RCM Robots: Optimize and Improve RCM Operations - CAH CFO-Administrator Forum

RCM Robots: Optimize and Improve RCM Operations

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EqualizeRCM Services‘ (ERCM’s) suite of healthcare solutions utilize robotic process automation (RPA) to optimize our clients’ RCM operations. Our subject matter experts deploy RPA to drive efficiencies in resource utilization. By leveraging both our expertise, our international teams and our RPA, we blend the right mix of human and machine capability to capture more revenue for our clients at the lowest total cost of collections. According to McKinsey & Company, more than one third of tasks in the healthcare industry could be automated, increasing efficiency. Our promise to clients is to close that efficiency gap in their revenue cycle operations.

How do Robotic Process Automation (RPA) Bots Work?

 Robotic Process Automation (RPA) is an emerging form of business process automation technology based on the concept of using software robots (a.k.a. bots). Powered by cognitive technologies like speech recognition, natural language processing (NLP), and machine learning (ML), these bots offer actionable insights, improved business efficiency, data security and effectiveness by imitating human actions, automating repetitive tasks across multiple business applications without altering existing infrastructure and systems.

In the healthcare space, our proprietary RCM bots integrate with client systems, including electronic health records, billing systems, patient payment portals, payer portals, clearing houses, credit card processing applications and the like. This automation is usually ideal for supervised learning, rule-based, repeatable processes that leverage the organization’s key systems, including claims follow-up, payment posting, AR calling, converting paper EOBs to ERA, and more.

How does a Bot Benefit RCM Operations?    
Decreased Costs 
Reduces the cost of performing equivalent work by up to two-thirds.

Improved Efficiency 
Can work 24×7.

Reduced Errors 
Eliminates human delay and error.

Increased Scalability 
Can dial up or down the number of bots deployed according to the volumes.

Increased Collections and Revenues 
Better accuracy improves collections. Efficient and faster billing enables quicker payments for providers and facilities.

Process Improvement 
Identifies bottlenecks and helps in optimizing and improving the core processes.

Capabilities of Our Suite of RCM RPA Bots    

ERCM Bot 1

Using payer websites, this bot analyzes the information and provides actionable insights.

  • Collects Data
  • Analyzes State of the Claim
  • Comes up with the Set of Actionable Insights
  • Performs certain Follow Up Tasks
  • Improves the Quality of Work by Achieving Consistent Accuracy
 
ERCM Bot 2

Analyzes the claims which are being created and applies business rules and checks. It takes corrective action or routes the actionable insights to the right person to take prompt action. The RPA bot uses supervised learning and has self-learning modules which continuously update the knowledge repository.

  • Drives up the Clean Claim Rate
  • Reduces Denials
  • Significantly Improves Resolution Time
 
ERCM Bot 3

The intelligent bot is powered by machine learning algorithms to learn the relationship patterns within as well as among different processes, production, audits and the like. It then analyzes the data and comes up with undiscovered bottlenecks, areas for process improvement and some uncanny statistical information to streamline business processes.

 
ERCM Bot 4

The Denials Bot examines the incoming ERA (835) files and takes the following appropriate actions:

  • Checks for Invalid Combinations
  • Automatically Corrects and Resubmits the Claim
  • Generates a Set of Actionable Insights for the Respective Responsible Parties on the Identified Issues
 
ERCM Bot 5

The bot is capable of converting a paper EOB to ERA (835) file so that the data can be fed into the system without any form of delay or human intervention.

Driving Excellence in Healthcare Solutions

EqualizeRCM is dedicated to its clients. With thousands of providers and facilities served, our team has the experience and the commitment needed to address your RCM needs.