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Automating Healthcare Revenue Cycle Management with RPA and AI

Robotic Process Automation Tools

The healthcare industry is a little more complicated than most other sectors, especially regarding RCM (revenue cycle management). The definition of ‘payment collection’ in healthcare is not as straightforward as sending invoices and processing payments.

Instead, a lot goes behind determining the scope of payment collection and actual payment receipt. The entire process includes determining who owes the payment liability, the insurance provider, or individuals. Post this, there is, the department also needs to initiate the further document verification process.

Now that you have an introduction to revenue cycle management, let’s start discussing the role of robotic process automation and artificial intelligence in this aspect.

Challenges of Revenue Cycle Management in Healthcare

RCM for healthcare includes multiple front- and back-office operations. Between these two, the healthcare authority is liable to share data with three crucial stakeholders, the patient, the service provider, and the payer (insurance company). If this sounds hassle enough, add the aspect of managing the entire process manually.

There are several challenges to managing these manually. Let’s know about them now!

  • Erroneous Medical Billing

    Healthcare institutes need a lot of data related to the patients’ registration bills, medical bills, claims, etc., to manage and maintain their revenue cycle. However, the documents and data circulating within such processes were tough to manage and kept error-free. So, with wrong and erroneous data on medical bills, the period between the billing and payment is high, impacting the revenue cycle management.

  • Regulatory Compliance Maintenance

    The healthcare sector often experiences new regulations and compliances, and being in line with them is imperative. Failing to do so can lead to problems of claim denial, delayed payments, billing backlogs, etc. And impact the revenue cycle.

  • Security Management

    Since a huge amount of data is circulating among a lot of staff, physicians, and IT service providers, data breaches and identity theft can become common issues and delay the claim process and payment. And apart from just the delay in the payment, it brings a lot of other issues to the table as well.

Robotic Process Automation and Artificial Intelligence in Healthcare

Revenue cycle management is on a growing trend. Statistically speaking, the RCM market is estimated to grow at a good CAGR of 11.6% between 2022 and 2030. Considering this growth, the demand for artificial intelligence and robotic process automation tools is growing too.

There are enough reasons behind this too. So, let’s start discussing the scope of RPA and AI in healthcare RCM.

  • Insurance Eligibility Verification

    In many cases, healthcare providers check patients’ insurance eligibility before seeing them. Now, verifying all these data manually can take a lot of time and hinder the productivity of the institute. However, robotic process automation services and tools are targeted at removing repetitive and tedious tasks.

    AI-driven technology makes the process more efficient by employing OCR and ML for data extraction and verification.

  • Claim Preparation

    The medical insurance claims process is another aspect of medical RCM that consumes a lot of time. It includes the physicians’ reports on the diagnosis, treatment, and surgery and is an important part of revenue management.

    Robotic process automation, in tandem with artificial intelligence, can help with seamless data integration across the institute from various physicians. In addition, automation here can cut down the time and effort invested in these tasks for faster data access and claim preparation.

  • Claim Submission

    Healthcare institutes share all the claims with the insurance providers through specified portals. However, the problem arises with data integration on multiple systems, which is a tedious process. To eliminate such challenges, a collaboration of RPA and AI in automation tools and services has been employed to drive better process efficiency.

The Final Story

Robotic process automation is the way for businesses in every sector, not just healthcare. However, many startups and mid-sized companies consider RPA to be an overwhelming transition from the manual; that’s not the case.

Want to know more about robotic process automation and its implementation? Reach out to us; let’s discuss!

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