Revenue Cycle Use Cases

The following is a transcription from Episode 14 of The Orange Chair Podcast, “RPA in Healthcare: Revenue Cycle Use Cases”

In this episode, we sit down with Anna Twomey, Senior Solutions Provider for Healthcare in the Americas for Blue Prism and Sam Whitten, Director of RPA Sales at KeyMark. They outline numerous ways Robotic Process Automation, or RPA, can automate processes within the revenue cycle as it pertains to the healthcare industry. Also, this episode will kick off our RPA in Healthcare series, so be sure to check out the other episodes in the series as they are released.

To listen to the full episode, or any other episode, you may do so by selecting your preferred podcast listening method on The Orange Chair Podcast page.

Introduction

Alex Frazier (18s): Hi, everybody. Welcome back to The Orange Chair Podcast! Today in the Orange Chair we have two special guests, Sam Whitten an Anna Twomey. They are here to talk about how RPA can help within the revenue cycle. Can you guys introduce yourself? Tell us a little bit about who you are.

Sam Whitten (34s): I am Sam Whitten. I am a director of sales for RPA within KeyMark. I’ve been with KeyMark since March of 2020, before that I had the pleasure of working with Anna at Blue Prism for 3 years. So, I’m looking forward to this conversation.

Anna Twomey (49s): Well, thank you, Sam. I’m Anna Twomey. I’m the senior systems advisor for healthcare in North America and I work for Blue Prism. As Sam said, we’ve been working together for a while on all of healthcare and it’s been a joyful ride working with RPA and helping to develop out the revenue cycle.

Alex Frazier (1m 11s): Well, thank you both so much for joining us today to talk about the revenue cycle. So that being said, can you give us an overview of what the revenue cycle is from a healthcare perspective?

What is the Revenue Cycle?

Anna Twomey (1m 25s): From looking at a healthcare in general, everything is more centered around the patient. Patient satisfaction, patient security and overall outcomes on patient care. But what are the key factors of that? Of course, one of those factors is the revenue cycle because everyone needs to make sure that their claims are paid and their bills are paid at the end of the day. If you’re worried about your health already, you don’t want to have to worry about that piece.

For years, the revenue cycle and claims management process has been a big obstacle in Healthcare of making sure that the patient still has a satisfactory outcome from the financial side, as well as from the healthcare and patient centered health side. 

We’ve taken a new look at not only patient access to their data and to their billing and to be enabled for them to receive updates on a regular basis that says “your claims have been submitted and your claims have been paid.” But that is something that RPA can take on. A digital worker can not only automate the revenue cycle process, but they can keep the patient up to date.

Patient Information Access and Communication

Anna Twomey (2m 54s):Its just like if you were to purchase auto insurance and then you had an auto accident claim and you had to submit your information. You usually get generalized data that says your claim has been submitted and your payments should be made within a certain length of time and how much of the patient responsibility would be.

We’ve taken that approach to looking at patient access of information. Not only from the time that you’re scheduling your appointment, which a digital worker can schedule appointments now off of any EMR.

One of the first steps in revenue cycle is to ensure that there is communication with a patient at the time of setting up the appointment. We have set your appointment, now we are going to check your eligibility. Checking their eligibility of benefits with the payer organization used to be a very time consuming process where people within the doctor’s office would sit there for hours trying to verify eligibility of benefits for a single patient that had a scheduled visit for tomorrow.

That is one key piece of information we are able to set up in a process. A digital worker can automate a daily process by pulling all of the next day’s patients, contacting the insurance provider, verifying eligibility of benefits and then supplying communication back to the patient that says, “we have verified your eligibility and we’ll see you at one o’clock tomorrow. This is your copay that is anticipated.” That is a huge task just at the initiation of the revenue cycle that we are able to implement with a digital worker. Sam do you want to add to that?

RPA and EMR Integration

Sam Whitten (4m 24s): That’s agreat point. When working with Blue Prism and working Anna, we determined they’re working with what is called an EMR system, which is the system of record for healthcare. There are a couple of different vendors out there. One of them being Epic, which is the big boy in the market. We’re working with some of our clients now that are on the Epic system to do three basic things within RPA.

One of them being what Anna just talked about with the verifying eligibility and benefits with a digital worker. She talked about how the digital worker can log into the schedule for the next day appointments and then log into the payer channels to verify eligibility of the benefits and pull back the benefit statements and then update the EMR system and send out an SMS or a text confirmation to the patients and attach benefit statement to the patient chart in the actual system of record, which would be Epic.

Some of the others that we’re looking at are electronic order entry and also claims reconciliation process within those EMR systems. We’re looking to work with some of our clients right now, where we are talking with them about doing this for them against the Epic system, because we feel once we created those, we’ll be able to go out and help other providers to go out there and do these process automations on a daily basis.

Pre-Authorization Checks

Alex Frazier (6m 1s): So how can RPA, you know, help within the revenue cycle? What are some specific use cases that you guys see that are maybe farther into that cycle and not necessarily just at the beginning?

Anna Twomey (6m 15s): There are a lot of use cases and I talk about this often that I probably go on and on too much. All throughout the healthcare life cycle from beginning to end, revenue cycle is kind of intermittent throughout each one of those phases. It’s one of the easiest handoffs to a digital worker because it is set up on a process. We talked about eligibility, next there would be something like, the doctor is recommended a procedure now and that procedure has to have an authorization from another source or from the insurance company. Without it your revenue cycle is again at a stop.

One of the key things, as Sam mentioned in Epic as well as some of the other EMR record systems, is all of them require the use of either a referral from a physician to go to another physician for a doctors visit. And the referral has to be in play before the claim can be submitted. A pre-authorization on a procedure that has to take place before the patient could be in entered into the hospital to have the surgical procedure done. There has to be a pre-authorization and many times that’s a step that is missed by humans. As this is set up in the revenue cycle from piece to piece to piece that is just three separate processes that a digital worker can handle.

A doctor is seeing a patient and he says, “I think I need to send you into the hospital. You need to have a surgical procedure done and it needs to happen right away.” That can kick off a process by a digital worker for them to go ahead and ask for a pre-authorization. It sends out to the insurance company or the payer organization and requests that a document be sent back and update the patient record that says “this has been pre-authorized” so that before services are performed, there’s already been an authorization process.

Denial Management and Claims Processing

Anna Twomey (9m 22s): Pre-authorization submissions are a use case that we see very often. Of course, there’s the denials management. If any of these steps get missed or the improper CPT code for a procedure code or the improper ICD9 code or improper diagnosis code appears on the claim, that results in different types of denials.

It’s all just a step by step process that has been widely defined over a period of time. We can take that process and give it to a digital worker and they can repeat those processes.

For example, checking the claims, scrubbing the claims and ensuring that all of the charges and the charge reconciliations are appropriate as well as being able to send that on through the claims processing life cycle. If it is denied, it can come back.

We have one process, for example, that opens Epic and checks to find out what the denial codes were after payments have been posted for the day. If there were any denials, they show up with a denial code. One by one the digital worker pulls that patient record and pulls that claim and it does the comparative analysis. Why was this claim denied and what needs to be a fixed to eradicate to adjudicate that claim? At that point they work each denial and either write it to patient responsibility or take off the claims adjustment within EMR.

You’ll see digital workers working in the system just as a human would be actively working those viable use-cases.

Claims Imaging Research

Anna Twomey (10m 8s): Another example is not only the claims processing, but claims imaging research. If there were additional x-rays or radiology exams that were taken that may need to be attached to a claim in order for payment to be submitted and it to be properly paid. That’s another task that could be handed to a digital worker, and that’s just to name five or six different claims. We have five or six different areas that affect the revenue cycle that are handled by the digital workers.

Sam Whitten (10m 37s): The ultimate goal here is to make sure that we’re freeing up physicians to do what they do best and that is to take care of the patients. But the second thing is to take the pressure off of the patients, so they do not have to worry about whether or not they’d got the pre-authorization to go in and see a specialist that the physican may have sent them to. And also that the patient is given the correct bill when it gets to them and that their insurance company is paying for the things that it needs to pay.

The flexibility of RPA within this particular process of the revenue cycle, we’re looking to help both sides out to make sure that they come together and can really give good service to the patient and the physician.

Elimination of Errors

Alex Frazier (11m 28s): It sounds like in addition to those benefits, it also cuts down on a lot of that human error within the multi-step process of the revenue cycle where there’s the possibility that things can get marked wrong or not done, or whatever the case may be. It sounds like it cuts down on a lot of that, right?

Anna Twomey (11m 51s): That is probably one of the biggest backlogs. In a revenue cycle, these are just the little minor things that people are constantly coming up against with doing this on a daily basis. We sometimes forget to double check. A digital worker never forgets to double check their work.

Or we get to moving so fast on the keyboard because we are keying in so many different transactions in a single day that we may just miss a step or a decimal point and that throws out the entire claim and it comes back for a reiteration again. Those are the things that are eliminated from the revenue cycle and the entire life cycle of the claim during the RPA process.

Alex Frazier (12m 48s): That also goes hand-in-hand with what you were talking about with the integration with Epic, right? Such as those pre-authorization checks and the claims processing.

Sam Whitten (12m 56s): That is correct. Like I said, the ultimate goal here is to make sure things are done in a timely manner. There are certain situations where the only thing that needs to happen is a person needs to go into the EMR system and check a button. And that’s missed and because that was missed the claim gets denied or they don’t get the pre-authorization they need.

To have a digital work and go in and do that means it will always get done and will never get missed. That can reassure the doctor and reassure the patient that everything is getting taken care of it on their behalf.

Wrap-Up

Alex Frazier (13m 41s): As our time comes to a close today, do you guys have any final thoughts? Was there anything I did not ask or anything that we discussed that you would like to elaborate on?

Anna Twomey (13m 51s): One last final thing that I’d like to say is along with everything that Sam has said, the final outcome of everything we do is a cost reduction in overall length of stays or a cost reduction the number of no shows for appointments, because those are costly mistakes that add up in the end.

The outcomes for the facilities and for the healthcare organization as an overall arching included platform is to look at those various different outcomes and ensure that we have made every effort possible to increase efficiency in all areas and get those scores up or down.

Depending on if your decreasing your no shows, then you want to make sure that you’ve got all of your authorization and everything is in place so that your patient is prepared to show up and pay their initial copay and move forward with their procedures.

At the same time, reduction in cost of hospital standardization is another outcome or goal that we want to look at. All of that leads to efficiency and efficiency leads to RPA.

Sam Whitten (15m 9s): As many things as Anna has talked about, there are many more processes within revenue cycle that can be automated. It’s just a matter of allowing us to come in and see the process that you are running and let us see how you’re doing it today and we can match that with a digital worker and build out that process for you. If any of the listeners are interested in talking with us about this, please feel free to get in touch with us.

Alex Frazier (15m 38s): Thank you both so much for our discussion today. Thank you for coming in and talking through the revenue cycle with me. I really appreciate it.

Well, that’s all we have for you guys today. Thank you so much for listening to this podcast. The Orange Chair Podcast is brought to you by KeyMark. If you like to this podcast, please leave us a rating and like and subscribe to our podcast channels wherever you guys are listening to podcasts. You can even follow us on Instagram and Facebook and we’d love to hear from you. This podcast is produced by Greg Aiken, Clay Tuten and me, your host, Alex Frazier. Until the next time, bye guys.