Role of Automation Technology in Revenue Cycle Management

Providers are looking for smarter and cost-effective solutions using automated technology to improve their revenue cycle as well as clinical operations. A large portion of the revenue cycle management is made up of manual and repetitive tasks that may be automated easily. Automation is particularly good at handling repeated tasks and it can free up valuable personnel for higher-value jobs by reducing repetitive manual labor.

Robotic Process Automation (RPA) and Artificial Intelligence are two examples of automation technologies that are of particular interest to healthcare practitioners (AI).  Robotic process automation (RPA) refers to the employment of specialized computer programs known as robots (or “bots”) to automate recurring activities. These bots are made to execute in the same manner every time they are given a simple, repetitive, rules-based task. It helps in coding, charge entry billing, accounts receivable, and interoperability.

RPA does not take the role of humans when it comes to solving problems. On the other hand, it can function as virtual assistants, allowing humans to delegate monotonous chores that don’t require analysis or interaction.

There are two approaches when it comes to automating revenue cycle management, 1. Taking care of low-hanging fruit such as converting manual EOB payments made by a user, into automated ERA payments coming directly from a clearinghouse or the insurance. 2. The second approach is a complex one for example the system will go through the database, catch and fix any claim denials from happening.

RPA’s Advantages and Potential Use Cases

RPA is perfect for activities that aren’t particularly difficult but require a long time to complete. This frees up human workers to do more high-value, patient-focused tasks. RPAots may work nonstop, 365 days a year, and are predicted to be 5 to 20 times faster than humans in completing jobs.

RPA also lowers the risk of human error. Even the most cautious individuals will make an error after executing the same action repeatedly—for example, transposing a number when bringing over information. When completing repetitious chores, humans feel tired or bored. Bots, however, do not. They regularly, efficiently, and accurately complete the same activity.

RPA bots are configured to do the same thing every time they execute a task. They don’t learn or adapt to new or better ways to complete tasks or solve difficulties. Artificial Intelligence (AI) can help with this by providing the next level of automation.

Revenue Cycle Management

The following are only a few examples of possible applications:

  • Prior Authorizations
  • Insurance Verification
  • Inquiries on the status of claims and follow-ups
  • Segmentation of accounts
  • Virtual assistants for clinic staff.

Artificial Intelligence (AI):

Artificial Intelligence (AI) is a term that refers to the use of intelligent computer systems to replicate human intelligence. Learning (taking in knowledge and applying contextual norms for using it), self-correction (learning from successes and failures), and even reasoning are examples of these processes (reaching conclusions by applying context and rules). This is accomplished through the use of algorithms that recognize patterns and plan future actions.

You’ve encountered AI if you’ve ever used a Chatbot on a website, Alexa in your house, or Siri on your smartphone to receive answers to a question. Machine learning, picture recognition, audio recognition, natural language processing, and language translation are all common uses.

AI’s Advantages and Possibilities:

Healthcare executives are still looking into how this advanced technology might help them improve both financial performance and patient satisfaction that including connecting patients with providers and estimating out-of-pocket payments in real-time.

Computer-assisted coding (CAC), which reads clinician notes using natural language processing are just a few of the possible applications.

  1. Enhancement of clinical documentation
  2. Authorizations in advance
  3. Verification of claim status
  4. Examining EHR notes and clinical data to find flaws and inconsistencies
  5. Chatbots and textbots to answer queries
  6. Scheduling (can account for peak hours, availability, and resource load)
  7. Predicting payer representative availability to reduce multiple calls and long hold times
  8. Learning patterns in claim denials and recommending corrective actions for example appending a modifier for a particular procedure etc as required by that specific payer.
Revenue Cycle Management

End-to-end or “unattended” automation can be achieved by combining AI with RPA. RPA employs pre-programmed logic to handle structured data, such as filling out a form, but AI builds its own reasoning and can handle unstructured data, such as free typing in a chatbot or textbot or analyzing speech in a phone call. Both types of data are used in healthcare RCM. It is feasible to automate an entire process from start to end by combining RPA and AI.

Prior authorizations, one of the most time-consuming revenue cycle management tasks, are an excellent example of this combination. RPA bots can automate the repetitive operations that staff typically conduct during the authorization process, while AI can learn from previous denials to predict changes and detect potential difficulties.

While artificial intelligence (AI) can automate many operations, it does not replace the necessity for human workers. When human action is required, AI can help convey the correct information to the right person at the right time. While patients may prefer automated techniques for basic chores, they still want a real person to assist them during “moments of truth”—interactions that require fixing a key issue or making a care decision.

With the right technology and practical solutions, MediFusion EHR can help you increase profitability, improve patient experience, and get the most out of your IT investment. Providers may be enticed by the promise of decreased operational expenses to integrate the latest AI technology, and there are plenty of possibilities.

However, while selecting and deploying automation, it’s critical to be highly deliberate. Automation isn’t only about lowering labor expenses; it’s also about freeing up employees to focus on more important patient-centric tasks. It can save operating costs while simultaneously improving the patient financial experience and staff morale when used wisely.

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