In the wake of the pandemic, turnover is on the rise in many RCM teams, as employees resist back-to-the-office strategies and instead often seek remote job opportunities at other organizations. At the same time, the volume of administrative work associated with denials has increased significantly.
RCM staff are now handling a barrage of repetitive work, rather than navigating patients through complex reimbursement rules.
During a Becker's Hospital Review webinar sponsored by Finvi, four RCM experts discussed how hospitals and health systems are using robotic process automation (RPA) to create intelligent, centralized workflows that boost team productivity, improve the patient financial experience and maximize revenue. The panelists were:
- Kevin Holst, chief revenue officer, Finvi
- Amber Farnworth, patient financial services manager, Glendive (Mont.) Medical Center
- Pam Jordan, senior director of collections, Parallon/HCA
- Andrew Woughter, chief executive officer, absolute Automations, Finvi RPA consultant
Three key takeaways were:
1. A common myth is that RPA is only suitable for very basic processes. In reality, RPA can handle complex workflows efficiently and effectively. The capabilities of RPA provide the opportunity for organizations to rethink how they might do things differently. "Most people believe that RPA is simply a software robot that logs into systems and does things on behalf of a human," Mr. Woughter said. "It's more than that, however. RPA can interact directly with software, triggering application programming interfaces and processing large data sets."
2. Hospitals and health systems are leveraging RPA for a variety of RCM workflows. Glendive Medical Center, for example, uses RPA to create good faith estimates for patients. "We didn't have the staff to meet the requirements associated with good faith estimates," Ms. Farnworth said. "Now a bot goes into our scheduling system, identifies the reason for the visit, picks up the charge from the charge master, builds an estimate and emails it to the patient."
Parallon/HCA is growing its use of RPA across all areas of the organization from payment compliance to front office tasks, coding and more. "Claim statusing on payer websites was one of the first things we did with automation," Ms. Jordan said. "The bot brings back the current claim status. We've built a mapping based on those values which identifies potential actions. It might be to accelerate the account and get it into the hands of a collector sooner, query whether a patient is eligible for another insurance or trigger an itemized bill."
When it comes to denial management, bots can be used to accelerate that work and reduce the burden on RCM teams. Although not all denials are avoidable, there are quite a few where it's possible to automate work and avoid the denial entirely in the future. "It may be using bots to send medical records for certain services that are usually denied for additional documentation. It could be fixing coordination of benefits errors upfront, by using a bot to scrub eligibility files that you get. The opportunity is to look at the transactional work your people are doing that could be accelerated through a tool that makes them more efficient," Mr. Woughter said.
3. Before deploying RPA, analyze current tasks and focus on quick wins. As hospitals and health systems begin their RPA journey, it's important to examine the RCM team's workload. "Is there transactional work that could be accelerated? Where can you improve staff efficiency and enable employees to lean into their strengths?" Mr. Woughter asked.
RPA can be used to remove noise from the RCM team's inventory. "Look for low-hanging fruit where you can get quick wins from automation," Ms. Jordan said. "Our employees now focus more on complex claims that require a higher degree of intentional review. That's been a win, in terms of getting cash in the door."
Looking to the future of RPA in healthcare RCM, bots will handle transactional work so humans can do the work they find most fulfilling. "We are entering an era where we must manage humans, bots and AI simultaneously," Mr. Woughter said. "How can we give employees more work that plays to their strengths, rather than miring them in repetitive work that technology can handle?"
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