RPA in Healthcare

The current buzz word in the business process outsourcing industry is RPA. Many of us, when we hear the word Robotic Process Automation (RPA), immediately imagine that robots are going to replace the human race!

Fortunately, this association is not true.

So what’s all this about RPA and how it’s transforming the way we work?  Let us take you through our ApexonHealth RPA journey in a US Healthcare provider and payor space.

Unlike any other industry, our US Healthcare Industry has many challenges. We’ve listed the major ones:

  • Volume of data handled is increasing per year
  • Complexity involved in the process is increasing with new healthcare reforms
  • Reimbursements are decreasing for clients
  • Legacy systems used are not easily customizable to meet current needs

Most organizations invest heavily in buying one RPA application and fail to bring the ROI as it may not fit the overall RPA requirement for all processes involved in the company.

At ApexonHealth, we created an “Enterprise Roadmap” for automation and provided solutions to some of the above challenges that our customers face. We use open source technologies which are measurable and reusable to overcome the constant change in Technology and process. All of our RPA applications meet security and privacy standards.

Our ApexonHealth Delivery excellence team has a perfect blend of both US healthcare knowledge & technical knowledge. Using the expertise of this blend, we constantly train our BOTs by feeding the required knowledge on how to handle the rules when processing a claim and addressing exceptions if any. We currently have close to 40-50 BOTs deployed in the live environment either in auto pilot or in the semi-autonomous mode based on the process complexity and requirement. We had successfully deployed the BOTs in various parts of Revenue Cycle right from EMR conversion to collection agency recollection. Below are a few of the successful BOTs we’ve implemented:

  • Citrix / Desktop environment to process a claim (Demo & Charge Entry, Payment Posting Etc.)
  • Website check (Eligibility Verification, Retro Eligibility for Medicaid to reduce the claims hitting the collections bucket) – Reduced denial % by 7% to 9%.
  • Customized Claim Scrubber to increase the first pass ratio by 3% to 5%
  • Revenue Reconciliation and Creating Month end reports etc.
  • Provider Data Management for a large payor client.

The outcome of creating the RPA ecosystem is outlined below:

  1. Any volume of claims we are able to scale up / down using the BOTs by meeting the TAT
  2. We help our customers to reduce the cost of processing a claim so they can take additional volume without incurring additional cost
  3. We help our customers to build RPA platform on top of the practice management system to meet the industry needs. Ex: PQRS measure validation etc.
  4. Overall KPI metrics (Denials, AR days, First Pass ratio, Revenue per encounter etc.) have shown a positive impact after RPA implementation.

We would like to hear your views! If you’re interested, we will collaborate with you to meet your organizational goals with the help of our RCM team and BOTs in action.