According to a recent study published in the Annals of Internal Medicine, 34.2% of all U.S. healthcare spending is attributable to administrative costs. In many cases, the administrative overhead of healthcare providers represents a similarly large portion of overall annual expense. In an effort to reduce costs that do not add to the value of care, many organizations are using automation to make certain office-based functions more efficient. Robotic Process Automation, or RPA, is the use of software tools or modern-day programming languages to partially or fully automate human activities that are manual, rules-based, and repetitive. Below are some great use cases and good candidates for RPA for healthcare providers.
When it comes to managing insurance claims, processes like data input, eligibility processing, evaluation, and dealing with appeals can be time-consuming, error-prone, and inefficient – this makes claims management a good candidate for RPA.
Claims Status Checking
If you simply look at the sub-process of claims status checking, the average amount of time to check the status of a claim is approximately 85 seconds. Now multiply this by the 100’s (if not 1,000’s of claims in the queue of your EMR), and you can see the significant amount of time it takes to simply check the status of claims (not even adjudicating the claim).
One large health system (multiple hospitals) implemented an RPA solution that was able to check claim statuses in just 12 seconds (compared to the 85 seconds it takes a human).
In short, one bot could do the work of nine people in a 40 hours work-week without errors, allowing the staff to focus on more complex tasks. In this case, the implemented bot was able to process over 11,000 claims status checks in a period of six months. This was 100% of the hospital’s backlog queue.
Eligibility & Denials Management
Claims denials cost hospitals over $260 billion annually due to the complexity of claims management processes. About 25% of these denied claims are due to registration and eligibility issues. One Midwest hospital implemented a bot to check patient eligibility from multiple potential payors including the state Medicaid provider, Medicare, and Medicare replacement plans. The bot created a report of all self-pay patients and their potential eligibility in for coverage under the available payors. It also identified missing information in the claim once an eligible payor was identified. Previously, registration and intimal claims were being submitted, and denials would be received 30 to 60 days later. Through the use of the bot, the hospital has more confidence that the eligibility information has been confirmed, and they anticipate reducing days in A/R significantly.
Leveraging RPA in the claims management process can streamline the process of managing insurance claims. RPA bots can speed up data processing for insurance claims and avoid errors. In this manner, RPA bots can avoid delays and monitor the entire process. These bots can also identify compliance-related exceptions and avoid non-compliance with regulations. Therefore, the adoption of RPA in healthcare services can improve the efficiency of complex insurance claims management procedures.
More and more, patients desire the option to schedule their appointments online, and the scheduling systems used must collect personal information, diagnosis, and insurance details in the registration process. Patient appointments have to be aligned with different doctors’ schedules and availability in hospitals. For instance, if a patient needs to be diagnosed by a neurologist, then their appointment must be fixed according to the neurologist’s timings in the hospital. Also, in case any doctor is unable to attend to their patients, then the hospital staff needs to inform the patients beforehand. Hence, scheduling patient appointments can be a complicated task.
Implementing a bot can resolve many of the concerns related to scheduling patient appointments. Bots can automate patient data collection and processing. With this approach, bots can optimally schedule patient appointments according to diagnosis, location, doctor availability, and other criteria. RPA systems can scan patient data to create a report that can be sent to a referral management representative to fix the appointment. Additionally, bots can notify patients when doctors are unavailable for their appointment. For instance, a cardiologist who is caught up with a time-consuming operation might be unable to attend their patients. The RPA software can track the cardiologist’s schedule to help alert patients in case of unavailability.
At the time of discharge, patients are given prescriptions to fill and are required to follow post-discharge guidelines. Checking whether the patients follow discharge instructions is a difficult task for many healthcare providers. For example, after chemotherapy, a patient may suffer from an upset stomach and a loss of appetite. In such cases, doctors may prescribe medications for their condition and suggest follow-up appointments. Healthcare providers have historically had difficulty in monitoring and ensuring compliance with such discharge instructions.
Bots can ensure the accuracy of discharge guidelines and send reminders to patients about prescription pick-ups. Bots can also notify their patients about upcoming doctor’s appointments and medical tests. Finally, bots can alert healthcare providers in case any patient needs further assistance with their condition. The use of bots is essential for the improvement of HCAHPS scores. With this approach, healthcare providers can enhance the patient experience, provide better healthcare, and reduce readmissions.
Recording Audit Procedures
The auditing procedure involves multiple tasks for risk assessment. Such processes and their results need to be recorded to generate reports. These reports are sent to concerned parties for verification and approval. Such audits can be done for multiple objectives, such as patient safety or quality of services. The reports generated during healthcare audits are necessary for regulatory compliance. However, collecting and evaluating multiple reports from different auditing tasks and collaborating with several concerned parties can be tedious, also, errors in these reports can result in non-compliance of regulations.
Audit procedures can be easily optimized by using bots. Bots can record data and generate reports during audits. The reports can be automatically shared with concerned parties for evaluation and approval.
Some other areas that are showing promise for robotic process automation include:
- Vendor contract management
- Inventory management
- Invoice processing
- Various types of reporting
These are just a few examples of use cases that are most common in the healthcare industry.