While it might not be one of the first industries talked about when considering the implementation of process automation, the healthcare industry is one where RPA has the potential for great transformation. From Claims Administration at a MHC to Patient On-Boarding for a Provider, RPA can add efficiency and accuracy to processes within the Healthcare Industry. Healthcare, particularly in emerging or previously underserved markets, is an evolving and growth-oriented field, and as the number of patients increases, the need for more efficient and accurate back offices processes for healthcare providers has seen significant increases in recent years. In a fast-evolving industry that has seen a significant increase in number of patients, as well as a rapid shift to digital transformation in the past few years, the need for fast, efficient and accurate execution of processes is becoming crucial. Billing, Claims, Scheduling, Patient On-Boarding, and Provider Credentialing are all areas where RPA can assist.
Technology Challenges for Healthcare
System Migrations, Yearly Benefit Enrollment, Complicated Benefits, Regulatory Changes, Fee Schedule Increases/Decreases, New Business creates processes too complicated to automate in a cost-effective way or not quick enough with SDLC programming or even BPM applications. This lack of efficiency and responsiveness results in massive number of claims that either need to be manually processed or allow to system automate incorrectly and adjusted retrospectively. Both approaches are expensive and can generate significant provider abrasion with related customer service and rework costs.
Some of the common processes frequently used by Healthcare providers that can be streamlined by using RPA include:
The healthcare industry is one that is modernizing rapidly – in part due to technology and in part due to external forces like government regulations and mandates. Instead of being reliant on paper charts, providers are digitizing patient information so that it can be stored electronically accessed online by other doctors and the patients themselves. In order to expedite the process and not be reliant on employees to transfer these records manually, RPA can be used to automate this transfer of data between paper files and legacy systems to the new system. This will also foster increased levels of customer service to the patient through transparency and ease of access to their medical histories.
Patients create appointments with their doctors on a regular basis but sometimes have to cancel them as well. Appointment cancellation and no-shows can be costly for health providers. RPA can be used to minimize the involvement of human employees in the scheduling process and can also help optimize appointment turnout by managing appointments with patients. Not only a benefit for the healthcare provider, appointment optimization will also positively impact patients who will now be able to schedule appointments sooner.
Billing and claims processing are of particular importance for the healthcare sector. A patient visits the doctor, an insurance claim is filed, a patient is billed for the remaining amount, and accounts receivables are monitored to ensure the patient makes the payment. These processes can be very time consuming and prone to errors. The importance of RPA for both health providers and also health insurance companies is quite clear – reduction in human error, increase in efficiency and time-management, and better control or custody of billings and claims as these tasks progress across the value chain.