Top 5 Mistakes in Claims Management – And How to Avoid Them
Claims management accuracy and efficiency are crucial for hospital billing, accounting and finance professionals. However, common missteps can cause...
In May 2022, more than 400 healthcare finance leaders reported revenue cycle workforce shortages, with almost 20% seeing 30 or more vacancies.
With no end to staffing shortages in sight, it’s important to consider time and cost-savings technology options. For instance, robotic process automation (RPA) can easily adapt to fluctuating volumes and offload repetitive tasks traditionally handled by staff, ultimately increasing staff productivity.
What is RPA in healthcare?
First, it is important to clarify what RPA is not. Different from other “software” that requires a human to log in with a password, RPA software robots or “bots” are given a password, enabling them to log into systems to perform work humans normally would do. In this way, RPA automates business processes by replicating the actions of a human worker.
Beyond simple screen scraping and keystroke emulation, RPA is also evolving to more sophisticated solutions that interact directly with objects in the user interface of systems, leveraging artificial intelligence to enable more robust automation.
RPA has caught the attention of healthcare organizations in particular. More than three-quarters of respondents (82%) to a 2021 HFMA survey revealed they are on their automation journey. In addition, Gartner anticipates that half of all provider organizations will invest in RPA technology over the next few years, mainly driven by payment reduction and the need to bolster the patient experience.
To improve payment reduction, we need to take a close look at how RPA handles medical claims and denials. Automation simplifies the claims process, helping revenue cycle teams work more efficiently and effectively to process high-priority claims.
Bots ease the claims process
If you were to watch an ICN/DCN bot in action, you would see it create and pull a worklist from a medical claims system to search for matches. When a match is found, the bot pulls in specific data elements, detailing these on a daily productivity report. It also updates ICN/DCN claims, clears the edits and gets claims out the door. This continues daily, with users getting a completely new list of claims out the door every day.
Learn more: How RPA Improves Your Revenue Cycle
Unique FinThrive RPA architecture
The FinThrive RPA architecture utilizes “micro bots,” which are standardized components that work together to deploy a process. This allows reuse and enables FinThrive to maintain components across multiple processes to reduce downtime.
FinThrive also leverages artificial intelligence to create even more sophisticated processes for users, enabling bots to recognize information on insurance cards, for instance.
Get started using RPA in your health system
A clear, guided path is recommended before you deploy RPA, including working with a vendor that has technical expertise and healthcare revenue cycle knowledge. Approximately 70% of the work is in identifying processes that will deliver the most value, optimizing and mapping these processes in advance of an RPA implementation.
Quantifying the labor savings
For hospitals and healthcare organizations that embark on an RPA implementation, the average labor savings can be dramatic. For example, one large, 50+ hospital that deployed bots for adjustment claims (XX7 type bill), eligibility denials and root cause (XX7 claims), eliminated two to four FTEs per application, resulting in ROIs up to 583%. Smaller facilities can also greatly benefit, often eliminating two or more FTEs.
To learn how RPA solutions can help your hospital or healthcare organization and lead to increased revenue cycle success, visit our RPA solution page or contact FinThrive.
