Prior Authorization Automation

A Philadelphia-based hospital implemented prior authorization automation after enduring delayed authorization approvals, and after a few weeks, they found that they were able to document fast within 1-2 minutes. This also increased the ROI by above $200K per month and saved 72 hours weekly.

Charge Capture Automation

Another health system with multiple locations struggled to keep up with the overwhelming volume of charges that needed to be entered daily. They have implemented an automated charge capture automation that was quickly able to adapt in a week’s time where it takes 10-15 minutes to capture a charge for a claim and a biller can only enter 50 charges per day during their 8 hours work shift.

RPA charge entry bots performed this process for them in just 1 minute per claim and were able to complete their daily production target within 3 hours avoiding late submissions and unnecessary collections problems. Overall they saved 3.7 days or 90 hours worth of pending backlog of charges if entered manually.

Accounts Receivables Automation

A Pittsburgh Medical Center implemented an automated Accounts Receivable system that improved its billing processes, resulting in a 20% increase in net revenue and a reduction in the number of days in accounts receivable by 20%. It created drastic production time variation as RPA bots worked within 7.5 hours whereas manual work hours exceeded 30 hours or 1.2 days.

Denial Management Automation

A New York-based Health System implemented a claim denial management automation system and saw a 12% increase in net patient revenue and a 50% reduction in the number of denied claims reducing their time to resolve denials by 5 hours rather than 20 hours.

Eligibility Verification Automation

A hospital in Ohio implemented patient eligibility and benefits verification automation because they faced 80% of claim errors. Manual verification of patient benefits and eligibility information by human staff takes an average of 30 minutes to an hour. It is costly for hospitals, with an average yearly cost of $160k per staff. Robotic process automation (RPA) can eliminate these time-consuming, repetitive tasks and reduce costs by minimizing denial rates and efficiently re-checking eligibility. It also saves providers 30 minutes per transaction and achieves an ROI of around $700K per year.

Patient Scheduling Automation

Another hospital in Utah was able to significantly improve its patient scheduling process. The hospital was able to process appointments more quickly and accurately, leading to a reduction in 98% of denied claims and an increase of 60% in revenue using patient scheduling automation. Furthermore, it saved a week’s worth of manual work hours and the staff was able to focus on more value-added tasks, such as patient care, rather than being bogged down by administrative work.

Medical Coding Automation

A Georgia hospital was struggling with errors that lead to frequent external audits from federal agencies. They soon realized medical coding automation and its results and implemented it in their coding processes. Within 3 days all coding errors were solved due to the RPA bot’s fully configurable 2-stage engine, an ICD10 engine that looks for all types of condition presences ranging from abbreviations to combinations, and a Natural language processing (NLP) engine as a second stage protocol paving way for better detection accuracy. Overall, the RPA bots use up to six different OCR engines depending upon the complexity of the coding in order to produce 60% fewer errors.

Payment Posting and Reconciliation Automation

A Rural Hospital in Arizona was severely affected because its staff did not account for each and every payment received. Around 40% of insurance companies still use paper documents to send payment information, which leads to delays and errors. Payment Posting and Reconciliation RPA improved this process by using optical character recognition (OCR) to convert scanned documents to electronic formats, then automatically posting the payments in EHR and PMS systems the hospital was able to create accountability for all their payments.