RPA in RCM (Revenue Cycle Management)

Optimization of medical billing processes is under increased scrutiny for efficiency and profitability. Robotic Process Automation is solving these RCM industry pressures paving the way to automate the manual tasks associated with reimbursement challenges, oftentimes with no change in process or complete software revamp.

Silex’s unique and proven approach to RPA allows our customers the flexibility with custom solutions to meet their specific business needs. We empower RCM professionals to respond to heightened pressures and growing demands to increase revenue and reduce coding delays. RPA enables coding/billing to be processed more efficiently, driving improved coding and clearing deficient chart backlogs.

IDENTIFY PROBLEM AREAS WITHIN DENIALS

The ability to track denials is the most critical component of an effective RCM operation. By tracking and reconciling denials from all types of payers and the most common errors associated, your organization can improve your first submission acceptance and reduce write-offs caused by timely filing. Typically denials are caused by lack of supporting documentation, erroneous services or equipment being coded, or omission of credentialing.

RPA eliminates denials and addresses the additional RCM challenges below:

• Manual chart pulling
• Incomplete charts (missing and poor documentation)
• Charts missing signature
• Addendums
• Missing/updated patient demographics
• Eligibility checking
• Denials/chart re-pulls
• Upcoding/downcoding
• Patient dispositions (codable encounters)
• Volume reconciliation (seen vs. charts vs. coded vs. billed vs. paid) with third parties
• Clean claim rate (missing data based on payor)
• Coding audits and chart reviews
• Co-management opportunities (mid-level sharing visits with physician)

Inputting, processing and adjusting claims is a time consuming task that is extremely prone to human error which is typically the cause of initial claim denials. RPA navigates clinical and financial systems and repeats the searches and clicks just like a human. This requires no enhancement requests or development from the hospital/clinic/software vendor.

RPA eliminates clinical document deficiencies by re-pulling charts multiple times when missing data with no intervention from a human, saving time and costs. Frequent data collection ensures you have current and accurate information.