It’s been over four years since COVID-19 sent healthcare organizations into an unprecedented financial tailspin. But the good news is that healthcare finances are slowly beginning to restabilize and organizations are beginning the long road to recovery.

While there are many tools and strategies that organizations are using get back on track, one key factor stands apart from the rest. According to February’s National Hospital Flash Report by Kaufman Hall, one of the biggest factors separating successful organizations from those that are still struggling is “the adoption, or lack thereof, of advanced analytics and artificial intelligence.”

Now, Artificial Intelligence (AI) is a broad topic, encompassing many things. So, to make it a little less overwhelming, we’re going to focus on only one aspect of AI. Here’s everything you need to know about robotic processing automation or, RPA.

What is RPA?

Robotic processing automation is a software bot developed using AI and machine learning (ML) that replicates actions and workflows normally performed by a human. In doing so, it enables greater productivity and efficiency. It’s often applied to highly repetitive, tedious work, making it well-suited to lower-value tasks across the billing office. While a person may take several minutes to complete a task, a bot can perform the same action within seconds.

How can we use this in healthcare?

RPA can be applied to revenue cycle management (RCM) processes like claims processing, insurance verification and denial management. RPA uses historical claim data to “learn” over time, making it capable of identifying claims that are at risk for denial and alert your office staff. This gives staff members an opportunity to correct claims before they are submitted, thus saving time that would be spent correcting and resubmitting claims—and decreasing the time to receive reimbursement. Rules can also be applied to the bot so it can automatically correct claims based on repetitive processes and learnings, removing the need for manual intervention altogether. Now, office staff is available to work with the more complex cases that RPA can’t handle.

What’s the potential impact?

The typical time spent processing acute patient claims ranges from 4.22 minutes for a general inpatient visit up to 45.55 minutes for an inpatient surgical visit. If there are issues with data completeness or accuracy that lead to a denial, the time spent reviewing, correcting and re-submitting the claim can delay the processing of the claim from 12 hours up to 48 hours before re-imbursement is received. While a person may take several minutes to complete these tasks, a bot can perform the same action within seconds. Additionally, RPA can operate 24 hours a day, 365 days a year, unlike its human counterparts. Supplementing the physical workforce with RPA means business-office staff members can now spend more time on higher-value tasks.

RPA can operate 24 hours a day, 365 days a year, unlike its human counterparts. Supplementing the physical workforce with RPA means business-office staff members can now spend more time on higher-value tasks.

From a monetary standpoint, the average cost of fighting a claim is $43.84 per claim, not including the costs associated with added clinical labor ($13.29 to the adjudication cost per claim for a general inpatient stay and $51.20 to the cost of inpatient surgery.) A single denied claim may seem small, but when added together, errors in the revenue cycle can easily compromise cash flow and financial stability. Additionally,  the same report found that approximately 15% of all claims submitted to private payers were denied in 2022. Providers were able to overturn 54% of these denials but only after “multiple, costly rounds of provider appeals.” All in all, providers spent $19.7B pursuing delayed and denied payments from all payers in 2022. By using RPA to submit the right data the first time or to navigate the appeal process, we can reduce the cost associated with fighting denied claims. In fact, several U.S. healthcare institutions have already reported significant cost savings and other benefits from implementing RPA in their RCM processes. Research from KPMG indicates that hospitals and health systems could reduce revenue cycle costs by 25–40% with this technology.

Overall, RPA is a valuable tool that holds great potential to reduce costly RCM processes within the right organization. Organizations can accelerate cash flow, reduce operating expenses and quickly see the return on investment in this technology. That is not only a win for the business office, but for the entire organization and its ability to continue providing high-quality patient care for all. As a leading provider of healthcare technology solutions, Altera has the expertise needed for assessment and discussion. As we look toward the future, we’ll keep driving forward with RPA technology. To learn more about Altera’s RPA solutions, go here.