Revolutionizing Claims Management Through Robotic Process Automation

For modern healthcare to realize its true potential, revenue cycle management needs a new vision. The future requires a connected and holistic approach that empowers the providers, payers and patients who make the healthcare economy. Current processes are simply too manual and too inefficient. Learn how Robotic Process Automation (RPA) can help you ease workforce shortages.

Claims management is one area within the revenue cycle where these issues are as clear as can be. One in seven claims is denied, and of those, 65% are never resubmitted. The administrative costs associated with claims appeals have reached a staggering $8.6 billion, and that number will only continue to rise. Millions of dollars in claims are written off by hospitals and health systems annually.

While having a claims management solution in place is a great start, using RPA to complement your claims management solution can optimize your claims reimbursement process to make it as seamless and efficient as possible. RPA can handle tasks ranging from those that are simple, yet inefficient and time consuming, all the way to complex tasks that require you to account for multiple business and logic scenarios.

Claims management is only getting more complex 

Each year, changes in rules, regulations and payer codes multiply the complexity of claims management, resulting in a high volume of denied claims. These changes can easily result in claims being denied. Once claims get denied, they tend to fall into a backlog where it’s possible they may never get resubmitted. If you are short staffed, RPA can help you overcome these challenges by allowing your staff to focus on more complex or mission critical situations. You can also use automation to streamline process that might not have been optimized before.

How RPA can help

RPA can be used in a number of ways. RPA identifies claims with missing ICN numbers, performs daily searches for the EOB on the original claim and then populates the ICN on the rebilled claim. For a human, this process can be very time-consuming, requiring multiple attempts across many days to find the original claim EOB to resolve the edit. Additional Claims Manager automation examples include but are not limited to:

• Resolving invalid statement and service dates
• Automating account follow-up on unpaid claims
• Determining medically unlikely edits
• Conflicting claims as a result of another claim or duplicate claim

This list is by no means exhaustive but does highlight areas where RPA could be deployed.  FinThrive Claims Manager Automate provides your health system with RPA solutions to address these challenges. By integrating FinThrive Automate with your Claims Manager solution, providers like you can experience a holistic digital transformation experience with automated tasks and streamlined overall business process implementations.

The many benefits of RPA

The benefits of RPA are vast and well worth the investment. It’s no secret that humans make mistakes. Out of every 100 steps, a human is likely to make 10 errors, even when carrying out routine work. Satisfaction and morale will likely increase as your staff is no longer stuck doing mundane tasks. Instead, they can focus on more critical thinking tasks that need more human touch. You will also see labor savings in the form of employee hours saved since RPA gives you the outcomes of another employee at a fraction of the cost.

From a financial perspective, RPA can help you reduce cost to collect, A/R days and billing days, just to name a few. Experience quicker payment and avoid missing out on revenue from denied claims. In today’s world, every dollar that you are able to recover for your health system matters.

Ready to learn how FinThrive Claims Manager Automate can help your organization bridge the staffing shortage gap and do more with less? Let’s talk!