Revenue Cycle Management Automation

4 minute read

How to Automate the Revenue Cycle Management Process

Automate Your Revenue Cycle with Robotic Process Automation (RPA)

Healthcare revenue cycle management automation can be one of the most freeing activities for any organization who has a complex revenue cycle to manage. For integrated delivery networks (IDNs) or healthcare organizations with multiple facilities, the automation of processes using RPA represents a critical upgrade for healthcare revenue cycle management.

In fact, KeyMark can help IDNs automate over 70 processes in the revenue cycle to process claims faster and save the healthcare organization time and money. We want to help your doctors and staff can spend less on the mundane and more time taking care of your patients. So where do you begin automating the revenue cycle? We recommend 7 areas as prime for automation.

7 Areas to Automate in Healthcare Revenue Cycle Management

Here are 7 areas that are ripe for automation in the revenue cycle.


How RPA can automate pre-registration and registration:

Digital workers can contact and schedule patients. They can even be used to communicate with patients leading up to the appointment, cutting down on “no shows.”

What can be automated?

  • Time consuming tasks to communicate with patients
  • No-show appointments
  • Outdated methods of data collection may be leading to negative patient experiences

The RPA outcome:

  • Reduce the number of No Show appointments to less than 2%
  • Patient look-up in EMR
  • Patient eligibility verified with payer organization
  • System updated with verification information
  • Quicker patient response rates (using ChatBots and texting for scheduling & registration)
  • Improve onboarding and intake patient experience


How RPA can automate charge capture:

Use digital workers to scan and enter information from the patient’s electronic health record into the billing workflow, eliminating the chance for human error.

What can be automated?

  • Manual process to get data from patient’s EMR record into billing workflow

The RPA outcome:

  • Automate charge coding and posting process to shorten time to post and free employees to do more impactful work.


How RPA can automate coding:

Biller manually verifies the charges, billing codes and insurance company modifiers. Then, the E837 is created to start the scrubbing process. Digital workers can process file through 3rd party code verifiers and can even be set up to avoid scrubbing charges.

What can be automated?

  • Manual coding, human errors

The RPA outcome: 

  • Bots can identify CPT II code data in patient charts and apply those to the claim accurately prior to claims submission


How RPA can automate claim submission:

Digital workers automate claims eligibility verification and claims processing.

What can be automated?

  • Time spent submitting claims and ensuring data is correct
  • Denial management

The RPA outcome:

  • Claims can be submitted through to the payer portal electronically for faster claims remission
  • Denial management:
    • Denial look-up in EMR
    • Claims status verified and reason for denial identified.. (i.e., patient responsibility – charge off, authorization missing – verify authorization, etc.)
    • System updated with actions taken to continue automation or involve human resolution


How RPA can automate remittance processing:

The digital worker sends the appropriate payment to the bank for authorization. Once approved, it can log into and open the lockbox to automatically determine payment and patient responsibility. It then begins the payment posting, payment adjustment and reconciliation processes. An auditor would manually complete any exceptions the digital worker was unable to verify and then Digital workers communicate with patients about remaining balances.

What can be automated?

  • Time spent posting payment, adjustment and reconciliation

The RPA Outcome:

  • Payment posting, payment adjustment and reconciliation processes. All without human error
  • Can communicate with patients about remaining balances for the staff


How RPA can automate insurance follow-up:

Digital worker pulls a Continuity of Care document and sends to doctor for confirmation that the procedure was necessary.

What can be automated?

  • Matching continuity of care documentation and time spent sending to doctor and waiting for it to be sent back

The RPA Outcome:

  • Automatically pulls the Continuity of Care document and sends to doctor for confirmation of patient procedure


How RPA can automate patient collections:

Digital workers can enter information from checks and remittance advice into the billing system, invoice the patient, or correspond with the patient about unpaid balances and payment plans. If you’re selling the patient debt, the digital worker can package the information and send to collections agency.

What can be automated?

  • Manual data entry from checks and remittance
  • Time spent invoicing patient
  • Time spent setting up and education patients on payment plans
  • Manually gathered claim data if selling to a collections agency

The RPA Outcome:

  • Enters information from checks and remittance advice to billing system
  • Invoices the patient
  • Corresponds with the patient about unpaid balances and payment plans
  • Can wrap up all the debt information and send to collections agency if needed

Want more examples of how RPA can automate the healthcare revenue cycle? Download our free Revenue Cycle Management infographic.

Want to have a discussion with someone about whether robotic process automation could be a fit for your revenue cycle? Contact us today!

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