Electronic Health Reporter

By Venkatgiri Vandali, president of healthcare and lifesciences, Firstsource.

Solving the challenge of containing costs while improving revenue cycle operations despite labor shortages has a direct impact on a health system’s financial health and ability to serve patients. The good news is that automation solutions exist to streamline revenue operations, enabling revenue professionals to work at the top of their skill sets and giving patients better financial experiences.

Here’s a quick look at where and why automation can strengthen cash flow and revenue streams while patients and revenue professionals experience greater satisfaction.

Why should providers be concerned about the financial experience they deliver to patients?

Patients are now responsible for more of their health costs than ever. That means providers collect a higher percentage of revenue from patients.  Other service providers—think credit cards, mortgage lenders, online retailers—have trained consumers (aka patients) to expect easy, seamless, digital payment processes. Healthcare payment processes are not easy or streamlined. That makes it difficult for providers to collect from patients, slowing revenues. Patients increasingly will choose healthcare organizations that make it easy for them to understand and pay their bills.

How can healthcare providers improve financial experiences with continuing staffing and cost containment pressure?

Many hospital revenue professionals spend most of their time on tasks that don’t require much skill, such as looking up data in a payer portal or calling payers to check on prior authorizations. Automation can take over those tasks, freeing time for revenue professionals to work directly with patients, offering financial counseling, helping them understand their insurance coverage and calculating their financial responsibility. Automation can also assist professionals in high value activities, such as by checking claims for accuracy before submission and flagging potential errors for review.

What’s the difference between robotic process automation and AI and machine learning?

Robotic process automation (RPA) is proven, cost-effective technology that automates time-sucking repetitive tasks.  Using software bots, RPA mimics the keystrokes of human operators—including those needed to switch between applications and systems–and makes simple if/then rule-based decisions. A software bot can usually be trained and deployed in a matter of weeks.

AI and machine learning based automation is more sophisticated and often built on top of the processes and data accuracy improved by RPA. AI/ML solutions manage complex tasks that involve following business rules and making decisions based on the models’ data analysis.  Such solutions often are more expensive and take longer to implement than RPA. They are best suited for providers that already have standardized processes and cleaner data from existing automation.

Which revenue cycle functions are best suited to automation?

RPA excels at automating rote, repetitive processes that involve multiple steps and systems and/or substantial human and machine interaction. Processes that work well with bots include claims status checks; patient pre-registration activities; prior authorization workflows.

What’s an example of how automation could streamline a revenue process?

RPA can automate much of the patient pre-registration process to get cleaner data and set the foundation for collecting payment. After a patient agrees to interact digitally with a provider in a self-registration portal, RPA bots can download the patient registration requests; retrieve patient data from an electronic health record (EHR); then update the patient engagement system. The update can trigger the engagement system to send the patient a self-registration and payment link.  When the patient completes those steps, the RPA bots can access the payment and patient demographic data and update the provider’s EHR.

How does a provider get started with automation?

Start with a relatively low risk project that’s nonetheless inefficient, such as claims status checks with one payer. That enables providers to gain automation experience while solving a real problem. Make certain the bot is built with a flexible architecture so it can soon be extended to checking claims status for other payers. Then look for other rote, repetitive processes; success with one project often sparks ideas for other areas where bots can help.

Working with an RPA vendor with extensive healthcare revenue cycle experience minimizes the time and input required from provider revenue professionals to train the bot.

Finally, most RPA projects should deliver a return two to three times greater than their initial investment. Reconsider projects with lower expected returns or a long time to ROI.