What Is Robotic Process Automation in Revenue Cycle Management?

Emphasizing the efficacy of automation, Mr. Bill Gates quoted that “The first rule of any technology used in a business is that automation applied to an efficient operation will magnify the efficiency. The second is that automation applied to an inefficient operation will magnify the inefficiency.” With advanced technology powered by automation, the healthcare industry has set the stage for an overhaul with Robotic Process Automation (RPA), one that will streamline the revenue cycles, adding efficiency and holistic growth.

Robotic Process Automation (RPA) utilizes various software bots that mimic human actions to enhance efficiency and speed in repetitive functions and tasks. RPA in revenue cycle management involves the use of bots to access applications and data sources using structured data, in order to automate decision-making without any human effort. Operating on scripted processes, these bots drive logical steps and answers to situations, based on pre-set business rules.

Some key areas of revenue cycle management that are increasingly using RPA-led solutions include eligibility and insurance verification for patients, processing of claims, billing, submitting the claims, payment denials, and the data integration process across multiple systems. Automation is accelerating the speed and efficiency with RPA in the revenue cycle, penetrating the crucial areas of benefits retrieval to integration of pre-authorization and even managing patient communication through email/chat triggers for an enhanced patient payer experience.

Why Healthcare Organizations Are Turning to RPA for RCM

Exploring the potential of automation, RPA in the revenue cycle has significantly altered the operational and financial processes using advanced analytics, positively impacting the accuracy, speed, and quality of patient care. Increased adoption of RPA is attributed to the following key factors:

• Seamless Workplace

  A 24/7 work environment that is automated and also does not need any manual intervention is one of the biggest highlights of RPA-based bots. Intelligent automation bots work continuously and most accurately without impacting the physical workforce’s hours

• Efficiency in Operations

  From faster claim submissions to sped up patient movement, RPA enables accelerated action through automated workflows, and saves time and effort for the provider as well as the patient

• Workforce Optimization

  Promoting focus on higher value activities by offloading manual efforts, RPA in the revenue cycle encourages strategic decision-making and optimal utilization of human resources

• Reduced Bottomline

  Enabling reduction in labor hours through automation, RPA empowers healthcare providers by minimizing costs related to overheads, errors, and even rework

• Effective Communication

  RPA also facilitates seamless communication within departments and automates triggers for patient information, enhancing transparency and patient satisfaction

• Compliance Adherence

  By minimizing human errors and ensuring accuracy in billing, RPA enables HIPAA-compliant regulatory measures and audit readiness.

Key Use Cases: RPA in Revenue Cycle Management

Accelerating the efficiency through the revenue cycle, RPA is a game-changer, adding stability to provider financial health. The following are key areas of application for RPA through RCM

• Managing Pre-authorizations

  Leveraging RPA, it is easy to identify the need for prior authorizations by analyzing historic patient data and other relevant information. Deployed by a large hospital chain in the US, RPA-led Bots proactively sent pre-authorization submissions, saving time and money for the patients and increasing the workflow efficiency by almost 50%. Cutting down manual verification time by 60%, the Cleveland Clinic used RPA-based solutions for automated eligibility verification and for processing claims

• Automation

  Coronis Healthcare automated the entire revenue cycle by deploying RPA to streamline key areas of claim submissions, denial identification, and reimbursement optimization. With the timely identification of discrepancies, the firm managed to reduce claim denials, enabling strengthened financial health

• Claims Processing Automation

  A leading healthcare provider implemented RPA to drive the processes of reviewing, submitting, and verifying patient insurance claims, enabling a 60% reduction in the processing time for claims and minimal errors

• Accounting and Payments

  Adding transparency and speed to accounting operations, a major healthcare service provider, Banner Health, leveraged RPA for payment posting automation and billing inquiries, and experienced a 70% reduction in manual tasks. Enabling real-time visibility into revenue performances through AI-based dashboards, RPA also empowers providers with accurate and timely financial information.

Is RPA Right for Your Healthcare Revenue Cycle?

Robotic Process Automation adds value to the Revenue Cycle in more than one way; however, an evaluation to assess its operability and feasibility for a certain RCM is essential for success. Providers should consider reviewing the following factors before RPA adoption:

• Characteristics for the RCM process and task, including its functionality type, quality of data available (raw/structured), frequency of high-volume transactions

• Assessing manual effort and its impact by taking into consideration the time spent in repetitive tasks and the change that automation can bring. Comparing the error percentage and reimbursement delays with manual tasks against automated tools

• Understand the benefits of automation on patient engagement and organizational efficiency with reference to error monitoring, claim approval timelines, risk mitigation, and the overall cash flowc

• Reviewing the compliance adherence of the proposed RPA solution with critical regulations, such as HIPAA, and ensuring it helps maintain transparency

• Readiness to implement, including clarity of RPA managing roles, a ready change management strategy, and stakeholder involvement

Foresight for Future: Robotic Process Automation and Its Role in Revenue Cycle

Displaying potential and tangible benefits, RPA promises to revamp the revenue cycle holistically. Expected to grow up to $13 billion by 2030, RPA adoption is poised to witness a shifting paradigm, with an emphasis on integrating AI capabilities across various revenue processes for advanced automation. Areas of coding, predictive analysis, and denial management will leverage Generative AI (Gen AI) and Natural Language Processing (NLP) to aid in the proactive prevention and optimization of revenue. To enhance RCM interoperability and allocation of resources, providers are also integrating cloud platforms with machine learning, supporting decision-making and scalability.

How WNS Accelerates Healthcare RCM with RPA

Powered by intelligent automation-led solutions and unmatched domain expertise, WNS has been supporting leading names to drive end-to-end hyperautomation across the healthcare revenue cycle. Leveraging a suite of proprietary and partnered tools and frameworks like RCMplify that boost process accuracy and ensure compliance.

Transforming businesses with AI-driven platforms and advanced analytics, WNS empowers healthcare providers to effortlessly perform and scale by enhancing operational efficacy, strengthening payment cycles, and delivering smarter patient experiences.

Connect with our experts to navigate through the complexities of the revenue cycle with WNS’ advanced digital solutions and accelerate your organization's financial health!