• Effy Healthcare

Where RPA Can Make a Difference in Healthcare

Robotic Process Automation (RPA) streamlines tasks such as eligibility, cost estimates and more.


As healthcare business professionals, we hear a lot about the value of automation. We know that automation makes systems more efficient, thereby boosting productivity and accuracy. Almost every market-leading revenue cycle platform uses automation to power claims scrubbers, organize workflows, submit claims and post payments.


However, many organizations using top-tier revenue cycle management (RCM) systems still struggle with denials and operational challenges. Why? Conventional automation cannot reach across systems to integrate business processes or mimic repetitive manual processes. What can? Robotic Process Automation (RPA).


RPA is much more than automation


RPA is different than standard automation. It is a system that is layered on top of existing RCM and medical record platforms to:

  • Integrate human interactions into processes that eliminate tedious, repeated manual tasks

  • Reach across disparate software and locations to monitor and aggregate data

RPA improves the business of healthcare


RPA is ideal for simplifying data processing in the revenue cycle; processes that are rules-based and high-volume are perfect candidates. There are several time-consuming RCM activities that would benefit from RPA, including:


  • Eligibility and verification: Many organizations use staff to log in to multiple websites to confirm or retrieve coverage information, leading to high labor costs and the potential of human error. RPA accelerates data-gathering and improves accuracy by automating logins and data retrieval.

  • Cost estimates: Cost estimates are a labor-intensive service that involves layers of information from several disparate systems. Patient treatment information, insurance eligibility and verification, payer fee schedules and provider chargemasters all have a role to play. RPA can quickly gather all the information and generate a patient estimate.

  • Pre-authorizations: Like cost estimates, pre-authorizations require layers of information from different sources. RPA can reach into clinical and practice management systems to populate the pre-authorization and even submit the request if there is a payer portal available.

  • Denials: If you can identify the root cause of the denial, RPA can help you mitigate or eliminate it. One example is duplicate claims. RPA systems can check-in with payers for claims status, scrape claims systems to ascertain if a previous claim was sent, and then either resubmit the claim or alert staff to an adjudication time outside the norm.

RPA has valuable clinical applications


RPA can be used anywhere data is generated. For example, complex patients often have massive amounts of health information, including notes from providers, test results and diverse treatment plans. RPA can quickly extract and optimize health data (with customizable formats such as tables or graphs) to assist in diagnosis and patient management next steps.


RPA can reach across all systems for analysis


An obstacle for many large organizations is aggregating and analyzing data from disparate systems. RPA technology can extract the data you need, when you need it, and instantly produce insightful analysis to inform business decisions or help deliver targeted patient care.


Compliance is easy with RPA


Because information transfers are automated, they are not subject to transference errors and virtually eliminate the possibility of a HIPAA breach. Another advantage is calculation accuracy. Since all processes are rules-based and manual computation is removed, correctness is virtually assured. Plus, all operations are tracked, documented and readily available for audits.


RPA: the emerging healthcare revenue integrity technology


A recent annual survey found that revenue integrity tops the list of revenue cycle executives' concerns, and 30% listed it as a focus. In 2018, no respondents of the survey cited RPA as a strategy to ensure revenue integrity. However, by 2019, 15% said they were focusing on RPA as an RCM productivity solution.


The increasing awareness of RPA is mainly due to its success in other industries. Deloitte LLP surveyed over 530 executives across industries about their RPA use. The results may explain why word is getting around that RPA is a strategy to consider for healthcare:


Percentage of survey respondents that indicated RPA implementation continues to outperform expectations on*:


  • Improved productivity – 95%

  • Cost to implement – 94%

  • Improved compliance – 93%

A bonus of RPA is a happier workforce – over 80% of the organizations using RPA reported an increase in employee satisfaction.


The biggest advantage of RPA is its flexibility to ensure financial, clinical and compliance best practices. When organizations embrace RPA, they are taking advantage of limitless opportunities to overcome operational and clinical challenges that will improve patient care, increase patient satisfaction and assure steady revenue.

Interested in learning how RPA can benefit your healthcare organization? Contact us to know more.


*Source: Deloitte LLP. (n.d.). The robots are waiting | Are you ready to reap the benefits? London, UK.


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