Automation in Healthcare RCM

RPA bots offset cost pressure and preserve margin for healthcare revenue solutions


Healthcare RCM solutions are focused on developing efficient use of technology solutions to better financial performance and improve patient experience while reducing overall costs. Disparate systems, large volumes of data and healthcare regulations add to the already arduous task at hand.

In addition to more than 14,000 medical codes, the average hospital has 29 different systems that must be maintained and updated to effectively run its business.

Healthcare RCM Challenges

Claim Denials

15- 20% submitted claims are declined stemming from authorization issues or charge capture leakage.

Complex Interfaces

Stand-alone applications which do not interact well, resulting in numerous manual processes, in turn making tech advancements a priority.

Yesteryear Technology

79% of RCM areas such as Revenue Integrity, Physician Documentation, EHR Workflow, Reporting, and Coding are technology intensive, but yet not up to date.

An RPA bot can process a claim for as little as $1.25.

Providers Focus Mainly on Technology to Drive RCM improvements.

Nearly Three-Quarters of Healthcare Industry will Increase Revenue Cycle Technology Spend.

Revenue Integrity is essential to ensuring that revenue is accurate in coding and charge capture, contains reasonable pricing for complies with laws and regulations.

Applying holistic approach to technologies that drive RCM through RPA benefits the healthcare industry.

RPA can bring in RCM an integrated EHR solution, advanced & efficient coding platform, high reduction in claim denials.

How Does a BOT Work for RCM Solutions?

Revenue integrity (RI) is essential to ensuring that revenue is accurate in coding and charge capture, contains reasonable pricing for services provided, and complies with laws and regulations.

Benefits of RCM Automation

Several health insurers have implemented robotic process automation to extend the functionality of existing adjudication platforms and increased auto-adjudication by more than 10% points.

RPA can stand to help in labour savings, if not bring in greater future value by preventing compliance mishaps and gaining more top line revenue.

Here is what some RCM providers have already achieved by employing RPA BOTs –

  • Integrated EHR solution
  • Error free, efficient coding platform
  • Reduction in claim denial & claim to payment time
  • Faster transaction processing and anomaly resolution