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Patient access staff spend countless hours on the phone with payer reps, trying to determine if a particular procedure requires authorization. Still more hours are spent going between systems, figuring out why a patient’s insurance claim was denied. What if a robot handled these tasks instead?
“Many revenue cycle processes are time-consuming and repetitive,” observes John Woerly, RHIA, CHAM, FHAM, an Indianapolis-based revenue cycle consultant.
Departments struggle with inefficient, error-prone, manual processes. All this makes patient access an “excellent candidate” for robotic process automation (RPA), according to Woerly. For patient access, using software robots to automate often-mundane tasks could be a real game-changer. For one, it can stop many costly mistakes that are causing denied claims and lost revenue. “RPA, if used correctly, allows staff to refocus upon customer service and other value-added responsibilities,” Woerly says.
RPA is most effective for highly manual, high-volume tasks, that are prone to human error. There is certainly no shortage of those in patient access. Woerly says the list of tasks RPA could take over include, but are not limited to: scheduling patients for appointments online, reverification of insurance data, identification of secondary insurance, predictive screening for Medicaid and charity care, and identifying what causes claims denials. “RPA should allow patient access departments to be more productive and improve overall quality,” Woerly argues.
RPA also could mean some significant financial benefits for patient access. Leaders dream of reducing claims denials, decreasing A/R days, and increasing collections, all with no extra staff. It will not happen overnight. “Complete automation of the revenue cycle is not likely a near-term reality,” Woerly says.
Patient access staff, if they have heard of RPA at all, probably worry it will take their jobs. In the revenue cycle world, this kind of concern probably is unfounded, says Isaac Sieling, a managing director in Huron’s healthcare business. “When you hear the words ‘robots’ or ‘automation,’ there is the immediate perception that it means downsizing of the workforce. However, we are not seeing that to be the case,” Sieling notes.
Doing more with existing resources does not necessarily mean fewer full-time employees (FTEs) on the payroll. It just means those FTEs will be handling different tasks. Essentially, RPA is a digital workforce that “augments the human workforce,” Sieling explains.
In the case of patient access, RPA would handle the kind of simple, repetitive tasks that no one particularly enjoys performing anyway. Patient access employees would switch to dealing with tasks that can put them on a path toward advancement because they align with organization-wide goals.
“For instance, what else could your team be doing to make sure patients receive care at the right place and at the right time?” Sieling asks.
While registrars are working on that complicated issue, RPA can take care of simpler, but time-consuming tasks. Two areas in particular are obvious choices for departments, according to Sieling: “We see many organizations start with eligibility and prior authorization.”
If talented registrars are not hindered with constant tedious tasks, they will have time to work on some tasks that really matter to patients. “Not only could automation enhance the patient experience, it could also improve staff morale and job satisfaction,” Woerly offers.
There are two possibilities that can benefit patients: First, by automating authorization statuses, prior authorizations could be initiated earlier to prevent rescheduling. Second, if the process to submit and confirm Medicaid enrollment is automated, then patient access staff could provide outreach to patients in need instead.
RPA software platforms can collect data from multiple sources; the electronic health record or payer websites are two examples. Right now, registrars gather that data manually. “But it is the blend of people and technology that can truly optimize patients’ access to care,” Sieling adds.
For instance, deciding to reschedule a patient because prior authorization was denied requires a human to approve it. The same is true for answering questions on the cost of care or resolving scheduling errors.
Even with RPA, the personal touch still matters, possibly more so now than ever. For patient access, this kind of human connection “continues to be a differentiator for organizations,” Sieling says.