Big ideas

Robotic Process Automation for revenue cycle is a reality

Revenue Cycle process automation. Is it a pipedream? Hardly. Recondo's Robotic Process Automation (RPA) processes for data collection can provide up to a 90 percent reduction in costly human intervention and drastically increase the likelihood of hospitals being paid in full. A single query on billed claims does not often provide an informative, straightforward response. Many payers post vague statuses of claims resulting in staff inefficiently navigating to a portal to find more detailed information regarding a claim. According to Recondo's clients and industry standards, over half of the follow-up staff work on open items that do not require specific attention (i.e. most claims have since been paid, or are on a hold from the payer and should not be investigated). Staff members then manually note information from calls, emails and portal visits in the host system. Automation of even a portion of these status updates can reduce unproductive follow-ups.

Major healthcare organizations are using RPA tools, like Recondo, to quickly return an actionable response. The automated tools request and collect real-time information on all aspects of claims and remittances and no manual effort is required. As a result, participating healthcare organizations have eliminated a significant amount of manual intervention on claims.

Recondo continues to have significant strides in the business rule development, resulting in decreased human variability and costs as well as increasing productivity. These rules are what drive the status of claims, while also creating useful notes regarding specifics of the account state. Responses will include payer specific information in the details but group them into categories for organization and simplicity of assigning tasks to representatives. The robotic process automation (RPA) consistently includes new payers and statuses to further decrease the time spent pursuing claims that do not require human intervention. The development and continued improvement of these rules drives the automation and standardization of claim statuses from multiple states and payers. By creating common categories and sub-categories, variability between payers and staff can be reduced or redeployed on more value added tasks. This, in return, streamlines follow-up processes to review only claims that require human intervention. All users can retrieve status details on nearly all accounts receivable inventory from any payer who is part of the system with all responses, even from multiple payers, retrieved and consolidated into a single standardized format. This information includes payer specific adjudication codes telling the exact status of a claim and if anything needs correction. The business rules of the RPA are what drive the claim through workflow and pull out standardized exceptions that require a touchpoint.

Growing hospitals and health systems continually struggle to keep up with the backlog of claims requiring review, and without an automated tool staff become perpetually behind. With a growing backlog another concern is the increasing delay in follow-up time, which decreases likelihood of being paid in full. Recondo's clients can attest that write-offs due to untimely filing have decreased since implementation, which results in more revenue being generated for participating hospitals.

Target outcomes with RPA implementation include status updates on all accounts, driving those that require follow-up are sent directly to the correct individual. Again, this functionality will likely remove over 50 percent of accounts awaiting follow-up that would be marked complete or pended out further. This creates a more efficient workforce and rapid liquidation of accounts.