High operational expenses, cumbersome processes, stringent compliance requirements, and large patient volumes burden the modern healthcare space.
These difficulties negatively impact the efficiency and effectiveness of patient treatment, process management, and general operations.
Therefore, automation is essential to driving the digital transformation of healthcare, just like it is in other sectors like financial services, manufacturing, and retail.
The healthcare industry is no different; implementing digital capabilities like robotic process automation (RPA) in healthcare can increase efficiency and enhance the patient experience.
Thus, in this guide, we will discuss what robotic process automation is, its healthcare use cases, the robotic process automation lifecycle, and which processes would benefit the most from it.
So, without further ado, let’s get started!
What is Robotic Process Automation (RPA)?
Robotic process automation (RPA) employs automation, robots, or “software bots” to carry out repetitive, high-volume activities that follow the rules.
RPA solutions automate processes by imitating human activities to lighten workloads, increase productivity, and more. It can be included in your healthcare tech stack to give long-term support that affects costs, business continuity, and productivity, while it can be a temporary fix for some firms.
THREE TYPES OF RPA
Attended Automation
- Bots that require human intervention for automation process.
- It reduces the processing time. E.g., a process that would have taken ten screens can now be completed with a single click.
Unattended Automation
- Bots with AI helping in decision-making.
- It is best for businesses that require speedy processing.
Hybrid Automation
- Bots having both qualities of attended and unattended automation.
- Businesses utilize this automation for structured processes and include human intervention for decision-making.
RPA Lifecycle
Robotic process automation’s life cycle doesn’t have a set structure, although there are generally four stages. These stages are as follows:
- Stage 1: Analysis: Identification of the business process for RPA development through analysis
- Stage 2: Development: Compliance with regulations
- Stage 3: Testing Phase: Carrying out quality inspections
- Stage 4: Deployment and Upkeep: Bot deployment and maintenance
Stage 1 – Analysis
The RPA life cycle starts with analysis. To develop a strategy for why they require Robotic Process Automation and how it may benefit them, a team of business analysts and an RPA architect collaborate.
They employ a developing methodology and create a plan for task automation to eliminate manual labor as much as possible.
The robotic process automation lead determines a timetable for implementing this strategy. They begin the development process after completing the necessary documentation and other requirements.
Stage 2 – Bot Deployment
Work on the automation task’s requirements has begun by the development team. Depending on the type of automation needed, coding may or may not be involved. There is typically no code. Yet there might be some exceptions.
Stage 3 – Testing Phase
The bot is tested by the development team or a separate testing team, similar to traditional software testing, depending on the type of automation generated and the organization.
Stage 4 – Deployment and Upkeep
The bot is now prepared for deployment after a successful development and testing phase. If there appears to be an issue after deployment, the development team will review it again and retest it. Besides, the bot goes through maintenance and gets updated each time it is used.
Role of Robotic Process Automation in Healthcare
Healthcare tasks like staffing, data management, administrative work, claims administration and other things are frequently done by hand. These procedures require human involvement, which makes them error-prone, restricts productivity, and causes severe operational inefficiencies. This may result in poor patient experiences, insufficient personnel, overworked workers, longer processes, and high operating costs.
By automating processes based on specified rules and conditions, structured data, and logic, the integration of robotic process automation in the healthcare industry enables enterprises to accomplish more with fewer resources.
Robotic process automation solutions boost productivity, enhance medical outcomes, and boost staff satisfaction, whether used for data administration, patient scheduling, care, or running IT helpdesks.
Furthermore, healthcare firms can go beyond eliminating human labor and job automation by combining RPA with more sophisticated technologies like artificial intelligence (AI), machine learning (ML), and natural language processing (NLP).
With this approach, they can improve operations by intelligently carrying out duties normally performed by humans, including addressing business problems, making wise decisions, evaluating data, and more.
RPA Use Cases in Healthcare
Healthcare is battling exorbitant prices, stifling regulations, enormous data quantities, and rising patient expectations. Healthcare providers can overcome these obstacles, lessen the workload of back-office duties, and greatly increase operational effectiveness by implementing robotic process automation systems.
Appointment Scheduling
When performed on a larger scale, appointment scheduling is tiresome and error-prone. Even though online booking has replaced call-based scheduling, human oversight is still required.
Robotic process automation can make booking appointments easier by automating most of the related chores.
The bot can give the patient time slots with the appropriate provider, estimate the appointment’s duration, delete the slot in the event of a cancellation, and alert both the patient and the doctor based on the request, the availability of the healthcare provider, and the location of the clinic.
Claim Management
Hospitals must manage insurance claims regularly, and as patient volumes rise, staff members frequently encounter delays in processing hundreds of claims.
RPA bots can automate this time-consuming, rule-based process by automatically accessing external systems, processing claim data, and updating the hospital’s RCM solution or any other applicable system.
This is an efficient alternative to manually transferring information between the insurer’s website and a revenue cycle management system.
According to McKinsey, healthcare businesses can save up to 30% by using robotic process automation solutions to automate most claim-processing stages.
Post-Discharge Supervision
Patients must fill prescriptions and adhere to discharge instructions after being released. The duty of making sure the patient follows post-discharge instructions is difficult but crucial for healthcare personnel.
For instance, people frequently have different post-operative side effects, such as headaches and nausea, necessitating the prescription of particular medications and follow-up sessions. Robotic process automation (RPA) units can remind patients about forthcoming visits and prescription pick-ups and ensure discharge rules are followed as planned.
Such post-discharge management strategies have been shown to be effective in raising HCAHPS scores and improving the patient experience.
Check-in at a Self-Service Kiosk
Many healthcare organizations still depend on in-hospital check-in. Hence, some hospitals use self-service kiosks with RPA capabilities. Upon arrival, visitors can enter their data onto a self-service kiosk for front-desk staff to further triage.
The fundamental triage utilizing the symptoms and statuses of patients can also be carried out by bots using more advanced robotic process automation technologies. In this method, patients are listed by priority for the front desk staff, thus lowering check-in times.
Effective Data Management
Medical records are a major factor in the decisions made by clinicians. Although manual data transfer between several apps offers space for errors and security breaches, hospitals still struggle to keep data updated across all systems and departments.
For instance, lab personnel typically manually transfer patient profiles once medical test results are entered into the lab’s system. Instead, the results can be automatically entered into any pertinent system by an RPA bot.
By doing this, information accuracy is guaranteed, data breach risks are reduced, employees are relieved of menial tasks, and medical records are synced and updated.
Additionally, robotic process automation improves data security by storing only reports of bot-related activity and protecting the privacy of patient data.
Management of Billing and Payments
Healthcare professionals deal with various bills and payments, such as those for hospital stays, provider visits, tests, medications, and more. Healthcare providers also collect and use many types of data, including disease codes, prescription information, and data from medical records, all from diverse sources, to settle payments or receive reimbursement from insurance companies.
By automatically generating invoices based on the services a patient receives, RPA bots can be used to simplify the challenging billing process. This speeds up invoicing, makes pricing transparent for clients, and prevents mistakes.
Asset Management
It can take a long time for nurses to find misplaced medical supplies. Even for emergency patients, the delivery of care may be delayed due to inefficient nursing performance.
To assist employees in finding devices, checking inventory, and keeping tabs on the state of equipment, hospitals can pair robotic process automation solutions with digital sensors.
Moreover, the same RPA-based tracking technique can be used to locate organs intended for transplantation, enabling more accurate surgical planning and flawless operation.
Staffing Efficiency
Achieving the right staffing numbers is challenging for hospitals since they must avoid understaffing and employee burnout while staying within budget.
Thus, hospital administrators can use robotic process automation to manage attendance, organize shifts, and track employee performance across several systems. RPA bots can synchronize data across all staff-related platforms to collect performance, payroll, and other metrics.
Data Analytics
Healthcare firms streamline internal research using robotic process automation tools since they access enormous amounts of important data. In order to help medical personnel make more precise diagnoses and provide individualized care for each patient, bots can be designed to input patient data and prepare it for analysis.
Care Consistency
Healthcare professionals should maintain accurate and readily available records of their previous visits and treatments to ensure medical aid consistency for returning patients.
It takes too much time and effort to manually search through numerous registers or look for an Excel sheet with outdated data, and it is not always effective.
RPA solutions may save all additional patient information and capture patient data starting at the time of registration, giving medical staff quick access to the data they need.
Physicians can manage patient medical histories and provide individualized treatment regimens for various patients using RPA-enabled reports.
What Challenges Does Healthcare RCM Face?
Healthcare providers need RCM teams with an in-depth understanding of treatment and reimbursement rules to manage the process efficiently. Unfortunately, despite their competence, they have a high tendency for data entry errors because of the volume and variety of data they must review. As a result, the task of practice leaders is being made more difficult by trivial issues like data entry mistakes.
Issues Originating from Patients
- Unpaid bills due to being uninsured or underinsured
- Limited price transparency and confusing bills
- Shortcomings in patient access management
Barriers
Inflated patient collection time negatively impacts the financial standing of practices.
What’s Needed?
Effective claim tracking and queueing.
Issues Originating from Hospital Staff
- Failure to collect accurate information upfront during patient scheduling and patient registration
- Errors in ICD coding and not verifying insurance eligibility prior
- Incorrect processing of patient information
Barriers
Incorrect medical coding, billing, and insurance claim submissions.
What’s Needed?
Error-free claim processing and submission process to increase first-pass rate.
Issues Originating from Insurer
- Failure to collect accurate information upfront during patient registration
- Errors in ICD coding
- Steep learning curve associated with understanding claims creation processes
Barriers
Revenue leakage resulting from unpaid ARs and denied claims.
What’s Needed?
Reduced error rate and rework.
How Robotic Process Automation Can Help You Overcome RCM Issues?
Before we go any further, realizing that robotic process automation isn’t a magic solution that will instantly end your revenue cycle management problems is crucial.
However, it is a powerful technology developed to automate highly particular revenue cycle operations in the healthcare industry and produce excellent cost and time-reduction outcomes.
Here are the top healthcare revenue cycle automation applications and the outcomes that AR specialists may anticipate:
Benefit and Eligibility Verification
Prior Authorization
RPA bots can access the payer portal’s eligibility check area to obtain data for prior authorization requests. Moreover, a list of patients who need eligibility checks can then be opened, and the process can be carried out by choosing one patient at a time.
Keeping Patient Data Updated
Robotic process automation bots can fill data spreadsheets with crucial details to calculate reimbursement amounts. Using the data from payer portals’ normal reimbursement facility rates, it appropriately records the reimbursement amount that should be granted to providers.
Document Preparation for Review
After determining eligibility, the billing supervisor can receive a compiled list of all the examined patients from the robotic process automation bots.
Charge Entry
Superbill Review
Superbills are downloaded by RPA bots, who then prepare them for the medical billing team’s evaluation. These superbills contain all the information about patient visits and clinical encounters. It also collects and aligns data with the practice management software during the charge submission.
Claim Submission
Bots are set up specifically to consider the workflow of medical practices and guarantee the appropriate compilation and submission of charges for claims processing.
Medical Billing
Data Exporting
RPA solutions extract accounts receivable data from practice management systems of healthcare providers by applying filters like “time in the queue.” After logging in, they can retrieve the status of certain claims by going to payer portals.
Managing No-Response Claims
The only remedy for claims that are unanswered by payer organizations is effective and ongoing follow-up. When a claim meets the “no response” criterion, an RPA solution can filter it out and periodically notify AR specialists to escalate the issue.
Payment Posting
Posting ERA
To download and analyze the electronic remittance advice, or ERA, RPA bots can log into clearinghouse and payer websites. Then, bots can electronically post the finished ERAs.
Validation and Error Checks
As a last step in the quality assurance process, the RPA solution can validate ERA files to ensure the patient treatment information provided in the ERA document is accurate.
Delegation Management
The Exception Flow
Robotic process automation helps prevent claim denials and significantly aids AR specialists in managing denials. When a claim cannot be saved, bots move it to an exception path flow so that AR professionals can move it to a high-priority manual intervention and correction queue.
Pattern Detection
RPA solutions can “track” and “highlight” erroneous patterns in the claim denial management process. AR professionals can make efficient or corrective adjustments to the claim submission procedure thanks to the analysis that RPA bots highlight.
CareCloud’s RPA Solution
CareCloud’s RPA solution uses microbots to automate typical revenue cycle management processes so you can concentrate on more significant, money-making tasks.
- Our open design and commitment to the healthcare industry enable us to eliminate expensive, time-consuming processes from your revenue cycle workflow.
- Microbots, in contrast to other robotic process automation solutions, were created expressly to recognize and address certain RCM issues in the healthcare sector.
- Our connections with leading clearinghouses result in a more effective processing procedure.
- Your PM, electronic health records (EHR), and other healthcare systems can communicate with each other using an open API architecture.
- Developed with consideration for the challenges of healthcare data security.
- With our RPA solution, implementing a fully packaged, plug-and-play revenue cycle management system could take only a few weeks.
- When you get our robotic process automation solution, you can concentrate on patient care while we take care of the technological matters of your revenue cycle.
- Our top-notch technical support team handles everything, including implementation, development, and maintenance.
Automation keeps your claims from getting lost in the shuffle. Microbots analyze your open claims in the background and handle denials to guarantee timely settlements and payments. This results in a 33% reduction in aged accounts receivable on average.
Conclusion
In this guide, we discussed in detail robotic process automation, its lifecycle, and what role this technology plays in the healthcare space. We also listed all the potential use cases for RPA in the healthcare industry.
Besides, there is one process that greatly benefits from the implementation of RPA: revenue cycle management.
So, to clarify how RCM efficiency is achieved, we first discussed the challenges faced in healthcare revenue cycle management due to patients, healthcare staff, and payers and then explained how RPA helps practices overcome the roadblocks.
