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One of the most important topics in the healthcare industry today is ensuring all healthcare practitioners and staff are paid for their efforts. In order for everyone to be reimbursed correctly, there are many steps to go through. Each provider needs to be able to bill, adjudicate claims efficiently, verify payees, etc.  All of these activities support a healthcare organizations’ critical revenue cycle management.

As the healthcare industry continues to move toward adopting fully digital records, providers must balance their growing data operations with growing patient volumes, and insurance requirements. Make sure your system of record is up to date by automating your data.

Why Robotic Process Automation (RPA)?

The average hospital has 26 different software systems ranging from medical records to billing to pharmacy. This means there is a great deal of manual processes around the data. They take up time and increase the likelihood of human error. Relying on temps and part-time workers, as well as ad-hoc data-management tools, is in no way commensurate with the critical demands of modern business needs, such as security. In healthcare, this specifically includes the Health Insurance Portability and Accountability Act (HIPAA), which obligates all healthcare organizations to protect the interests of their patients.

In the healthcare industry, RPA can be used for a variety of tactics such as:

  • billing automation
  • claims adjudication
  • credentialing automation
  • interfacing systems

Use Cases

Healthcare companies can use RPA software to replace all manual spreadsheets, connect databases and systems that don’t interface. In fact, here are three ways healthcare organizations can use RPA to improve their all-important revenue cycles.

Medical claims submission is a cottage industry with tens of thousands of small home-offices submitting claims for healthcare providers. A key part of generating revenue for these home-offices is by proving their credentials are up to date. RPA offers data extraction software functionality to automate credentialing workflows to help ensure compliance with Joint Commission and other regulations, as well as work with third parties during the process.

Additionally, healthcare companies seeking medical reimbursements must deal with a number of constituents who don’t have access to computers and must handle this process manually. Given that claims reimbursement constitutes the biggest source of revenue for most practices, the speed and efficiency with which an organization turns those hard-copy forms into hard currency is of the utmost importance. An RPA tool provides a quick and accurate solution when dealing with the volume and complexities of payer contracts, insurance company rules, coding and filing, claims tracking and more.

To take RPA’s usage a step further, a large provider of patient ID technology needed to update its radio frequency identification (RFID) data into the electronic medical records (EMR) system so that they could be tracked through the hospital. Because there was no interface, they were faced with doing this manually; however, through the use of RPA, the company can automate the process. In addition to automating workflows and patient onboarding into EMR systems, integrating data from third parties is another big need that RPA software can streamline.

Healthcare organizations are accustomed to mission-critical tasks. There’s no reason why their operations, including revenue cycle management, should be second-rate. When you consider the rapidly changing landscape of the healthcare industry, now more than ever companies need automation to streamline their critical data operations.