In healthcare, automation could be something as simple as a bulk of daily emails or text messages reminding patients of their appointments the next day. Or it may include automation of complete patient care cycle including Revenue cycle management (RCM). It comprises a series of complex business interaction with patients and care providers that entails many touchpoints, starting from the pre-claim stage, passing through various stages including insurance verification, both point-of-service and after-service collections to finally reach account receivables management and analytics.
There can be about a dozen stages in the revenue management cycle, making it difficult to avoid errors and delays out of the entire process. Healthcare providers must receive insurer and patient payments in a time to maintain profits. This also entails keeping up with changing government regulations and insurer reimbursement policies, and ensuring that claims are filed and paid efficiently. Mismanagement of any of these functions can impact patient and clinical satisfaction scores and harm the reputation of the organization through avoidable denials and bad debts.
RPA and AI can be leveraged to automate these processes and reduce the number of errors made in long, drawn-out assignments like coding & charge capture, patient records, payment posting, revenue allocation, claim status, patient statements, inbound and outcome calls, etc. Using Automation in healthcare, you will spend less time and money auditing, reviewing, or revising mistakes and focus on. Let’s see how?
Since there is a shortage of health care workers, automation is poised to help the industry make healthcare more affordable and accessible. Especially in pandemic situation where there is a need to continuously monitor and check-in large patient populations; automation is the way forward!
As increasing health costs worry patients and care seekers alike, striking a balance to provide the right care at the right price has, therefore, become extremely imperative for all. In such a scenario, automation can play a significant role in controlling rising costs and catering to a bigger volume of care seekers(especially the increasing number of aged population).
Traditional approaches to patient care depend heavily on human intervention, and are not suited for high-volume and repetitive actions. When it comes to healthcare, there can be no compromise on quality. It requires the highest degrees of accuracy, repeatability and reproducibility to take care of patients and save lives.
Automation can simplify the patient care taking and revenue cycle and provide significant cost savings throughout the patient care cycle involving different stages like–
Pre-Claim
• Contract negotiation and provider credentialing
Pre-Visit
• Patient registration and eligibility verification
Visit
• Patient check-in, documentation and payment arrangements.
Claim submission
• Easy access to insurance coverage details
• Quick availability of patient claims history
Account Receivable Management
• Claim status; denial analysis/appeal and resolutions
• Patient refund
Reporting and Analysis
• Cash collection
• No show rate and payers denial rate
• Rejection Analysis, etc.
How can Automation make healthcare efficient and affordable for masses?
Replacing human/manual intensive and repetitive tasks – By replacing manually intensive, repetitive & mundane tasks with automation, we can eliminate the need for human assistance for trivial jobs thereby reducing staffing costs and improving efficiency and speed of patient care. Leveraging automation helps eliminate manual effort for acquiring data from multiple clinical financial and administrative systems.
RPA and AI solutions empower healthcare facilities the ability to streamline claims management, reduce claims rejection, efficient claims submission, implement discharge instructions quickly and effectively, and simplify the patient account creation, appointment-scheduling process.
Eliminating human error – Automation tools help eliminates human error. Further, it also overcomes human fatigue, thus providing a consistent service and patient care. Automation has application in areas of maintaining medical records, data/order entry, and decision support to minimize cost and complications. With Automation, you can streamline communication between patients and claims agencies, eliminate errors in claim processing and rejection/returns This will enable organizations to move at a faster clip and transition without costly errors by eliminating all technical and administrative overlooks.
Freeing your hospital staff for more complex and important tasks – By transferring back-office, clerical tasks such as claims filling, complicated procedures for patient information documentation or new patient appointment requests to robots, doctors and other staff members can use their clinical skills to better address patients’ needs and make healthcare not only more affordable for them but more personalized.
Making multi-tasking easier – Leveraging automation you manage multiple task easily. Automation can help make tasks involving multiple activities and solutions such – eligibility verification, fetch claims status data from Payer website, automated payment posting, automated file management solutions much easier to manage.
Additionally, you can manage a lot of other operational activities like patient appointments, claims evaluation, administration and management, or clinical documentation error-free and fast; healthcare organizations can stamp out re-processing costs and noticeably reduce the overall costs of healthcare.
Bringing in cost efficiency – Apps and smartphone features enable healthcare providers to replace expensive equipment with smaller, relatively inexpensive devices, and enable patients to carry out simple tests themselves at home. Patients can save the cost of travel and consultation and also the time spent in travelling to the hospital and time spent waiting for their appointment.
Leveraging automation, healthcare providers can focus on augmenting the patient experience while reducing costs and improving efficiencies across the back office. You can easily automate the segregation of calling and non-calling accounts based on the availability of information on the payer website and a host of other similar activities.
How automation makes healthcare accessible to a wider audience
Automation in healthcare can support in providing adequate medical care to a large number of people. Instead of a physical visit to doctor and as an alternative to hospitalization processes, automation can make healthcare more accessible to the masses through the use of telemedicine and quality healthcare apps.
This will also help patients in remote places to avail medical support through electronic means, automation can drive relief and support almost real-time or instantaneously. Casualties and lives lost to time delays can now be saved easily.
Automation can turn your normal smartphone into a medical device; using medical apps patients can easily view, record, and maintain vital bodily stats & functions and send reports across to doctors for immediate diagnosis and cure. This will save considerable time and money in travelling all the way to the healthcare center.
By automating scheduling, healthcare organizations can reduce the time spent on administrative work such as booking appointments, answering calls and reminding patients about appointments. Patients can easily view when appointments are available and book a slot using their mobile phone or any other device– thereby increasing attendance while saving time and money.
Telemedicine can make healthcare more accessible to extremely sick or immobile patients or patients in rural communities, who do not have easy access to health services; by providing healthcare services remotely. Virtual consultation is often cheaper than in-person visits and doesn’t require sick people to go out in public, which can endanger others.
Patients in distant rural areas no longer have to travel far distances to see a doctor in urban areas; video conferencing enables primary care doctors in rural areas to consult with a specialist virtually and avoid sending patients for expert consultation all the way to a physical location.
Using Automation tools, policyholders can submit claims using a web portal or even a mobile phone. It brings tremendous value in the process of claim reviews; patients can easily submit their claims and hospital staff can easily view details of the claim for quick closure.
By avoiding the use of paper, spreadsheets and other paper reports that lead to a lot of waste, automation can accelerate the care delivery process and connect nurses and patients easily and efficiently and minimize waste.
Revenue recovery is an important aspect of the overall financial performance of a health care provider. According to a report from Becker’s Hospital Review, the healthcare industry nationwide spends roughly $8.6 billion on appealing denied claims. Further, an average hospital loses almost $5 million in revenue due to denials.
It has been found that mostly a denied claim is the result of a simple data entry error, duplicate filing or missing information; all of which are largely due to the fact that this process is very manual, and human error is unavoidable.
Improve consistency of patient care
In the last couple of decades, digitization has made information sharing across disparate solutions, including revenue cycle solutions, third-party portals, scheduling applications, EMR/EHR, laboratory information systems, etc. with healthcare professionals much easier and has improved the efficiency of patient care and overall service outcomes.
Automation is revolutionizing the healthcare industry and making it more cost-effective for healthcare organizations to run day-to-day operations. If you are planning to start your automation journey in your healthcare environment, start by applying the same on simple standardized, and repeatable processes; choose something that is a common procedure that is performed on a large population of patients on a regular basis.
Organizations are using Automation, AI & ML, Microsoft Teams, Microsoft Platform, and Azure to drive better health outcomes, improve cybersecurity, scale faster and enhance data interoperability.
Reducing administrative workloads by leveraging these advanced technologies will not only help make healthcare more affordable and accessible to a larger population but also result in the utilization of human skills for more strategic work, enhancement of information exchange, and consistency & accuracy of patient care.