Ramping Up Value with Revenue Cycle Process Automation: Three Key Considerations

Nearly four out of five health systems say they rely on automation in revenue cycle or are in the process of doing so, up 12 percent since 2000, a Healthcare Financial Management Association/AKASA survey shows. But there is a big difference between automating revenue cycle tasks or functions and automating workflows. The approach that a health system takes directly impacts the value from their investment.

When many of us think of robotic process automation (RPA)—or “bots”—in healthcare, what comes to mind are bots that assist with patient check-in or scheduling, automate billing edits, or automate prior authorization submissions. These tasks can be handled more efficiently when they are automated, but that’s not where RPA’s only value lies.

A next-level approach to deploying bots seeks to transform processes. These processes can include the way in which consumers are pre-registered for care by engaging them digitally, providing self-service options for patient registration that consumers can initiate at their convenience, and prompting patients for additional information when data is missing or questions arise. This approach can appeal to millennials’ desire for digital touch points and self-service options from healthcare providers. It can also boost efficiency while empowering health systems to pre-register 95 percent of scheduled patients—an industry best practice—before care is delivered.

A Process-Based Approach to Automation

Through 2024, large organizations will triple the capacity of their existing RPA portfolios, according to Gartner, with the market for RPA projected to reach more than $7.6 billion by 2028. For revenue cycle, benefits include seamless transfer of data, better data quality, enhanced revenue integrity, and greater operational efficiency. Among health systems interviewed by The Health Management Academy, 80 percent say their primary goal for investments in RPA and artificial intelligence (AI) is to bolster operational efficiency (91 percent), followed by cost reduction (82 percent) and increased revenue capture (74 percent). These health systems use RPA and AI for:

• Claims statusing (40 percent)
• Coding (28 percent)
• Payment posting and reconciliation (28 percent)
• Prior authorization (22 percent)

In addition, healthcare revenue cycle leaders can use bots to transform workflows.

For example, by using bots to redesign patient registration, hospitals can take a digital-first approach to patient registration. A 2021 study suggests that 80 percent of consumers prefer to communicate digitally with healthcare providers—whether via text or online messaging—at least some of the time, and 44 percent prefer digital communications most of the time, a shift in preferences that has occurred during the pandemic. At a time when a webchat provider has predicted the COVID-19 pandemic will fuel the “death of the call center,” given challenges staffing call centers, long wait times for live service, and some consumers’ reluctance to answer customer service calls, this might be a good time to open the door to omnichannel communications.

Additionally, bots open the door for self-service options that put data entry into the hands of consumers and data verification—in real time—in the form of AI-based tools that help prevent data gaps and inaccuracies from the start of the encounter. With the percentage of hospital claim denials rising—often due to missing or invalid data—bots present a way to tighten these processes without putting pressure on IT departments or revenue cycle staff.

And, when revenue cycle leaders deploy bots to map out the processes employees use for specific workflows, this enables revenue cycle leaders and IT teams to pinpoint inefficiencies in work—down to the keystroke—that could be eliminated with additional training, automation, or other supports. This reduces redundancy in work effort and elevates team members’ ability to work at the top of their game.

Supercharging the Value of RPA Deployment

How can revenue cycle leaders most effectively leverage RPA to elevate performance and strengthen the patient financial experience? Here are three considerations.

1. Partner with the organization’s chief digital transformation officer or IT department in making the business case for automation. Research by KPMG suggests RPA could reduce revenue cycle costs by 25 to 40 percent for hospitals and health systems, with nearly double the improvements in productivity of outsourcing specific processes. In organizations where a chief digital officer exists, gaining this senior leader’s support in initiating revenue cycle transformation through automation will help validate RPA in revenue cycle as a key strategic initiative. Support from this senior leader or the organization’s IT team also is valuable in connecting the dots for innovation in revenue cycle and developing the right plan for deployment.
2. Use RPA-enabled process mapping to strategically identify opportunities for automation. This creates visibility across all revenue cycle workflows, including the average time associated with each workflow. From there, revenue cycle leaders can consider: “Where can we remove variations in work or the potential for rework? What are the process bottlenecks that impede performance, and what steps can we take to eliminate these obstacles to increase agility?” Leaders also become better positioned to prioritize areas where automation makes sense for their team. One healthcare organization that relied on process mapping to examine claim processing workflows discovered that 75 percent of claims that were adjusted were not sent to the payer on time or were submitted with incorrect member or provider information. Nearly one out of five claim adjustments stemmed from errors in manual data entry. Through process mining, the organization discovered that automating certain aspects of claim processing could reduce claim processing expense by 74 percent.
3. Build a digital mindset culture in healthcare revenue cycle. Revenue cycle staff may be fearful of that RPA will mean losing their jobs. It’s important to level-set with employees that RPA is a tool to help them perform their work the right way the first time, every time, and to focus on the types of activities that enable them to contribute in bigger ways. For example, in talking with an insurance company about a claim that was denied for medical necessity, revenue cycle staff can easily point to the clinical data that supports their position and make their case. Staff also could become empowered to write simple bots at the desktop level to increase efficiency in day-to-day work, giving them ownership over this new tool.

By taking a comprehensive look at ways that RPA can be leveraged for process automation, healthcare revenue cycle teams can craft an approach for strategic innovation and long-term results.

Noel Felipe is senior vice president and revenue cycle practice leader for Firstsource.

For more on artificial intelligence in the revenue cycle, explore the AHIMA CDI Leaders Academy, which focuses on AI and machine learning specifically applied to the healthcare revenue cycle and clinical documentation improvement.