RPA solving critical problem areas in RCM.

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2. Introduction Health care systems and hospital management, C-level executives, and board members now understand the use of RPA and the potential positive side of the implementation. However, there are some RCM processes that need streamlining with robotic process automation. We shall explore in detail some of the most critical RCM processes which can get better over time by the use of RPA. WWW.BILLINGPARADISE.COM

3. RCM processes that can function better with RPA Patient access, registration, and scheduling Patients like to browse online and look to leverage all electronic and automated modes for accessing care, registering with network hospitals, and scheduling appointments. Patients nowadays hate to be on hold while your front office staff is busy trying to coordinate between the patients who are in the hospital for the visit and communicating with patients who are trying to schedule a visit. Robotic process automated patient access registration and scheduling processes will ease your front office staff of the burden of answering constant phone calls. THE REASON WHY IS BECAUSE COORDINATING WITH THE PATIENT VISITS IN PHONE CALLS WILL CREATE THE FOLLOWING PROBLEMS: 1. 2. 3. 4. OBTAINING INCORRECT PATIENT DATA. UNABLE TO VERIFY PATIENT DATA ON CALL. NETWORK PARTICIPATION ISSUES. LACK OF CARE COORDINATION. WWW.BILLINGPARADISE.COM WWW.BILLINGPARADISE.COM

4. Prior Authorization reigns at number one in critical RCM processes which need streamlining. It is understood that most. Time and money are spent by health systems and hospitals to obtain authorization. The services need approval from the health plans in order to get reimbursement. Robotic process automation can easily streamline this process as it is lengthy and the RPA bots function is to perform lengthy and time-consuming processes. Instead of your human staff verifying from one platform to another, leaving this job to RPA bots will be much more effective as their rule engines are x10 times faster than a normal human staff can process. These verification tasks before submission of the authorization application are the most tedious part when compared to paperwork. However, paperwork also is a time-consuming process but the major issue occurs with incorrect data capture in those applications leading to a denial of authorization requests. Prior authorization The greatest benefits of automating prior authorization processes are never missing timely submission, identifying utilization numbers, performing patient history verification, reduced cost, and fewer human staff oversight. WWW.BILLINGPARADISE.COM

5. Charge capture and entry Manual charge capture and entry is the most error-prone process there is. Staff with a lack of experience always tend to make mistakes and then reflected as rejected or denied claims creating revenue leakages for the entire hospital. Robotic process automation (RPA) enabled charge capture and entry and ensures that the diagnosis and treatment plans are properly captured by physicians at the time of service allowing lesser errors before entering the charges for submission. Overall streamlining the charge capture and entry process can result in better reimbursement, faster collection rates, correct coding, and other incentive programs the treating healthcare professionals are enrolled in. WWW.BILLINGPARADISE.COM

6. Medical records management Clinical documentation is a federal law that all healthcare professionals and facilities need to follow. Without proper CDI a hospital’s reputation to stand out as a better care provider will be eliminated and the hospital or health system might get constantly audited for lack of proper clinical documentation. Robotic process automation in clinical documentation is the perfect way to streamline this process. RPA bots are regularly updated on federal clinical documentation guidelines whenever a medical record, chart, progress notes, etc are documented. It will automatically cross-verify the rules and regulations and abide by them. If there are certain changes to be made the RPA bots will notify the respective healthcare professional of these corrections. RPA-enabled clinical documentation and medical records management will increase the chance of your healthcare organization obtaining HFMA MAP awards and being a shining example of clinical documentation excellence. WWW.BILLINGPARADISE.COM WWW.BILLINGPARADISE.COM

7. Payment posting and reconciliation Although the payment posting process has become electronic using ERA, there are still many payers who still use paper documentation. Most insurances use paper documentation only for letters, correspondence, etc. Some payers even use paper documents for payments as well such as paper checks, EOBs, recoupment, and overpayment letters. These documents will be piled up in your hospital’s mailing rooms and are kept unattended until the last moment. Healthcare management leaders can debate whether their mail room is doing a great job Or not, but converting these documents to an electronic format will keep your hospital or health system accountable for all payments and denials received. Reconciliation of payment will be much easier if RPA converts these paper documents to 835 formats for uploading in the respective claim. The next action steps for payment and denied claims would be much smoother without the last-minute hassle of portraying charges vs payment and other KPI reports for that matter because RPA bots will have already done it for you and present you with exportable formats of your choosing. WWW.BILLINGPARADISE.COM WWW.BILLINGPARADISE.COM

8. Claims denial and appeal management Claim denial and appeal management is the crucial part of the RCM process where revenue returns back for the services rendered. According to surveys, 80% of all claim denials can be resolved by identifying the errors in human staff performing RCM tasks. Robotic process automation (RPA) used in claim denial and appeal management is one of the critical aspects to consider as human staff would need to categorize and analyze denials claim by claim because ANSI, CARC, and RARC codes need to be interpreted, analyzed, and resolved which takes anywhere between 15-30 mins depending on the complexity of denials. RPA bots can simply complete this process within 1-2 minutes and perform the next action resulting in day-to- day denial resolution instead of weekly or monthly as in-house staff may be occupied in the current billing cycle. We have understood that hospitals and health systems utilizing RPA for claim denials and appeal management have collected millions of dollars worth of claims which were deemed as non-collectible when RPA provided the collection report. WWW.BILLINGPARADISE.COM WWW.BILLINGPARADISE.COM WWW.BILLINGPARADISE.COM

9. Claims denial and appeal management Hospitals and health systems, CFOs and RCM directors should identify the cost involved multiple times working on the same processes with no resolution whatsoever. They also need to identify the crucial parts of their RCM where RPA is needed, without these initial steps for implementing robotic process automation there would not be success rates in achieving the goal set for your healthcare organizations. We are here to accept challenging questions and concerns related to RPA implementation in RCM. Talk to our certified RPA experts now! WWW.BILLINGPARADISE.COM

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