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RPA use cases in Denial Management

The use case for Robotic process automation enabled denial management for your hospital of health system.

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RPA use cases in Denial Management

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  1. RPA use cases in Denial Management www.billingparadise.com

  2. Introduction: Denial management is key when it comes to navigating a hospital or health system’s financial wellbeing. Robotic process automation (RPA) technology used in managing denials for your healthcare organization will significantly reduce denials as these RPA denial bots use cases for denial management are an intelligent data-driven digital workforce that doesn’t allow room for error. According to surveys, hospitals have increased by 11% denial rates. Most of the denials, that is 80% of all denials are resolvable and can receive payment. Robotic process automation (RPA) use cases for denial management are purely on the basis of analysis and to automatically perform the next qualitative action. Unlike human staff who take many hours to analyze and come up with a resolvable action, RPA denial management bots will simply do all that for your human resources and allow them to just monitor the performance of these RPA bots. www.billingparadise.com

  3. Robotic process automation (RPA) use cases for healthcare claim denial management Cost savings Denial management is an expensive process. Submitting corrected claims, reconsiderations, appeals and other documentation itself costs a hospital anywhere between $10-$20k clearinghouse, and other charges. redeterminations, which includes EDI, Additionally, adding resources to perform a denial management process will cost the hospital or health system around $50-$100k depending upon the volume of denials your healthcare organization faces. RPA denial management technology’s best use case is the reduction of cost by 96% as the investment for RPA bots is one time and the management costs of these bots will reduce over time creating faster ROI compared to human denial management staff. www.billingparadise.com

  4. Reduced manual work hours (time-saving) The next best RPA use case for the denial management process is saving manual work hours. A typical denial management expert with 3+ years of experience in denial management would analyze and come up with the following resolution action that would take 30 mins to an hour. The reason for this much time consumption is because denials are categorized to patient, provider, and payer as the denial management experts need to figure out the route cause of the denial to make sure the same denials do not repeat over and over again. A robotic process automation (RPA) bot would perform this task within 2-5 mins drastically reducing the time taken for analysis and next action. A denial management RPA bot can easily perform 100+ denials resolution in human staff work 6-8 hours per day. Productivity, Quality, and efficiency As you can see from the above-mentioned time-saving robotic process automation (RPA) use case for denial management the time taken for RPA bots can single-handedly solve the reason for a claim denial and perform resolvable action in 5 minutes giving a greater advantage in productivity as the RPA bots run 24/7 365 days a week. Hospitals can take this as an advantage and resolve more and more denial recovering thousands of dollars every day. The reason why the quality of the RPA bots is impeccable is that the adaptive intelligence technology programmed inside the AI which includes ICD 10, and CCI database is already accessible by the RPA bots which eliminates any coding-related issues. www.billingparadise.com

  5. Similar to the coding databases RPA bost have access to denial-specific insurance CARC and RARC codes, Remark codes, clearinghouse reactions codes, etc to quickly analyze the issue right there instead of waiting for other senior level expertise human staff to resolve the frequently received denial problems increasing quality and productivity simultaneously. The rather proven RPA use case for denial management is efficiency because RPA bots do not take holidays, do not get sick, or go on vacation, the continuous efficiency of the denial management process will allow hospital decision-making leaders to get more recovered revenue in a month compared to their previous financial performance. Interoperability between applications Interoperability between various applications is the workflow of any denial management process in hospitals and health systems. Navigating through these applications by a human staff is repetitive, and tedious, and chances for errors are possible. Some insurance companies would like to submit any denial rebuttals through their web portal where manual claim information needs to be entered. www.billingparadise.com

  6. All these interoperable processes can be carried forward by RPA bots quickly and more efficiently than a human staff due to their OCR (optical character recognition) reading and writing engines combined with their NLP (natural language processing) engines can perform these tasks more efficiently and without any data errors as appeal and redeterminations process need precise information for the insurance companies to evaluate. Automated denial management paperwork The most time-consuming process of denial management is creating paperwork to rebuttal the claim denials with proper documentation. This RPA use case for denial management is highly important because most appeal documents are incorrectly sent with the wrong health plan appeal forms or sent to the incorrect insurance plan resulting in further denial of the claim. RPA bots can automatically populate the fields in the appeal forms by identifying the correct health plan appeal form and filing information. This allows human staff to concentrate on more manual processes like responding to correspondence sent by the insurance companies through the mail and seeking necessary actions using the RPA bots. www.billingparadise.com

  7. We hope these use cases for RPA denial management were helpful to identify the aspects of your hospital or health system problem areas and were beneficial in making key decisions for RPA implementation. We also understand that you will have many questions after reading RPA use cases for denial management, worry not! BillingParadise, as an expert in both healthcare revenue cycle management and Robotic process automation (RPA), can provide you with expert consultation for your RPA requirements for denial management and other processes as well. Our certified RPA experts are more than capable of answering your complex questions and providing the necessary insight for RPA-enabled RCM processes! Schedule a free consultation now! www.billingparadise.com

  8. Contact us Website www.billingparadise.com Email inquiries@billingparadise.com Phone +1 888-571-9069 Address BillingParadise 24x7 INC 53 Emerald Road, Robbinsville, NJ 08691. United States.

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