How Software Robots or "Bots" Automate Processes

3 minutes and 14 seconds

Average time for billers to work each XX7 claim looking for an ICN/DCN

16.7 seconds

Average time for bot to work each XX7 claim looking for an ICN/DCN

Robotic Process Automation uses software robots or “bots” to automate processes that replicate the actions of a human worker interacting with one or more systems’ user interfaces, resulting in improved productivity and efficiencies. Evolving from simple screen scraping and keystroke emulation, bots interact at the OSI Layer 7, leveraging artificial intelligence to convert human processes to computer automation.

A typical RPA bot example:

  • Looks up claim in payor website

  • Gets medical records directly from EMR

  • Downloads as a pdf

  • Creates an appeal on payor website

  • Attaches medical records pdf file

  • Submits the appeal

  • Gets the ticket number from payor website

  • Puts note into patient accounting system stating what it did and includes the payor ticket number for the appeal

Because deploying bots can be an expensive venture, a "try before your buy" approach helps to lower your investment risk. nThrive can deploy bots live before you pay and we may even be able to guarantee your return-on-investment (ROI) threshold for specific bots.

At nThrive we also architect our bots by component to enable maintenance at industry scale. For example, our component that logs into specific payor websites is common in processes for many different health systems. This allows us to maintain one component and update it across all processes for all clients, creating some of the most robust bots in the revenue cycle industry.

Here are cases where nThrive RPA is deployed today:

  • Working Denials requesting Medical Records
  • Lockbox Correspondence
  • Late Charge Automation
  • Loading Fee Schedules
  • Clearinghouse Submission/Retrieval
  • Medicaid Remit Data Extraction
  • Eligibility Research
  • Billing Edits
  • Plan Code Selection from scanned Insurance Card
  • Government Eligibility Denial Elimination
  • Underpayment Recovery
  • Prior Auth Submission/Tracking
  • Initial Attachment Submission
  • Notice of Admission
  • Late Charge Validation Pre-Bill
  • Charge Reconciliation to Dept Systems
  • Medical Records for Work Comp – Jopari
  • Missing Internal Claim Number (ICN)/Document Control Number (CDN) Claim Edit/Hold
  • Medicare Hospice Overlap
  • Medicare Bad Debt Validation

Examples of client success:

CLIENT SUCCESS:

LARGE 50+ HOSPITAL

GROUP #1

  • Adjustment (XX7)
    Claim Type Bot

    AVG. LABOR SAVINGS:

    2.5-4 FTEs

    ROI:

    365-583%

    ADJUSTMENT CLAIMS
    (XX7 Type of Bill)

    Eliminates high labor cost and accelerates billing cycle

    Checks for ICN/DCN daily and fixes any claims for which it finds an ICN/DCN

    Eliminates time-consuming claim holds and prevents delays caused when ICN/DCN is available prior to the hold date expiration

  • Medicare and Medicaid
    Eligibility Scrub Bot

    AVG. LABOR SAVINGS:

    1.8-3 FTEs

    ROI:

    263-438%

    ELIGIBILITY DENIALS

    Addresses denials for Medicare/Medicaid patients whose claims were rejected/denied for having a MCO Medicare replacement plan

    Identifies the MCO plan and gathers the needed registration information to update the account prior to billing

    Prevents denials rather than simply automating the working of the denial

  • Late Charge Management Bot

    AVG. LABOR SAVINGS:

    1.2-2.75 FTEs

    ROI:

    175-401%

    ROOT CAUSE
    (XX7 Claims)

    Supports Adjustment Claims Bot

    Leverages the pricing engine in Contract Manager to adjust the late charge for those that will not have net reimbursement effect

    Eliminates the need for an adjustment claim

CLIENT SUCCESS:

LARGE 50+ HOSPITAL

GROUP #2

  • False Underpayment Variance Bot

    AVG. LABOR SAVINGS:

    3.6-6 FTEs

    ROI:

    525-875%

  • FALSE VARIANCES

    Works within the nThrive Contract Management system

    Scrubs accounts with payment variances

    Checks several sources to identify if the variances are false

  • Finds registration data discrepancies (The largest root cause of false variances)

    A second bot in development stages will address root cause to help registration select correct plan code based on information entered or scanned insurance card

A small 25-bed hospital expects to save two FTEs once their cash-posting bot is live.

The functions the bot performs are:

  • Getting cash posting files
  • Modifying cash posting adjustments to prevent credits and other posting errors
  • Automation of manual posting into Hospice and Durable Medical Equipment (DME) systems
  • Reconciliation of posting to bank deposits

Ready to reduce time and prevent errors with next generation RPA services and technology?

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