RPA for Healthcare: Transform Healthcare Admin Work with AI and RPA
Transform Operations, Boost Efficiency & Compliance
Healthcare providers are facing high claim denial rates (~10-15% industry average) because of inefficient manual admin processes. Average healthcare practice losing up to $125,000 annually due to RCM (Revenue Cycle Management) inefficiencies. Another significant challenge for healthcare providers is slow reimbursement cycles averaging 50-60 days affecting provider’s cash flow.
RPA for Healthcare together with AI-agents has become the industry standard for automating medical coding review, claims submission, insurance follow-ups and payment posting enabling Healthcare providers to reduce denial rate by 30% and shorten reimbursement cycle to 30-40 days.
Increased business efficiency
Errors in assigning correct medical code may lead to denial – it’s a very often case in the healthcare industry. Submitting a claim and then processing the denial adds cost to operations which very often is more than the profits from the service provided to the patient. Healthcare provider owners have to write-off these claims.
Another issue is when claims are being missed, not-followed properly and in time – in this case after a period of time the claim is no longer reimbursed by the insurance leading to a write-off.
AI-agents are efficiently being used to review medical codes and making sure that the right medical code is assigned in line with guidelines. Once the code is assigned and the claim is formed by the AI-agent it’s then submitted for reimbursement by RPA via insurance portal. RPA bots perform automatic follow-ups and monitor payment status everyday. Once the payment is made RPA posts it in the practice management system.
Cost reduction and better ROI
Healthcare providers either outsource or insource revenue cycle management function. Given current advancement in AI technologies like LLMs and RPA take KPI’s of this function to new heights. It ensures better return on investment when compared to traditional outsourcing that doesn’t use modern technologies.
Shortening reimbursement cycle
Claims follow-ups performed automatically using RPA ensure that claims are not being missed and shorten the time taken to get the payment from insurance by 10-20 days
Use Cases of RPA in Healthcare
Once claims are formed RPA is used to submit it to the insurance portal. Numerous insurance providers don’t provide direct API connection, so do insurance brokers. RPA could submit claims to multiple insurance portals saving time and making sure that no claim is missed. RPA doesn’t require an API as it could mimic human action using the web portal user interface.
In order to make sure that reimbursements are being paid in a timely manner RPA is used to monitor the payment status of each submitted claim and to do automatic follow-ups. This enables healthcare providers to shorten the duration of reimbursements to be paid.
Once the payment is made the payment status is posted in the practice management system via API or using the user interface of the system. Automatic payment posting makes sure that all payments are properly managed and no manual errors occur.
RPA Implementation in Insurance
01
Gather data for the business case
Healthcare providers should gather data and calculate the denial rate, overdue claims (missed) throughout the year. Then calculate the cost of denial management (writing appeals, follow-ups) and cost of outsourcing/insourcing RCM business function.
02
Business case analysis
Automation service providers then assess the end-to-end RCM process and provide estimates on implementation fee and number of RPA licenses needed. If the total fee is fit to ROI expectation then an automation project is started.
03
Deployment and Integration
The RPA platform is either deployed on customer infrastructure or in the cloud that should be HIPAA compliant. As for AI-agents, the LLM provider should be HIPAA compliant too in order to ensure that patient data is secured and used in a safe manner. After that the automation project is being built for each part of the RCM process and testing is performed on a limited number of claims. After the successful testing the project is scaled to all claims.
04
Continuous Monitoring and Optimization
When automating the RCM process the project should include managerial reporting to track the performance or robots should be passing data to dashboards. Dashboards should be reflecting real-time analytics on all the claims.
Get Started with RPA for Healthcare Today
Discover how RPA can streamline your Healthcare processes, reduce costs, and improve customer satisfaction. Contact us today to learn how we can help automate your operations. Take your insurance business to the next level.
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FAQs
AI-agents with RPA could automate medical coding review, claims submission, automatic insurance provider follow-ups, payment monitoring and posting.
AI-agents and RPA makes sure that medical codes are assigned in accordance with guidelines, no claims are missed. Both technologies enforced by security controls comply with HIPAA requirements.
RPA and AI could reduce denial rate by 30% and shorten reimbursement cycle to 30-40 days.
RPA implementation depends on RCM processes, number and type of medical services provided. It might take from 1-3 months to automate RCM processes.
Successful implementation requires robust compliance frameworks (HIPAA), staff training to reduce employee resistance to change, and scalable governance.
Successful implementation requires robust compliance frameworks (HIPAA), staff training to reduce employee resistance to change, and scalable governance.
Key metrics that are being improved by implementing RPA and AI-agents are average denial rate and average reimbursement payment cycle duration.
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