• Jorie Healthcare Partners

Things You Need To Know About Healthcare Revenue Cycle Automation

Automation is the key to innovation. Driverless cars, smart homes, and continuous learning technology are just a few examples of innovations made possible by automation. As automation brings about disruptive new capabilities for healthcare operations, leading providers are embracing new management paradigms and adopting novel technology strategies to capitalize on the benefits of these innovations.

Revenue Cycle Management is among the most attractive business functions to automate for healthcare providers. Robotic Process Automation (RPA), Intelligent Automation, and cognitive methods such as Artificial Intelligence (AI) can help healthcare organizations improve efficiency and ultimately reduce the cost to collect, which is a key for improving cash flow.


Eligibility Check and Benefit Verification:


Prior Authorization - RPA bots are capable of navigating to the eligibility check section of payers' portals to gather information needed to submit prior authorization requests. Once this information is gathered, the bot can open a list of patients who require an eligibility check and perform the process by selecting one patient at a time. The Management Minutes Category Code (MMC Code) is used to determine reimbursement amounts. Providers who use the standard reimbursement facility rates data on payer portals will have their reimbursement accurately recorded using the standard reimbursement facility rates data on payer portals.


Data export is a common feature of RPA bots, which allow them to retrieve account receivables data from practice management systems. They can then log into payer portals and retrieve claim status for specific claims. No-response claims are claims that go unanswered by payer organizations. Effective and continuous follow-up with no-response claims is the only solution to this problem.


A/R specialists can use claim filters to identify claims and regularly alert them for further escalation. Superbills is a software program that downloads superbills containing all the patient visit and clinical encounter information, and primes the information for review by the medical coding team. It also extrapolates and aligns data with the practice management system during the charge submission process


Charge Submission: Bots are configured to specifically address the workflow of healthcare practices and ensure that the data for claims is compiled and submitted accurately.


Expected Outcomes: A reduction in errors during data entry, along with a reduction in FTE hours by 40% during the charge submission process.


Denial Management: Exception flows assist with the prevention of denied claims, as well as with denial management. Bots can move claims that cannot be salvaged to an exception path flow where A/R specialists can move them to a high-priority manual intervention and correction queue. RPA bots can track and highlight error patterns in the claims denial management process, thereby enabling A/R specialists to make effective/corrective changes to the claims submission process.



Revenue cycle processes are especially amenable to improvement using RPA. For example, with respect to Accounts Receivable (A/R), the role of RPA is to drive efficiencies in the level of effort required to collect from payers and patients, while also streamlining upstream processes such as eligibility and authorization.

When combined across a single unified workflow platform with sophisticated analytics, the impact of RPA on the overall financial returns to healthcare providers both large and small can be significant.


As government and commercial payers reduce reimbursement rates and providers are forced to maintain compliance with a bewildering array of new and evolving regulations, automated solutions can help to address these challenges. The challenge of managing regulatory compliance within healthcare organizations requires additional cost and complexity. A proven way to accomplish this goal with significant benefits is to leverage RPA to improve Revenue Cycle Management services.


Business process outsourcing technology can take over routine, repetitive, and often time-consuming tasks within the revenue cycle. As BOT's functions 24/7 across an enterprise in complete harmony with staff, there is great potential to achieve higher levels of productivity and efficiency.



































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