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How AI and RPA Bots Streamlined a Podiatry Center's Accounts Receivable Process
Table of Contents
Introduction
The Challenge
The Podiatry Medical Center was dealing with a critical AR backlog that continued to grow over time. More than $100,000 in collections every quarter was tied up in pending AR claims. The volume of unpaid and underpaid claims affected the center’s financial stability while also placing additional pressure on its administrative resources. Traditional manual methods were proving ineffective. Repetitive AR reconciliation tasks were time-consuming and contributed to errors and delays. The backlog eventually reached approximately 96,000 claims by August 2023, creating the need for a swift and cost-effective solution.
Compliance Concerns
The facility’s non-adherence to important regulations was identified as 10% of its operational issues, with potential implications for patient trust and safety.
Our Solution
Medientsky Billing worked closely with the client to understand the existing AR process and identify how automation could improve the resolution of pending claims. The objective was to create an automated process that could streamline AR resolution while maintaining accurate account balancing and financial accounting.
The solution leveraged Robotic Process Automation (RPA) and AI bots.
1. Identifying Unpaid Claims
The AI bot was programmed to identify unpaid claims and open line-balance claims associated with each patient’s encounter, with a focus on the date of service (DOS).
2. Transferring Unpaid Amounts
The bot transferred unpaid amounts from pending claims to open line-balance claims. This reduced the payment due on the latest claim. The process was repeated for the same patient account until no applicable claims remained.
3. Updating Claim Status and Documentation
The AI bot updated claim statuses throughout the process. It also maintained a transfer sheet documenting each financial transaction according to the client’s specific requirements.
4. Notifying AR Specialists
To maintain transparency and accountability, the AI bot sent notifications to designated accounts receivable specialists. These notifications provided a summary of the financial movements associated with each claim.
The Impact: Improved Efficiency and Accuracy
The implementation of the Accounts Receivable bot produced measurable improvements in the AR resolution process.
100% Success Rate:
The bot achieved a 100% success rate in executing its assigned tasks. By automating the process, it eliminated errors associated with the tasks and significantly reduced the level of human intervention required in the AR workflow.
Dramatic Time Savings:
Before automation, manual AR resolution tasks required approximately 10 to 20 minutes per patient. After implementing the RPA bot, the same process was reduced to under 4 minutes per patient encounter.
Results
The AI-driven transformation also produced substantial cost savings.
Before Automation:
Annual Cost of Handling AR: $98,000
After Automation:
Annual Cost: $23,000
Cost Savings:
$75,000
Return on Investment:
133.3% ROI The reduction in annual AR handling costs demonstrates the financial impact of automating repetitive accounts receivable processes.
The Need for Automation in Healthcare RCM
Healthcare organizations continue to focus on improving patient-centered care while also increasing operational efficiency. For medical centers such as the Podiatry Medical Center, effective Revenue Cycle Management is essential to maintaining a healthy financial operation. RCM encompasses the administrative and clinical activities involved in capturing, managing, and collecting revenue from patient services. These activities can include:
- Patient registration
- Insurance verification
- Claims submission
- Payment posting
- Denial management
- Accounts receivable resolution
Accounts receivable claims represent outstanding payments owed by patients or insurance companies for services provided by the medical center. Resolving these claims accurately and on time is important for maintaining cash flow and supporting the financial health of a healthcare organization. As the Podiatry Medical Center experienced, managing a large AR backlog can become particularly challenging when processes depend heavily on manual work.
Common Challenges in AR Management
Increasing Claim Volume
Healthcare organizations often manage large volumes of claims, each with different requirements and complexities. Manual processing can be time-consuming and may increase the risk of errors.
Complex Billing Rules
Healthcare billing requires organizations to navigate insurance policies, regulations, and coding requirements. Maintaining accuracy while working within these requirements can be challenging.
Resource Constraints
Healthcare facilities may have limited staff time and financial resources. Manual AR resolution can place additional pressure on these resources and create operational inefficiencies.
Revenue Leakage
Unresolved AR claims can contribute to revenue leakage when payments are delayed or billing inaccuracies prevent claims from being resolved efficiently.
Conclusion: A Blueprint for Success
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Highlights
- 80% Hours a week spent doing manual AR tasks
- 78% Increase in team productivity
- 29% Monthly revenue lost
Client Specs
- Location: Washington
- Specialty: Behavioral Health
- EHR: Incredible
- Average collections: 300K per month
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