August 5, 2022

Transform your healthcare billing operation with RPA

Healthcare billing leaders: now is the time to leverage automation, or be left behind

In recent years, businesses across a wide variety of industries have embraced automation in various forms, from customer service chatbots on the front end to robotic process automation (RPA) on the back end. Despite the name, RPA does not involve actual robots. Instead, it uses software to replace repetitive, rule-based manual tasks. The RPA “bots” are actually software scripts that work behind the scenes, relieving people of tedious tasks while also helping businesses improve efficiency and accuracy.

Although automation has moved into the mainstream, the healthcare industry has been relatively slow to adopt it. Many areas of healthcare operations still rely on manual processes and standalone systems, either due to a “we’ve always done it this way” mentality or simple lack of awareness. But with important advances in technology, not to mention the ever-increasing complexity of medical billing and management, healthcare operations stand to benefit from RPA on multiple fronts — specifically around billing. Not only can RPA save your staff considerable time and effort, it can also reduce errors and increases overall profitability.

Basic automation vs. intelligent RPA

What most people think of as automation, replication of a simple task, has limited value for healthcare billing companies because it can only be used for applications that don’t require any real thought. For example, things like keystroke emulation or screen scraping may be useful for collecting data but won’t do much beyond that.

At Tebra, we take a different approach. We inject intelligence into RPA through the addition of complex rules that allow for actual decision making. Instead of building bots that just do one thing, our bots can be trained to take in information and make an intelligent decision about what step to take next.

While most RPA tools are built by pure technologists, who likely have little to no experience in the healthcare space, our solutions are specifically designed for the daily healthcare user. We start by working to understand the more complex, relatable tasks people are performing over and over. Then we create solutions to automate those tasks with a level of intelligence you won’t find anywhere else. By going beyond the basics, we enable our clients to do more with less — and produce significantly higher-value results across the board.

Automation bots can help you streamline, accelerate, and improve accuracy in:

  • Exchanging information between disparate systems
  • Bridging the gap between facilities for faster reimbursement
  • Creating your own data pipeline with customized rules
  • Standardizing billing processes across multiple practices
  • Scaling up quickly and with increased efficiency

How it works

Tebra’s RPA solutions allow for intelligent automation through the use of rules and tables that increase the number of options a bot can be programmed to do. We start by creating standardized rules — for example, automatically adjusting off Medicaid patient balances or ensuring that denials resulting from common errors don’t get pushed to patients. Next, the user configures those rules. This is where Tebra’s RPA solutions really stand out. We’re not just implementing RPA, we allow you to customize how it works for your practice.

For billing companies, this is a game changer. The ability to tailor RPA applications and control how various tasks, situations, and possibilities are handled means you’re really creating your own version of the software. And the value that adds can’t be understated.

Real world use case: ERA posting

Many healthcare billing companies use electronic remittance advice (ERA) to manage claims in bulk. When a claim is filed, the insurer can provide many possible responses including acceptance, denial, or passing a claim on to the patient. With an RPA solution that’s only able to replicate basic tasks, the bot can only be programmed to do one thing — for example, to post payment information. But if a claim is denied, whether rightly or in error, the bot won’t know what to do.

With intelligent RPA, billing companies can create a complex set of rules that enable the bot to make a decision the same way a person would. For example, “If billing code ABC appears, pass the claim to the patient,” or, “If billing code XYZ appears, treat it as a denial.”

This additional layer of complexity, the element of intelligence, and the ability for the user to build out their own rules is transformative. Billing companies can radically reduce the amount of time and effort required to process claims and post payment information to their internal systems.

It takes “work smarter, not harder” to a whole new level.

“What we do makes a big difference to the practices that engage with us. We’re not just saving time, we’re changing lives. And that happens through automation because the bot is capturing all these elements—it can really have an impact in ways that traditional software just can’t.”

Brian Cafferty, VP RPA Development

The power of integration

Tebra’s RPA solutions are not only uniquely designed to work in the healthcare environment, they’re also deeply integrated into the Tebra platform. For billing companies that are already using our platform, this significantly accelerates time to value. With other RPA tools, there’s no predefined interface associated with the Tebra platform, so you have to start by building one—which requires a deep understanding of how the platform works. From there, you have to program the RPA tool to interface with Tebra. And then you can start to build rules defining the tasks you want to automate. With no pre-built medical intelligence, you’re starting from scratch.

Our RPA solutions work with Tebra from day zero. In addition, an internal API deepens the data that’s available to the bot for making decisions. In fact, our RPA solutions tap into four unique sources of data: on the screen, behind the screen, in the API, and in our core data warehouse, the Tebra cloud. No other RPA product shares this ability.

Real world use case: Implementing a subscription billing model

The rise of Netflix has led all kinds of companies to rethink their business models, from software and apps to cooking and even clothing. The subscription economy has reached the healthcare industry, too, with some providers looking to adopt this popular way of doing business.

As an example, one large chiropractic practice offers a subscription model to make care more accessible for the working class. Services include adjustments as well as targeted treatment for pain as part of a monthly membership package. This model, combined with convenient service locations, makes it easier for people to get regular care that can improve their comfort, mobility, and quality of life.

The practice uses a Tebra RPA solution to manage the subscription model on the back end. Bots handle the monthly membership billing, charge on-file cards each month, and generate the authorization codes that members use to verify their “credits” and access services.

Why it matters: Tangible benefits

Implementing intelligent RPA into your healthcare billing operation provides a wide range of business benefits, including:

  • Increased accuracy
  • Eliminate manual mistakes resulting from fatigue, boredom, and simple human error, which require claims reworking, driving up costs and slowing down your cash flow.
  • Greater efficiency

Once you’ve trained your bots, they can work around the clock with zero supervision. Tebra users who add RPA see on average 50% operational efficiency improvement and 200% faster claims processing.

Automating all your billing processes leads to an average A/R turnaround of 40 days and a net collection rate of 96%

Time and cost savings

Drastically reduce the amount of employee hours spent on data entry, lowering overhead costs while also improving turnaround times. Seamless data sharing streamlines information conversion, transfers, and communication. Plus, you can free up your valuable staff to focus on what really matters—providing the best possible care.

Enhanced profitability

By automatically validating data, RPA helps you ensure a clean claims rate, increase first-pass rates, and accelerate reimbursement times. Get paid faster, lower operational expenses, and boost your bottom line.

Looking forward and leading the way

At Tebra, we’re always looking for new ways to drive value for our customers and solve emerging pain points as the industry evolves. Beyond billing, we’ve begun to implement intelligent RPA for the initial creation of clinical notes for certain services, taking in patient information from an outside EHR system and generating a baseline clinical note for the physician to review and sign off on.

And this is only the beginning. With insurance processes, billing requirements, and oversight regulations always changing, we’re constantly creating new ways to simplify, streamline, and accelerate the business side of healthcare.

Ready to unleash the power of intelligent RPA for your healthcare billing?