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Using Robotic Process Automation to Drive RCM Efficiency

SYNERGEN Health
May, 2021
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When it comes to collecting for services performed, organizations look for ways they can increase their time to cash. The longer receivables age, claims left underpaid, or unpaid altogether, creates a financial hardship for the practice. As the number of patient balances increases to over 50%, practices are looking for ways to reduce patient liability, improve time to cash, while reducing their costs to collect.

Consider investing in technology solutions to drive improved results across the back-end revenue cycle process. For example, artificial intelligence, machine learning, and robotic process automation in the following three revenue cycle processes:

Coding optimization and denial prevention

The Medical Group Management Association (MGMA) reports that the industry benchmark for total claim denials is around 5%, with the vast majority being a consequence of improper coding. In our experience, most practice denial rates are closer to 10% – 15%. By utilizing AI processes to automatically integrate with their claim scrubbing solution, providers can determine if a diagnosis and procedure code combination is accurate and warrants medical necessity, and if specific modifiers are required when submitting the claim. Proactive denial management based on predictive analytics from historical denial patterns eliminates the need for expensive follow up on the back-end.

Claim follow-up

Following up on claims is a necessary step in proper revenue cycle management when payers don’t respond. Insurance carriers require that providers log into their payer portal or Interactive Voice Response System (IVR) and enter multiple fields data to identify the status of claims one at a time. AI can be used to automate the claim follow-up process and lessen the turnaround time. By utilizing technology to do the tedious perform manual work, organizations can proactively address issues and free up resources for other billing related tasks.

Appealing denied claims

The Healthcare Billing and Management Association (HBMA) has reported that as many as 30% of claims are denied or ignored on the first submission, and 60% of those are never resubmitted. Appeals are labor intensive due to the time required to research, construct an appeal letter, and attach the required supporting documentation. as Each denied claim is said to cost an average of $25 to rework. Automating the appeals process to collect the required documents and upload them to payer portals according to their requirements can ensure appeals are filed and processed in a timely manner. This also allows providers staff to work on more claims simultaneously with higher throughput up to 400% in our experience. The end result increasing efficiency, lower costs while improving cashflow.

By improving revenue cycle efficiency, providers can continue to remain financially healthy as complex payment models combined with higher unemployment continue to largely affect operational costs. This includes incorporating the use of robotic process automation technology to optimize billing efficiencies and improve their time to cash.

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