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Robotic Process Automation

Robotic Process Automation (RPA) is a technology powered by virtual robots that work in tandem with existing software applications to automate manual and repetitive tasks. The process does not take the place of human staff but rather uses simple rules and business logic developed by those individuals to eliminate redundant and tedious tasks. The result: less time wasted and more time spent on higher revenue generating activities.

Many processes are great candidates for RPA. RPA is most valuable for processes that are mature, rule-based, follow specific protocols, process high volumes of data, and are prone to errors (such as data-entry errors often a result of human error.

Commonly processes could be described as follows: the user selects a field with their mouse navigating through multiple screens, data is manually entered into those fields by copy/paste from one place to another.


 

Benefits of Robotic Process Automation

Robotic Process Automation offers many benefits including:

Accuracy

Extreme accuracy and uniformity – much less prone to errors or typos.

 

Improved Employee Morale

Workers can dedicate more time towards engaging, interesting work.

 

Productivity

Process cycle times are much faster compared to manual process approaches.

 

Reliability

Bots tirelessly work 24/7 without interruption

 

Consistency

Routine tasks are performed the same way each and every time.

 

Low Technical Barrier

No programming skills necessary to configure a bot.

 

Compliance

Bots follow regulatory rules to a tee and provide an audit trail history.

 

Non-Invasive Technology

No disruption to underlying legacy systems, reducing the burden on IT

 

 

Today’s RPA performs actions such as data entry, data extraction, and data aggregation and integration with websites, portals, documents, and other systems.  In the future, intelligent RPA will automate the processing of unstructured data which may one day lead to true cognitive RPA where the technology possesses a deep, human-like understanding of complex situations to the degree it can make decisions based on unstructured data.


 

The Four Quadrants of Artificial Intelligence

There are four types of Artificial Intelligence part of Robotic Process Automation:

Four Quadrants of AI

  1. Process-oriented AI automates human action using AI techniques to support efficient business processes.
  2. Decision-oriented AI assists in or performs automated decision-making based on enterprise and/or industry data for a business function.
  3. Export-oriented AI provides insights and result set based on continuously learning from interactions with users and the environment.
  4. Knowledge-oriented AI assists in discovering, visualization and exploration of relationships amongst business elements.

 


 

How Might Hospitals Use Robotic Process Automation?

There are a number of ways that hospitals might put robotic process automation to use in their facilities.

Automating Prior Authorization

By automating prior authorization, hospitals can fast-track patient access and reduce follow-up times. Here’s how.  First, a prior authorization task is triggered by a rule or request. RPA is used to identify patient insurance and log into a prior authorization portal or payor website. Once logged in, RPA extracts patient information based on form rules and enters it into the portal. Required documentation is attached automatically in accordance with rules established within the workflow. Last, RPA records any transaction number into the hospital’s EMR and monitors/reports the status of the prior authorization.

Online Pre-Check In

Allowing patients to pre-check in reduces administration time and improves the patient experience. In this case, RPA could be used to trigger an outbound check-in communication to the patient based on the hospital appointment calendar. This could be done by text, phone or email. Once the patient is authenticated, s/he answers questions about insurance and payment. The patient’s response is monitored by RPA which then moves the patient to the next step. If a change in insurance is reported, the information is uploaded into the hospital EMR for pre-insurance verification. If a copay is required, payment is initiated against the MOP on file upon the request of the patient. The process concludes after RPA provides check-in details in the EMR so the front desk preventing duplicate processing.

Underpayment Review

Using RPA to review patient underpayments automates mundane and repetitive tasks and improves revenue cycle collection efforts. The process would begin after RPA initiates a report of potential payment variances from a contract analysis system. RPA logs into payer systems and review payment details from the explanation of benefits. If a true variance exists, an appeal is automatically filed or queues an appeal to be filed depending on the payer system used. If exceptions or questionable data elements are observed, RPA pushes a task to a staff member for evaluation.

Billing Claims

RPA has the ability to provide visibility of and improve self-pay collection activities boosting hospital self-pay recovery. RPA uses hospital-specific models to determine a patient’s propensity to pay, the timing of their payment, and how much they will pay. Automated workflows are executed based on the guarantor to mine for insurance eligibility, send statements and letters and/or outbound phone calls, texts and emails to drive patient action. Patients are driven to call to speak to a live agent, set up payment arrangements or (if qualified) assess financial assistance.

 


Augusta University Health Systems has been successful using RPA to improve their active self-pay recovery processes and boost patient engagement. Read their story.


 

Getting started with Robotic Process Automation may feel overwhelming. The first step is making a commitment to integrating RPA into existing processes. Focus on the benefits and commit the necessary human resources. Document everything and prioritize projects based on the potential impact the technology could have upon your organization. Before going live, test your processes thoroughly.

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