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Decoding RPA’s Role in Medical Coding and Billing with Use Cases4 min read

Decoding RPA’s Role in Medical Coding and Billing with Use Cases
Use cases for robotic process automation can help healthcare practices reap the benefits of a digital workflow. Increase efficiency with RPA.

We are identifying a significant transition in human history. Robots and automation have escaped the constraints of human imagination and entered the realm of reality. We are closer than ever to realizing what science fiction movies have been able to sell.  Machines are now able to replicate human behavior and do labor-intensive tasks more efficiently.

Recent research that was published in the Annals of Internal Medicine estimates that administrative expenses account for 34.2% of total healthcare spending in the United States. In many instances, the administrative costs incurred by healthcare providers account for a sizable part of total yearly expenditures. Many businesses are adopting automation to boost the effectiveness of specific office-based tasks. This is an effort to cut expenses that do not improve the value of treatment. Robotic Process Automation is the use of software tools or contemporary programming languages to partially or completely automate manual, rule-based, and repetitive human tasks. The excellent use cases for Robotic Process Automation in healthcare are listed below: 

Audit Standardization

Multiple tasks are included in the auditing process for risk assessment. To produce reports, such procedures and their outcomes must be documented. The involved parties get these reports for approval and verification. Such audits may be conducted for a variety of goals, including patient safety or service quality. For regulatory compliance, the reports produced during healthcare audits are essential. However, gathering and analyzing numerous reports from various auditing jobs, as well as working with several interested parties, may be time-consuming. Additionally, inaccuracies in these reports may lead to non-compliance with rules.

Bots make it simple to optimize audit operations. During audits, bots might produce reports and record data. The reports may be instantly distributed to the relevant persons for review and approval. Additional domains with potential for robotic process automation include:

  • Gathering and Cleansing Data
  • Risk Assessment
  • Administration of vendor agreements
  • Inventory Management
  • Processing of invoices

CPT Coverage Determination

In order to confirm the validity of claims and authenticate payout disbursements, insurance claim audit units conduct several appraisals. RPA boosts productivity and looks into any discrepancies in the claims that are submitted, saving insurance firms millions of dollars every year. Any claim system may be modified with bots. To establish CPT codes following NCCI changes and other industry standard edits, it features a virtual examiner. The amount billed, the amount owing, the contractual modifications, and patient obligations are all included in RPA’s analysis of payer-specific claims. The user can choose a time range for the data to be shown if an overall turnover has to be calculated.

Claim Management

Insurance claims administration is a strong feature for RPA since operations including data entry, eligibility processing, review, and handling appeals may be time-consuming, error-prone, and inefficient.

The average time to verify the status of a claim is around 85 seconds. If you just consider the sub-process of claims status checking, you can see how much time it takes to only check the status of claims. In just 12 seconds, one sizable health institution was able to monitor the status of a claim through the implementation of an RPA technology. In other words, one bot can complete nine people’s weekly work without making any errors. In this instance, over 11,000 claims status checks can be processed by the deployed bot in a six-month timeframe.

Patient Eligibility & Denial Management

The complexity of claims management procedures results in about $260 billion in yearly losses owing to claim denials. Issues with registration and eligibility are the cause of about 25% of these refused claims. A hospital in the Midwest used a bot to verify patient eligibility with several prospective payers and Medicare replacement plans. All self-pay patients and their probable eligibility for coverage under the various payers were compiled into a report by a bot. Once an appropriate payor was found, it also pointed up any missing details in the claim. Prior to this, denials for registration and internal claims were arriving 30 to 60 days after they were submitted. 

The hospital is certain that the eligibility information was verified by the usage of the bot, and they anticipate a considerable decrease in A/R.

Data Analytics & Diagnostics

Healthcare practitioners are forced to acquire a sizable volume of patient data that frequently remains undisturbed. RPA may be used to analyze this data and produce insightful analytics that is specifically suited to each patient. With more precise diagnosis and treatment, these insights can help healthcare providers and enhance the patient experience of care. A hospital in Dublin, for instance, has invested in RPA to enter and analyze patient illness codes and test data. By automating this procedure, the hospital saved around three hours of labor each day while simultaneously gaining insightful data about the patients.

The administration of insurance claims can be streamlined by utilizing RPA in the process. Data processing for insurance claims may be sped up and errors can be avoided with RPA bots. RPA bots can monitor the entire process and avoid delays. These bots may also spot compliance-related exceptions and help businesses comply with regulations. RPA can thereby increase the effectiveness of complicated insurance claims management processes in the healthcare industry. Additionally, RPA may be incorporated into telehealth services that are quickly expanding to do online screening procedures and support the diagnosis process. 

You can always seek assistance in automating healthcare processes and get endless benefits by teaming up with professional RPA solution providers.

Andrew Mark
Andrew Mark
As a healthcare IT expert, I bring extensive experience in revenue cycle management (RCM), medical billing, and coding. I am passionate about simplifying complex healthcare processes and empowering providers with efficient solutions.



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