Healthcare

“Your health is an investment, not an expense”

By leveraging RPA, healthcare companies can:

  • Reduce costs, errors, and time from claims administration
  • Increase cash flow and scalability
  • Improve patient and staff experience
  • Accelerate digital transformation

up to

%

Improved Claims Cycle Time

up to

%

Cost Savings

up to

%

Improved Cash Flow

Up To

%

Reduction in Employee Churn

Healthcare Providers & Payors

As patient numbers grow, Healthcare Providers are challenged with optimizing revenue management, managing levels of inventory, supporting digitization of patient files, optimizing appointment scheduling, and executing billing and claims processing. To help overcome these operational pain points, more and more healthcare providers are embracing RPA to alleviate these challenges and drive efficiency and growth. Healthcare is predicted to have a 36% automation potential. Some primary functions that can be improved through RPA include:

  • Patient Onboarding
  • Patient Inquiries
  • Revenue Management

In addition, more than a third of back-office functions could be automated, further improving efficiency.

For Payors, System Migrations, Yearly Benefit Enrollment, Complicated Benefits, Regulatory Changes, Fee Schedule Increases/Decreases, and Provider Data Management creates costly processes. A lack of provider data integrity, efficiency, and responsiveness can result in increasing costs and rising adjudication rates. Prime candidates for automation include:

  • Member Enrollment & Inquires
  • Claims Processing
  • Fraud Detection
  • Provider Data Management
  • Testing and Quality Control

Healthcare Providers: Member Enrollment & Inquires

A tremendous amount of paperwork needs to be completed and input into multiple systems when onboarding a patient. A robot can do the inputting in less time, with error-free results. RPA and intelligent chatbots can also handle many patient inquiries, allowing agents to focus on the more complex requests. Additionally, with the rise in TeleHealth, RPA can also be deployed in data extraction and staff readiness, as well as post-consult messaging to improve both patient and staff experience.

Healthcare Providers: Revenue Management

Between 10–20% of the Revenue Management Cycle can be automated, driving down costs and improving cash flow. Allowing a robot to verify insurance, check medical necessity qualifications, validate accuracy of procedural documentation, submit claim, check claim statuses, and complete claims audits through defined rules, ensures that the revenue will be realized. Where the robot notes a delay, the appropriate person will be immediately notified to resolve the specific issue. Reduction in cycle times of up to 80% are achievable. Other processes such as CPT & ICD code extraction assistance, patient billing, payment postings, collection letters, insurance payment audits, and cash application are also prime use cases for RPA.

Payors: Claims Processing

RPA is critical in supporting payors’ digital transformation journey and provides flexibility to scale up or down with demand. It can be deployed throughout the claims process, from prevention to prior authorization to adjudication. When supported by AI/ML, the automation potential raises across each step:

  • Prior authorization: 25% currently to over 50%
  • Medical record review: 10% currently to over 50%
  • Adjudication: 80% currently to over 95%

Not only does this power couple of AI/ML and RPA improve efficiency, it can also support fraud prevention and detection.

Providers & Payors: Back-Office Operations

There are many opportunities for automation across support functions that can result in more than 25% savings within enterprise operations. Some examples include:

  • Supply Chain: Order Management, Inventory Management, Vendor Management
  • Finance & Accounting: Procure-to-Pay, Record-to-Report, Collections
  • HR: Payroll, On/Offboarding, Recruitment, Administration
  • IT Support: Routine Maintenance & Monitoring, Password Management, Backup and Restoration, Member Data Updates

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Other Industries

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