for automation to streamline processes, eliminate redundancy and improve the patient experience. An initial patient encounter typically sets in motion a cascade of doctor’s orders and referrals for subsequent encounters with the laboratory, radiology/imaging, pharmacy and specialists. Making sure all of those downstream encounters are communicated, scheduled and confirmed across the various departments, providers and IT systems involved can become quite a juggling act. Applying RPA at process bottlenecks to speed throughput can help improve service quality, scheduling efficiency and patient access turnaround and deliver a better patient experience.

Prior authorization status

While most RCM processes have the potential to impact the bottom line, prior authorization can also impact the quality of patient care if treatment is delayed because of bureaucratic red tape. Insurers by and large have not standardized the information or process required to secure prior authorization for procedures, tests and admissions. For providers, this creates a tremendous burden to determine when authorizations are required and how to submit them. Enabling RPA to perform the function of obtaining authorization status frees up the staff to focus on submitting authorization requests as soon as services are ordered, reducing manual staff effort, improving slot utilization and enabling more timely services.

Charge and coding reconciliation

Complex systems like medical coding and billing with tens of thousands of diagnostic and procedure codes will always have their fair share of errors and disputes between provider and payer. Inaccurate or incorrectly coded claims lead to denials that have to be reviewed, recoded and refiled, slowing revenue collection and wasting precious staff time. Automating reviews of codes and charges across disparate healthcare IT systems can ensure that supporting information required by the payer is captured and posted to the claim to reduce denied claims and improve cash flow.

Benefits of RPA

While it’s clear that RPA is versatile and delivers considerable short-term value, hospitals are only scratching the surface of potential process improvement benefits. Here’s a summary of some of the most important benefits robotic process automation delivers.

    • Major cost savings: One recent study says US hospitals could save more than $13 billion annually by automating the administrative tasks in just the revenue cycle alone.

    • Better patient access: Improvements in scheduling efficiency and communication allow care providers to treat more patients and better utilize health system assets.

    • Improved accuracy: Automation eliminates human involvement in many information-processing workflows, reducing the risk of errors and improving data integrity.

    • Enhanced patient experience: Streamlined appointment scheduling, registration and check-in, along with better RPA-driven care coordination, make for a better patient experience.

    • Increased employee satisfaction: Revenue cycle teams are made of educated people who prefer doing strategic work with high value for the hospital over routine tasks and manual processes. Intelligent automation frees them to do so.

Justifying the cost of RPA implementation

While the cost of robotic process automation may be a concern for healthcare providers who have yet to adopt the technology, the benefits can so clearly outweigh the costs that most industry analysts predict a boom in RPA adoption over the next few years. Cost pressures exacerbated by the COVID pandemic, ongoing staffing issues and the demands of quality-based care are not going away. RCM team workloads are not getting smaller or easier and will continue to drive adoption. The only question is, will your hospital benefit from RPA, or sit on the sidelines?

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