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 RPA 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.