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Robotic Process Automation and Medical Billing

Robotic Process Automation and Medical Billing

If the phrase “robotic process automation” (or RPA) has you picturing an R2D2-style droid floating around the medical billing office of the future doing filing and data entry, then you’ve got it all wrong. This futuristic-sounding tool can help with medical billing tasks, but its applications are available now and are already working behind the scenes across the medical billing industry. No metallic droids needed.

RPA Defined

RPA is actually software that automates repetitive, standardized tasks through a series of linked functions. Think of it like a Microsoft Excel macro on steroids. RPA also utilizes artificial intelligence: It can be programmed to move through complex but predictable decision functions and even has machine-learning capabilities through regular feedback on errors and exceptions. 

As an industry that processes more than 1 billion claims each year, medical billing is rife with RPA possibilities. Throughout the entire revenue cycle, repetitive tasks could be automated to improve accuracy and efficiency: entering demographic information across multiple platforms, uploading charge line items, scrubbing claims to ensure standard coding and billing rules are applied, transmitting claims, posting payments, identifying denied or underpaid claims, and more.

Savings and Cost

According to KLAS Research, RPA already has “significantly reduced the costs associated with claim statusing, balance adjustments, and denial management across the medical billing industry.” And research from McKinsey & Company estimates that “by 2030 more than half of current claims activities could be replaced by automation.” 

Of course RPA also comes with a significant price tag. “The costs for creating and putting to work a complex network of bots can range into the millions of dollars,” writes Sam Hanna, executive-in-residence at American University. But key findings by the Deloitte Global RPA Survey back in 2018 show that payback on the investment is typically realized in less than 12 months, with an average 20 percent of full-time equivalent (FTE) capacity provided by bots. RPA also met and exceeded expectations across multiple dimensions including: improved compliance (92%), improved quality / accuracy (90%), improved productivity (86%), cost reduction (59%). And more than 75 percent of those who had already implemented RPA expected to significantly increase investment in RPA over the next three years.

Humans vs Robots

As CIPROMS implements RPA throughout its revenue cycle processes, including claims batching, charge entry, and payment posting, Teresa Sams, Vice President of Operations, says she hopes to see faster, more efficient processes that allow more time for staff to research and resolve any errors and exceptions. 

“We don’t want to replace humans but reallocate,” Sams says.

CIPROMS Senior Vice President and CIO Matthew Simpson agrees. 

“With RPA, the goal is for the staff to be working the exceptions instead of everything,” he says. “If we can get clean data going in most of the time with repeatable processes, we can let the humans focus on the exceptions.”

Learn More

To learn more about ​​robotic process automation, check out these resources:

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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