Automation can be applied across multiple areas of the healthcare revenue cycle. The examples below demonstrate how different healthcare organizations have used RPA to address specific operational challenges.

Prior Authorization Automation

A Philadelphia-based hospital implemented prior authorization automation after experiencing delays in authorization approvals. Following implementation, the organization reported that documentation could be completed within approximately 1–2 minutes. The organization also reported:

• More than $200K in additional ROI per month
• Approximately 72 hours saved per week

The example demonstrates how automating repetitive authorization-related processes can reduce processing time and free staff to focus on other responsibilities.

Charge Capture Automation

A multi-location health system struggled to manage the large volume of charges requiring daily entry. Manual charge capture could take 10–15 minutes per claim, while a biller could enter approximately 50 charges during an eight-hour work shift. After implementing RPA charge-entry bots, the process could be completed in approximately 1 minute per claim. The organization reported that its daily production target could be completed within three hours, helping reduce late submissions and collection-related issues.The automation also helped eliminate a backlog equivalent to approximately 3.7 days or 90 hours of manual work.

Accounts Receivable Automation

A Pittsburgh Medical Center implemented an automated accounts receivable system to improve its billing processes.The organization  reported:

• A 20% increase in net revenue
• A 20% reduction in accounts receivable days

The example also highlighted a significant difference in processing time. RPA bots completed the work within approximately 7.5 hours, compared with more than 30 hours of manual work.

Denial Management Automation

A New York-based health system implemented claim denial management automation to improve its approach to denied claims.The organization reported:

• A 12% increase in net patient revenue
• A 50% reduction in denied claims
• Denial resolution time reduced from approximately 20 hours to 5 hours

This demonstrates how automation can help healthcare organizations identify, process, and resolve denial-related work more efficiently.

Eligibility Verification Automation

A hospital in Ohio implemented patient eligibility and benefits verification automation after facing significant claim errors. Manual verification of patient eligibility and benefits could take approximately 30 minutes to one hour per transaction. The organization reported that RPA helped:

• Reduce repetitive manual verification work
• Save approximately 30 minutes per transaction
• Reduce denial-related costs
• Generate an estimated ROI of approximately $700K per year

The example illustrates how automating repetitive eligibility checks can improve efficiency while reducing the burden on administrative staff.

Patient Scheduling Automation

A hospital in Utah implemented patient scheduling automation to improve the speed and accuracy of appointment processing. According to the reported results, the organization achieved:

• A 98% reduction in denied claims
• A 60% increase in revenue
• A reduction equivalent to approximately one week of manual work hours

By reducing administrative workload, staff could spend more time on higher-value responsibilities and patient care.

Medical Coding Automation

A Georgia hospital was experiencing coding errors that contributed to frequent external audits. The organization implemented medical coding automation using RPA system with configurable coding and language-processing capabilities. According to the reported results, coding errors were resolved within three days, while the automated process produced approximately 60% fewer errors. The system used multiple OCR engines depending on the complexity of the coding requirements and incorporated ICD-10 and Natural Language Processing (NLP) capabilities.

Payment Posting and Reconciliation Automation

A rural hospital in Arizona faced challenges in accounting for payments received from insurance companies. Paper-based payment information contributed to delays and errors. RPA was implemented to improve payment posting and reconciliation. Optical Character Recognition (OCR) was used to convert scanned documents into electronic information, which could then be posted automatically into EHR and practice management systems. This helped improve accountability and streamline the payment posting process.