15+ Ways to Use Robotic Process Automation in Healthcare

The number of ways organizations can use robotic process automation (RPA) to streamline workflows and eliminate time-consuming, monotonous tasks are virtually limitless.

Because RPA utilizes software robots that interact directly with the existing user interfaces of software applications and websites, and because these “bots” can adapt to special use cases and outliers, RPA can be applied to almost any scenario or work process.

1. Prior Authorization – Bots not only request authorizations on payer portals, clearinghouses, or via automated fax requests, but also search and continuously monitor for authorization status.

2. Insurance Verification – Real-time eligibility verification ensures that surprises are eliminated on the front end of the patient encounter and proactively resolved to prevent denials and claim rejection.

3. Coverage Discovery (Insurance Scrub) – Finding existing healthcare coverage (such as Medicare, Medicaid, and other payers) that may have gone unreported ensures that the proper payer is pursued earlier in the revenue cycle.

4. 835/ERA/EOB Posting – Bots will pull 835 files from clearinghouses, upload them to SFTP and trigger automated posting of denial codes and adjustment amounts. They also process, interpret, and convert paper-based EOBs into Excel-formatted import files and post the transactions directly to the billing system to eliminate redundant data entry.

5. Payer Portals – With RPA there is no need to manually create, and package supporting documentation and then log in, navigate, and upload it to payer portals. Instead, the user simply clicks “Send Document Packet” to their chosen destination and lets the bot do the rest of the work.

6. Benefits Hold – RPA can be used to run eligibility and identify deductible remaining. When deductible remaining exceeds the small balance adjustment amount the bot can place a billing hold on the encounter claim and check eligibility every 48-72 hours. When deductible remaining amount is less than the set amount, the bot releases the claim.

7. Real-Time Note Posting – Several EMR/EHR and billing systems will prevent notes from being posted while an account is viewed by another user; plus, their batch import options do not occur in real time, and they provide limited exception handling for locked accounts. Bots, on the other hand, automate this process and support real-time posting with advanced exception handling.

8. Progress Reporting – Progress reporting typically involves tedious, manual work that requires pulling information from multiple systems. Bots automate the process by navigating across all systems and capturing reports, screenshots, and other supporting documents to build the appropriate progress report for each patient.

9. Monitoring Websites and Forms – Keeping tabs on changes to government and/or payer programs, forms, and other supporting documents is a daunting task. Monitor bots manage a library of websites and forms to detect when changes occur, enabling organizations to proactively adjust and avoid surprises.

10. Single Registration – Providers who maintain multiple EMR/EHR and billing systems struggle with the process of broadcasting a single set of patient demographics and encounter-level detail across all systems. RPA can facilitate this interchange with systems that are “closed” and provide limited connectivity.

11. Medical Records Aggregation – Bots will navigate one or more source systems to capture medical records, upload them to payer websites, or e-fax and/or print them to a secure print/mail service center.

12. Reports Aggregation – Bots will navigate multiple EMR/EHR and billing system platforms to produce reports and package them for delivery; these same report extractions can be used as source data for dashboards and other analytics initiatives.

13. Vendor Interfaces – Bots can extract data from EMR/EHR or billing system platforms to build custom interfaces for vendors or internally-sourced projects. RPA allows for posting updates directly to the same systems to avoid rekeying information or manual updates from vendors.

14. Credentialing and Monitoring – The credentialing process is much easier and less labor-intensive with RPA. Bots will automatically query websites that validate medical licenses, DEA, CDS, OIG, and other provider enrollment data and capture and post the results to the source system for review/processing.

15. Intelligent Document Processing (IDP) – IDP transforms information found in unstructured and semi-structured formats (such as PDFs, emails, images, and scanned documents) into structured, actionable data. IDP and RPA technologies can be strategically combined to further enhance workflow automation.

There are countless additional ways to use robotic process automation, and each of these helps healthcare facilities with the growing challenge of healthcare staffing shortages. When software robots take care of the time-consuming, repetitive tasks, healthcare employees can focus on higher-level objectives and interactions with patients and enjoy a more manageable volume of work.

How Will You Use Robotic Process Automation?

Not sure where to start? HealthWare Systems specializes in analyzing workflows and users’ activities to identify and automate redundant work through RPA. We customize our bots and RPA solutions to meet the individual needs of our clients and to address specific actions within their business processes.

Set up a free consultation to discuss how you can userobotic process automation and start realizing its many benefits as soon as possible!

By Stephanie Salmich