What is Healthcare Revenue Cycle Management Automation?

The top priority for healthcare organizations is to provide quality services. This also involves reducing operational inefficiencies in the delivery of treatments such as making appointments, sharing data across applications, and reducing waiting times while managing financial applications involved throughout the process. Financial processes are crucial for the effective management and running of the organization. And that’s where Healthcare Revenue Cycle Management comes in.

It is the process by which healthcare organizations bill for services provided and generate revenue – working with doctors, patients, and health insurance companies. For a healthcare organization to stay healthy with the right number of staff and state-of-the-art devices and technologies, it is important they have an optimized and streamlined revenue flow. And it can be achieved only through seamless automation of the Healthcare Revenue Cycle Management (RCM) process.

What is Revenue Cycle Management Automation?

By the definition of it, it is understandable that RCM involves a lot of manual and paperwork. Revenue Cycle Management Automation is the process of using technologies such as Robotic Process Automation (RPA) and Artificial Intelligence (AI) to automate all the manual processes in the RCM workflow. Essentially, RCM Automation is one of the most commonly implemented technologies across several use cases in Healthcare. It is already a known fact that the healthcare industry is strained by a shortage of staff and the burden of administrative work. Especially with the push from CoViD-19 there has been growing interest and application of RPA in RCM.

Healthcare revenue cycle leaders have been using RPA solutions in order to streamline the RCM process for better financial management, greater efficiency, and less burden on hospital staff. As a result, in the past two years, around 80% of hospitals engaged and implemented some form of RCM Automation in their workflow. However, it is important to note that in order to be able to achieve an effective RCM system with RPA, healthcare systems require an efficient implementation approach.

Understanding the Levels in Revenue Cycle Automation

In order to effectively automate your revenue cycle, it is important that we understand what is the current level of automation at which your organization is operating. Some small healthcare organizations may have no automation or have partial/ low automation and would have to start from scratch, while large hospitals would already have some automation in place and would like to move to the next step.

Once we understand the level of automation, we can then plan and strategize for the implementation of RPA in RCM Automation. We have classified six levels of automation based on our research and experience. Each level of automation is explained below.

Level Zero - Pilot Automation

This applies to most of the small healthcare organizations/hospitals that are entirely operating on manual work. They might have digital systems in place, but not the capabilities of a revenue cycle. This means all claims, denials, applications, etc. must be processed manually by a set of staff.

Level One - Human-Assisted RCM

Organizations with level one automation usually have revenue cycle systems in place. However, the systems are not controlled by the people of the organization. Partially automated features might be included in these systems and it would require the support of a human operator to work effectively.

Level Two - Partial Automation

Here the RCM system design would involve some automation that combines functions and features. However, it requires healthcare administrative workers to be constantly engaged with the system. They would have to continuously monitor the workflow to resolve any issues or manage any claims or denials. However, the data would be centralized and everything would be accurate when compared to no automation, making the life of admins easy.

Level Three - Conditional Automation

In this level of automation, people aren’t a necessity. All the condition-based tasks are automated with RPA in RCM Automation. However, there should be staff who can take control of the system whenever necessary. To state an example, tasks that don’t involve rule-based work would require human intervention. This is a sweet spot to be, where the administrative tasks are mostly automated and don’t burden the staff.

Level Four - High Automation

A system with high levels of automation would perform almost all the tasks seamlessly. They don’t require a major human interaction, although people would have the option to take control of the system. There might be high-level tasks/ emergency tasks that would require human intervention, however, that would be a rare case and all the standard tasks would be performed by custom bots

Level Five - Fully Autonomous System

This would be the ideal goal for all healthcare organizations down the line. Though 100% full automation is not possible in reality, we can automate a majority of the processes to be fully autonomous. The RPA systems implemented would learn and perform all the tasks under all the conditions. This way, there is an evolution of the system with time where all tasks are covered and performed by the bots, with minimal to no human interaction.

In order to assess your level of automation, you might have to hire Revenue cycle automation experts and get started with the implementation approach of RPA. A higher level of automation means decreased administrative tasks and costs, thereby improving the healthcare services offered.

The Best Revenue Cycle Automation Approach

What does it take to go from Level Pilot to Level Five of RCM Automation using RPA and other technologies? Well, it is a heavy lift. However, the vision is more important. Such a heavy lift today will improve efficiencies which will ultimately help your organization in the long run. In order to start and achieve automation, we would need to break down data silos, unify data sources, place some rules across the organization, and integrate multiple workflows such as claims, denial management, financial clearance, etc.

However, with the proper approach and vision, these implementations can happen effectively and can start small as given below. The approach would, however, change based on the organization’s level of automation.

1. Start Small and Automate

McKinsey report on Intelligent Automation tells us that automation of 50 to 70% of tasks would result in triple-digit percentages of Return on Investments. In healthcare organizations, most of the tasks are data-rich, manual, repetitive, rule-based, and crucial to the functioning of the RCM system. Start your automation approach by aiming to automate such small and repetitive tasks. This would result in a relieved workforce, RoI on automation that you can reinvest, and a positive start to your automation efforts. Start small and grow big on your automation.

2. Find and Invest in the Right Technology

Finding the right technology to reach an autonomous RCM and investing in them is one of the very important steps in your RCM Automation cycle. Robotic Process Automation can help you automate your everyday repetitive tasks. However, for a long-term fully autonomous revenue cycle you would also have to invest in technologies such as AI, ML, Intelligent Automation, etc. With the help of these tools, you can unify the data silos, improve data integrity, build powerful algorithms, and data interfaces to automate your entire RCM workflow.

Additionally, you also need to invest in training your employees on efficiently and rightly using these technologies, for long-term benefits and effective implementation of RCM Automation.

3. Find Data Sources and Break Down Silos

A hospital is a literal ocean of data. Everything operates on data right from patient entry, tests, diagnosis, and coding, to discharge. A discontinuity in the data of such magnitude would result in a disaster. Imagine, if reports/ bills accidentally get swapped due to unwanted data silos.

With no to minimal automation, the employees are already strained with work and hence it is important that these silos are found, broken, and data is unified. The key to revenue cycle success is harnessing and unifying the data sources. The data should involve both the data that requires action and how users interact with them. This way the tasks can be automated effectively with the data and the work with the user interactions mapped to software robots.

4. Find the Right Partner

There are multiple platforms to build custom software robots for your RCM Automation and there are myriads of documentation and steps to follow to get them to work effectively. Hence, in order to achieve the required automation in a decent timeframe, your organization would definitely need the support of Intelligent Automation companies/partners. Investing in the right partner is one of the major and best investments in your RCM automation cycle, for they will perform everything from seed to tree of your automation efforts.

With the right partner, you relieve yourself from the burden of building a team to start your automation efforts. You don’t have to worry about the logistics of it. All you would need is a technical partner who is at the forefront and drives change. Like all other industries, you can avail Automation-as-a-service and drive long-term change and efficiency.

5. Drive Organizational Change

The most important step in implementing RPA in RCM Automation is inspiring and driving organizational change. From making the smallest changes in the workflow to achieving the highest level of automation, you need the support of everyone in your organization. Everyone who has access to any of the data sources and is involved in the RCM should adhere to the automation standards and use the tools religiously.

In order to inspire the people and the culture to do the same, the leadership should be at the forefront and drive change. Stakeholders should know and understand fully how their short-term efforts are helping the organization in long-term automation. Once everyone is on board, it results in the culmination of efforts and automation of the revenue cycle.

Droidal - Your Trusted Healthcare RCM Automation Partner

Droidal is one of the leading Healthcare RCM Automation service providers in Dallas. We have helped various healthcare organizations automate their revenue cycle process and become efficient and secure. At Droidal we understand the transformative capabilities of RPA for your organization and the people. Hence, we are always excited whenever we help a healthcare organization with their RCM Automation. Contact us today for a free demo and consultation! Let’s work together for better healthcare availability for everyone.

Looking to Automate your processes ? Book a consultation now


Looking to automate your processes ? Book a consultation now

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