In an era when consumers may digitally apply for mortgages, buy vehicles, trade stocks and transfer funds easily and securely, the healthcare financial experience is often frustrating for patients and their families. Growing numbers of patients say financial transparency and options for financing care determine which providers they select. A recent survey found that answering coverage questions and resolving bills, among other finance-related transactions, had a substantial impact on patient satisfaction ratings.
However, many providers don’t have the revenue professionals necessary to engage patients with personalized service. One study showed 63% of healthcare providers are unable to fill key revenue management roles. At the same time, many hospital revenue professionals spend considerable 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. That’s time that could be spent on higher value and more satisfying patient-facing work.
Automation can solve many of these issues simultaneously. Robotic process automation (RPA) is proven, cost-effective technology that automates time-sucking repetitive tasks. Enabled and augmented with RPA, revenue professionals can engage with patients more meaningfully to improve the patient financial experience and ultimately help build loyalty and capture more revenue.
Automation and the patient financial experience
RPA excels at automating rote, repetitive processes that involve multiple steps and systems and/or substantial human and machine interaction. Using software bots, RPA mimics the keystrokes of human operators and can make simple if/then rule-based decisions. Many bots can be developed and deployed in a matter of weeks. They then work tirelessly and accurately, including during off-hours. RPA and its bots can manage a wide range of revenue cycle management functions, including:
- Claims status checks. Bots can look up claims data and other information in payer portals, then update systems and even initiate next steps, eliminating these rote tasks and returning time to revenue professionals.
- Automated patient pre-registration. RPA bots can link applications and systems together to simplify the execution of transactions and knit together the seams among systems. 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.
- Digitally enabled prior authorization. Bots can easily retrieve patient data, insurance details, CPT codes, physician details, diagnosis codes and schedules from an EHR; flag cases requiring prior authorization; and submit them digitally to a payer portal. Then bots can update records with approved requests. They can also automatically route denied cases requiring additional information to the right clinicians, then refile them when updated. This all expedites the prior authorization process, getting answers to patients and their clinicians more quickly.
Getting started with automation
Developing RPA software bots requires minimal IT input, a critical factor given the competing projects that most provider IT organizations have under way. Choosing an RPA vendor with extensive healthcare and revenue cycle experience helps minimize the time and input a provider’s revenue professionals must give to the engagement as well.
Bots should be built with flexible frameworks so they can can be extended to other applications with minimal programming. That enables a provider to gain automation experience before attempting more ambitious projects. For example, automating claims status checks is a relatively low-risk project that nonetheless solves an area of major concern for many providers. A bot with a flexible architecture can first execute claims status checks for one payer, then easily expand to work on claims from other payers.
Finally, most RPA projects should deliver a return 2 to 3 times greater than the investment. Reconsider projects with lower expected returns or a long time to ROI.
Patients are now responsible for more of their health costs than ever. As a result, they increasingly expect intelligent, seamless payment processes while provider revenue operations get leaner. RPA addresses both challenges. Providers deliver the streamlined transactions patients want while revenue cycle professionals work smarter. More efficient revenue operations strengthen cash flow and revenue streams while patients and revenue professionals experience greater satisfaction. That’s a winning equation.