Doing more with less has become the new normal for hospitals and healthcare organizations, with the medical industry as a whole struggling under the weight of today’s economic challenges, much of which stem from the COVID-19 pandemic. Many are turning to Robotic Process Automation (RPA) to offload repetitive tasks traditionally handled by staff, freeing precious resources for higher value work.
What is RPA in Healthcare?
First, it is important to clarify what it is not. Different than other “software” that requires a human to log in with a password, RPA software robots or bots are given a password, enabling them to log into systems to perform work humans normally would do. In this way, RPA automates business processes by replicating the actions of a human worker.
Beyond simple screen scraping and keystroke emulation, RPA is also evolving to more sophisticated solutions that interact directly with objects in the user interface of systems, leverage artificial intelligence to enable more robust automation.
What can you do with RPA?
RPA can be leveraged across the revenue cycle, including but not limited to:
- Denials management requests for medical records
- Missing Internal Claim Number (ICN)/Document Control Number (DCN) claims
- Eligibility research
- Medical billing edits
- Prior authorization submission/tracking and more
If you were to watch an ICN/DCN bot in action, you would see it create and pull a worklist out of a medical claims system to search for matches. When a match is found, the bot would then pull in specific data elements, detailing these on a daily productivity report. It would also update ICN/DCN claims, clear the edits and get claims out the door. This would continue daily, with users getting a completely new list of claims out the door every day.
Unique nThrive RPA architecture
The nThrive RPA architecture utilizes “micro bots,” which are standardized components that work together to deploy a process. This allows reuse and enables nThrive to maintain components across multiple processes to reduce downtime.
nThrive also leverages artificial intelligence (AI) to create even more sophisticated processes for users, enabling bots to recognize information on insurance cards, for instance.
How to get started on RPA
nThrive recommends a guided path for your healthcare organization, working with a vendor that has technical expertise and healthcare revenue cycle knowledge. Approximately 70 percent of the work is in identifying processes that will deliver the most value, optimizing and mapping them in advance of an RPA implementation.
Quantifying the labor savings
For hospitals and healthcare organizations that embark on an RPA implementation, the average labor savings can be dramatic. For instance, one large, 50+ hospital that deployed bots for adjustment claims (XX7 type bill), eligibility denials and root cause (XX7 claims), eliminated between two and four FTEs per application, resulting in ROIs of as much as 583%! Smaller facilities can also greatly benefit, often eliminating two or more FTEs.