The Role Of RPA In Revenue Cycle Management

Efficiency and cost-effectiveness are paramount for healthcare organizations. The role of RPA in revenue cycle management (RCM) is crucial for revenue growth and flexibility.

RPA offers a transformative approach to streamlining RCM processes, boosting productivity, and ultimately, improving financial performance for healthcare services. Let's explore how RPA is reshaping healthcare finances.

The Role Of RPA In Revenue Cycle Management

Robotic process automation (RPA) bots mimic human actions, interacting with software systems just like your team members would. Unlike human employees, these digital workers operate 24/7, performing repetitive, time-consuming tasks with speed and accuracy. This makes them ideal for automating numerous aspects of the revenue cycle and complying with requirements.

Automating Key RCM Processes

RPA excels at automating several key processes in revenue cycle management, including automating revenue. Consider claims processing, for example. Bots can rapidly process high volumes of claims, input and validate information, and submit clean claims to payers.

RPA bots also improve prior authorization, significantly reducing the administrative burden. Eligibility verification is another prime example.

Manual verification is often time-consuming but critical for maximizing reimbursement and ensuring accurate patient coverage. With RPA, patient eligibility can be checked instantly, cutting delays and increasing cash flow. RPA also boosts efficiency in these tasks:

• Patient Registration: Bots automatically populate patient information, speeding up admissions.
• Insurance Discovery and Verification: Bots gather patient data to confirm insurance coverage and prevent claim denials. According to CAQH, automating tasks like eligibility and benefit verification could save billions. A recent HFMA/AKASA survey found automation reliance in the revenue cycle up 12 percent.
• Claims Processing: Automated tools increase claim processing speed and accuracy. Research by KPMG suggests RPA decreases revenue cycle costs. RPA tools process claims efficiently, helping with claim management, making sure payer guidelines are met, and reduce denial management efforts by flagging issues when claim denials occur.
• Prior Authorization: RPA tools help staff manage prior authorizations, reducing administrative hassles for employees.
• Payment Posting: Bots can automate payment posting, minimizing manual errors, and accelerating account reconciliation, making processing tasks like ERAs easier. Automating can decrease turnaround times and prevent errors that can affect financial statements.

Editor's Note: Many of the errors that occur during registration or eligibility verification are due to data entry mistakes. Many companies in the healthcare industry, like Dignity Health, are turning to Magical to help with these errors.

Magical is an automation and productivity tool that eliminates repetitive typing tasks like patient registration and transferring patient data between systems. You can set up automations with Magical to autofill forms, thereby reducing errors and saving on costs.

Improving Efficiency and Reducing Costs

A CAQH study found automating administrative tasks could generate massive savings in healthcare. Through increased speed and reduced human error from data entry tasks, RPA can significantly lower administrative costs.

This frees up staff for more valuable tasks like resolving complicated patient issues or tricky claim denials. RPA helps reduce costs, maximize revenue cycle efficiencies, and streamline business processes.

Automating the revenue cycle leads to significant financial improvements, making financial statements more accurate. This also leads to improved financial performance and financial health overall.

Improving the Patient Experience

Implementing RPA in the revenue cycle benefits patients, particularly related to medical billing and accounts receivable management. Patients want more digital communication options with providers. More digital, mobile, and remote engagement options boost patients' convenience and access.

Bots accelerate processes like prior authorizations, meaning less waiting and frustration for patients. This can increase patient satisfaction with telehealth services and provide better patient financial responsibility education.

Enhancing Accuracy and Compliance

By reducing manual data entry, RPA minimizes human error and improves data accuracy and integrity within the revenue cycle, ensuring that patient information is correct. This is crucial for accurate medical coding, billing, and claims status tracking. Standardized, rule-based automation improves regulatory compliance with consistent, detailed records.

The Expanding Role of RPA

The use of RPA in revenue cycle management is expanding as the healthcare industry finds more applications for this technology. Forward-thinking providers are expanding RPA initiatives in their revenue cycle processes. Automating high-volume and data-intensive tasks shows positive effects.

Gartner predicts large organizations will triple the capacity of RPA portfolios. RPA is becoming indispensable for maximizing profitability in healthcare, improving employee work-life balance, and enhancing patient payment accessibility.

Real-World Example

A large health system struggling with inefficient prior authorizations used RPA to expedite the process. They deployed bots to collect data, populate authorization forms, and track status updates. As a result, authorization times decreased dramatically.

Denials related to prior authorization also plummeted, reducing staff stress and saving costs. This positively impacts patient care as it ensures quicker access to necessary treatments and reduces administrative delays.

Partnering for Success

Successfully leveraging RPA requires collaboration within and beyond your organization. The goal is to fully understand the role of RPA in revenue cycle management before implementation.

Internal Partnerships

The chief digital transformation officer and IT department are crucial for successful RPA implementation. Their technical guidance simplifies building a business case for automation.

KPMG's research shows significant financial implications, indicating substantial cost reductions. These savings highlight RPA's potential and the importance of team integration.

External Partnerships

External vendor partnerships maximize success when implementing automation plans for the revenue cycle. These partnerships offer access to industry best practices and specialized expertise, refining RPA's role in revenue cycle management and filling proficiency gaps.

Choosing partners with RPA experience in the revenue cycle helps with vendor evaluation. Ensure internal alignment among stakeholders regarding strategic alignment, financial impacts, and the overall enterprise vision for integrating AI and RPA technologies.

Partner with The Academy or leading healthcare systems for thought leadership on improving processes throughout your healthcare ecosystem. This collaborative approach helps healthcare organizations to develop effective strategies and maximize the benefits of RPA implementation.

Final Thoughts

The role of RPA in revenue cycle management is evolving. It goes beyond task automation. RPA and propensity-to-pay models enable healthcare organizations to achieve better revenue generation, operational savings, and improved regulatory compliance, allowing greater focus on patient engagement and patient care.

This also reduces administrative burden which allows the staff to focus more of their time on other areas like patient communication, such as scheduling and billing.

From patient registration and eligibility verification to claims processing and payment posting, RPA simplifies, quickens, and improves RCM accuracy.

If you're part of a healthcare organization and want to know how to manage revenue cycle management, patient data, and other administrative tasks more efficiently, try Magical. Magical is used at more than 50,000 companies like United Healthcare, Optum, and Nuance to save 7 hours a week on their repetitive tasks.