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Business Process Transformation in Revenue Cycle Management

Today healthcare operations are undergoing a disruptive transformation as automation is bringing forth brand new capabilities across a wide range of business processes. Leading healthcare providers are adopting new management paradigms and novel technology strategies to capitalize on what this boom can offer them. Revenue Cycle Management is among the most attractive business functions for healthcare providers to begin their automation journey. Technologies such as Robotic Process Automation (RPA), Intelligent Automation, and cognitive methods such as Artificial Intelligence (AI) can help healthcare organizations improve efficiency and ultimately reduce the cost to collect, which is a key for improving cash flow.

Automation driven by Analytics yields dramatic Financial Improvement

With its emphasis on workflow and analytics as foundational technologies, revenue cycle business processes are especially amenable to improvement using RPA. For example, with respect to Accounts Receivable (A/R), the role of RPA is to drive efficiencies in the level of effort required to collect from payers and patients, while also streamlining upstream processes such as eligibility and authorization. When combined across a single unified workflow platform with sophisticated analytics, the impact of RPA on the overall financial returns to healthcare providers both large and small can be significant.

Maximizing Reimbursement – Grasping the ever-receding horizon

As government and commercial payers reduce reimbursement rates and providers are forced to maintain compliance with a bewildering array of new and evolving regulations, the need for automation to manage these challenges have never been greater.

There are few means to overcome this challenge without additional cost or complexity. A proven way to accomplish this goal with significant benefits is leveraging RPA to improve Revenue Cycle Management services.

BOTs can form a digital layer on top of existing Electronic Health Records (EHR) and financial management systems to take over the routine, repetitive and often time-consuming tasks within the revenue cycle. As BOTs function 24/7 across an enterprise in complete harmony with staff, there is great potential to achieve higher levels of productivity and efficiency.

Our Solutions

  • Eligibility & Insurance Discovery

    Eligibility and insurance discovery are important steps in the creation of clean claims that hold the highest potential for payment. These components are also important in managing the A/R process. The ability to see real time eligibility within any workflow system is another key advantage to speeding up the claims resolution process. While many systems and clearing houses offer this benefit when used in conjunction with RPA led coverage discovery, the results and data can be far more comprehensive and supportive of a robust and efficient claims management process.

    BOT driven processing provides accurate data with little manual intervention, reducing the handling time spent on processing rejected or incomplete claims.

    BOTs can quickly search volumes of payer data for coverage and benefit details so that claims are properly filed the first time and denials due to incorrect information are minimized without manual intervention. This is particularly important when coverage information is not readily available as may be the case with EMS billing.

  • Authorization Management

    A vexing problem that regularly leads to higher denial rates is improper or incomplete authorization information. Payers increasingly demand authorizations for an ever-expanding set of procedures. At each stage, from determining if one is required, though a medical necessity, to patient notification and admissions, this process is fraught with potential for denial write-offs. RPA offers a way to standardize and streamline the process that reduces denial rates and improves clean claim rates.

    Our RPA BOTs work with your rule sets and payer contract data to gather and process correct authorization information the first time, eliminating the need for spreadsheets and ad-hoc paper-based systems for managing prior authorizations.

  • Claims Data Collection

    Data retrieval for patient and billing information is a varied process and its implementation creates logistical and processing hurdles that are often solved by manual means. For example, web portals used to collect data are inherently inefficient as login credentials are required for everyone to access a system, however they often expire monthly.

    Hexaware’s proprietary platform that utilizes BOTs to perform major portions of this process can reduce cost and improve collection rates almost immediately.

  • Payer Contact

    Reducing the time spent waiting on hold while contacting payers is a complex challenge that drastically affects the productivity of revenue cycle operations. The amount of time spent on hold with payers can take up to several hours of productivity out of an associate’s day.

    Payers have invested heavily in web portals but have not realized the sought-after benefits of call avoidance. Maintaining login credentials is a thorn in the side of many system administrators, particularly when third-party partners are involved or if high turnover is a concern. The constant issuing, deactivating and resetting of passwords is time-consuming and a drain on productivity.

    Our platform leverages BOTs to allow providers to schedule when and how they want to be contacted by a payer – even to the point of specifying which accounts the associate wants to discuss with the payer. By eliminating the need for an associate to place a call and navigate the payer’s IVR system, thousands of hours of productive time are recovered each month thereby lowering the cost to collect. These savings are passed along to our clients in the form of lower fees and higher recoveries.

  • Claim Status Processing

    Actionable or enhanced claim data processing represents another area where RPA is having a significant impact on revenue collection. For example, it is not uncommon for account information to be lumped together by payers, often simply because of incorrectly documented subscriber identifiers. Obtaining remit information though a BOTs driven system from payers to supplement claim status responses for a “Super 835” provides a much more comprehensive view of the claim. Adding remit data such as patient responsibility to claim status responses drives higher call avoidance rates.

    Using our advanced analytics engine to drive workflow and put effort where it will be best rewarded, our BOTs can retrieve claim status and provide detailed claims resolution data far more quickly than non-automated methods. By alerting the staff as to which claims are likely to be denied and for what reason, we resolve claims more quickly and with higher quality.

Quadrupled collections with Intelligent Automation

Read our case study to know how Hexaware automated the revenue cycle to deliver operational efficiency and process transformation and helped the CFO achieve the set targets.

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