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How Healthcare Providers Can Improve Patient Experiences With RPA, AI And Digital Workflows

Forbes Technology Council

Uday Birajdar, CEO and Co-founder at AutomationEdge. Building delightful workplace experience with AI and Automation.

Currently, the healthcare industry is at the confluence of mounting operating costs and a growing volume of patients, with an urgent need to provide positive patient experiences while complying with stringent regulations. With a deluge of data and a plethora of repetitive, manual processes that require a need for accuracy, automating processes may be just what the doctor ordered for this industry.

Taking a cue from other digitally mature industries, like retail, travel and financial services, hospitals, too, have taken on improving patient experience at every touchpoint, even before the visit commences all the way through follow-up care. According to a recent Deloitte-Scottsdale Institute survey, “Most survey respondents are hoping to achieve better patient experience (92%) as the top desired outcome from digital transformation.”

Hospitals are using the automation stack for both nonvertical processes like staffing and running IT helpdesks and for vertical processes such as physician credentialing or verifying insurance eligibility. Beyond just automating tasks, robotic process automation (RPA) today leverages adjacent technologies like AI, ML, NLP, image recognition and intelligent document processing (IDP) to accurately and efficiently capture, extract, analyze and report results to the end-user department. RPA is transforming the lives of patients, doctors, nurses and administrative staff.

A few of these processes include:

• Patient Onboarding.

• Appointment Scheduling.

• Medical Billing.

• Claims Processing.

• Report Generation.

• Prescription Management.

• Discharge Instructions.

• Audit Procedures.

• Account Settlement.

Here are a few of the touchpoints that hospitals can strive to improve for better patient experiences.

• At Pre-Registration: As much information about the patient and their insurance as possible can be collected before any service commences. Pre-registration details are collected prior to patient arrival for inpatient or outpatient processing. This step ensures the smooth running of downstream patient interactions.

• Registration And Eligibility Verification: Preexisting medical conditions are captured, and payee contact information is reviewed to meet established clinical, financial and regulatory demands. After the scheduled appointment, the patient’s insurance is verified.

• Claim Submission: Claims could be submitted one at a time by entering information directly into an online claim form on the portal, or batches of claims could be submitted via the provider’s practice management system. Reports to verify claim receipt and identify errors before adjudication and payment could be auto-generated.

• Remittance Processing: Payments associated with a bill for medical services could be reviewed to determine whether to accept or deny payments. The hospital’s accounts receivable system could automatically prompt for verification of insurance process claims electronically wherever possible. It could also submit clean claims and appeals in a timely manner to the net maximum collection in the shortest time.

In the recent past, hospitals used to have armies of data entry staff to prepare, collate, check documents for accuracy, address and make necessary corrections as needed, scan documents into databases and transcribe information into electronic formats as required. In fact, up to 33 cents of every dollar we spend on medical care pays for healthcare’s back office, and billing and insurance account for more than half these administrative costs. These sobering statistics take away from the hospital’s core function of providing patient care at affordable costs.

Hospitals are home to a number of applications for carrying out myriad tasks, from patient scheduling and settling payments to electronic health record management and verifying insurance claims. Robotic process automation allows healthcare institutions to automate their processes noninvasively. RPA sits outside the legacy walls of the hospital’s mission-critical systems and reaches into the applications, automating processes without any hard coding. Choosing an automation platform that communicates with the critical applications in the hospital’s application landscape would help automate its crucial processes without any time-consuming coding or data migration.

“Fifty percent of U.S. healthcare providers will invest in RPA in the next three years,” according to Gartner. As healthcare matures to value-based care being delivered to patients wherever they are, every process along the delivery chain will have to be explored for automation potential. The scalability of automation will be the key determinant of reigning in the costs of providers.

The CAQH index estimates the healthcare industry’s costs of conducting administrative transactions to be $39 billion, and by fully automating some manual transactions, an additional $16.3 billion in costs might be avoided. Patients have come to expect the same experience from healthcare that they do from other document-intensive industries such as banking and insurance. It is time for healthcare to step up and deliver.

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