How can RPA help in Healthcare RCM?

Recent research shows that the healthcare RCM market is projected to grow to USD 65.2 billion by 2025. This growing market would need skilled workforce, which is already a scarce resource. With this tremendous projected growth, hiring and retaining top talent will pose to be a huge challenge.

Unlike other automated approaches, Robotic Process Automation (RPA) delivers non-invasive automation. RPA automates processes, using the UI of the existing application, mimicking human interactions with it. The healthcare RCM space, with its lack of skilled labour can benefit immensely from RPA BOTS, which can help to automate mundane rules-based tasks freeing up skilled employees and enabling them to take up more skilled tasks. This will further help in retaining top talent and providing them with a better career path.

Healthcare RCM with its numerous rule-based processes, deem to be a good fit for RPA.

Candidate processes for RPA implementation are:

  • Capture of patient demographic information into practice management tools like Centricity, Kareo etc.
  • Verification of procedures performed (CPT or HCPCS codes) and diagnosis code (ICD -10 codes)
  • Entering charge capture information
  • Verification of the status of a submitted claim
  • Generation of patient bill statement including Explanation of Benefits (EOB) where applicable
  • Verification of claims before submission

RPA can improve speed, performance and accuracy of billing processes. It can help navigate the RCM bottlenecks, lower overall cost of operations and much more.

RPA builds a virtual workforce which works alongside humans in the RCM back office to –

  • Improve billing efficiency
  • Decrease time between claims and payments
  • Decrease claim denials by improving quality of claims

Implementation of RPA would see changes in terms of technology requirement and process upgrades. But, that should not be treated as a deterrent in the implementation of RPA BOTs to simplify work, and improve outputs. The important aspect is clarity of objective and an understanding of benefits expected from an RPA implementation, which will help in being adequately prepared with needed inputs.

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Sandeep M Somashekar

Sandeep M Somashekar

Sandeep heads the Robotic Process Automation (RPA) practice at iNatrix. He has worked on a wide range of technologies such as embedded programming, OS internals, and latest web technologies. In his personal time, he enjoys cycling, and reading non-fiction.