Implementing Automated Claims Processing in the Medical Industry

No matter the country, the healthcare sector is a complex but vital system to its citizens’ general well-being. Due to the complex nature of the healthcare system, managing data that relates to scheduling applications, clinical applications, enterprise resource planning (ERP), HR, radiography information systems, and third-party portals is usually an overwhelming task. And that’s not all, the integration of these processes across the healthcare system is also very labor-intensive and challenging.

The healthcare system is so complex that, to guarantee seamless patient care delivery, there’s a need for stakeholders, insurance companies, doctors, including the patient to fully cooperate and work together. However, that has proven difficult due to the level of paperwork that continues to increase with the increase in healthcare patients.

To this end, a good percentage of healthcare companies are beginning to adopt Robotic Process Automation (RPA) as an effective solution to the paperwork involved in hospital processes.

When integrated into a healthcare system RPA effectively processes data in record time and addresses the challenges that result from human error. As a result, healthcare companies can increase operational efficiency, reduce cost, and rid their systems of human errors as regards data processing.

Hire RPA consultants and find out what value can RPA bring to your business.

Manual Claims Processing VS Automated Claims Processing

Claims processing is a detailed workflow involving lots of checkpoints that every claim must pass through before getting approved. When claims make it through all these checkpoints without issues, the insurer approves and processes it for any insurance payments. If it doesn’t, the claim is rejected and sent back for proper vetting and analysis.

Processing claims have been mostly done manually for years. The automation solutions that have been existing on the market were usually expensive and available only for big practices and billing providers.

RPA is changing the game – thanks to Robotic Process Automation we can build small and effective automation on the budget and even for the smallest companies.

Some of the benefits offered by automated claims processing over manual include:

Improved Processing Speed

Manual claims processing takes a lot of time because humans can only carry out a single claim at a time. But, with the automation of claim processes, you have the advantage of time through computational power and multithreading.

Furthermore, automation enables healthcare workers to focus on other tasks and learn new skills which increase productivity in the long run.

Improved Reliability

Automated claims processing assures that tasks are carried out on time and in an orderly sequence. Reliability is unaffected as the absence of workers does not impede the progress of claim processing.

In situations where workers are stressed and tired, reliability is bound to reduce. For example, NCBI asserts that 75% to 90% of doctors’ visits to the clinic are stress and ailment-related cases. With the integration of RPA, doctors get enough time to relax and reliability increases.

Cost Savings

Not having to manually access every single claim has offered many healthcare companies the opportunity to downsize their claims department personnel.

Reducing the number of employees translates to spending less on employees’ remuneration and salaries. With automation, and fewer personal requirements hence healthcare companies can save a ton of money on recruitment. That’s not all, automation also saves many healthcare companies the overhead costs incurred since fewer supplies and equipment will be needed.

Customer Satisfaction

Automation lessens the time spent attending to a patient and thus increases efficiency. When patients are attended to quickly and within a short time, they are mostly satisfied and healthcare companies can easily compile the needed data.

Customer loyalty and trust often begin with satisfaction, and establishing a solid base of long-term customers is beneficial for your company’s growth. Above all, a satisfied patient is bound to recommend your healthcare company to the next sick person.

The Checklist Before Automating Claims Processing

Claims processing automation has no doubt improved efficiency, and reliability and reduced the time spent in processing claims in the healthcare sector. However, to effortlessly achieve these results, certain conditions must be met before automating claims processing. Below is a checklist of things to consider before automating claims processing.

Ensure Your Business Processes As Efficient As Possible

Claims processing can easily be automated because they are predefined rules about what happens and to whom it happens. In order to make a smooth transition from manual to automated claim processes, you have to make sure all procedures are clearly mapped out and improved.

This step is essential because leading with automation without ensuring the efficiency of your processes might make you miss dysfunctional systems ripe for improvement. If it takes your organization 10 steps to process a claim, redesign it to 10 steps for easy automation.

Consider How Suitable Automation Will Be For Your Company’s Culture

Change is constant, but as individuals, we tend to react to change differently. Automating claims processing can be a drastic change for organizations and customers alike. To avoid situations where an adaptation might prove hard to achieve, the following questions should be pondered and suitable solutions are provided;

Will automated systems be a great addition to your worker’s capabilities?

Will there be effective working conjunction between workers, customers, and automated systems?

How reliable and suitable will an automated system be for customer use?

Will a continuous improvement approach be maintained with automated processes?

Don’t Be In A Rush To Overhaul All Annual Claims Processes

You risk a lot when trying to automate all processes at once. It will be more difficult to isolate issues and fix them. Prepare and manage the existing systems in a way that integrating automation won’t make things complex. The whole idea of RPA in claims processes is to enable a streamlined workflow, not make life difficult.

Automate Workflows

Keep in mind that RPA is designed to make the workplace more efficient by simply rebranding business process management (BPM) automation and workflows.

In the past, RPA was only accessible to large enterprises that wanted to mitigate repetitive functions while cutting costs. Now, the technology has had time to mature and the adoption of virtual robots is becoming mainstream.

Ultimately, make sure that the software you select is user-friendly, abundant in features, possesses cross-device functionality, and is very easy to use. Above all, endure that the RPA software that you select can be well blended into the EHR system of your healthcare company or agency.

When it comes to RPA software, there are lots of options available in today’s market. This software can be customized to meet your specific requirements and goals. However, ensure to get one that will be easy to integrate into your system.

There is also an opportunity to provide holistic automation of your key business processes that will hyper boost your efficiency and increase profitability with Intelligent Automation.

How To Implement RPA into Claims Processing

Implementing Robotic Process Automation into claims processing in the healthcare sector is a process of first making a list of insurance steps that take place at the front-line employee level.

These steps and actions listed are input into a computer or other electronic devices and then used to automate data movement across the system. Insurance RPA is usually implemented by your staff, or IT consultant as “blueprints” used to automate scripts that operate across various systems to process data.

We recommend that you don’t purchase RPA software until you’re certain of the functions of the bots and the licenses needed for the use case.

Implementing Robotic Process Automation into claims processing may look complicated but it isn’t. Follow these simple steps to get started;

Step 1: Take note of the sub-processes on the process map where RPA robots can be integrated

Step 2: Evaluate and prioritize the entire insurance use cases and sub-process to know which gives the highest advantages.

Step 3: Lastly, document and devise the rules, keystrokes, and requirements for the use-cases that the bot must manage and oversee.

Use-cases of RPA in the Healthcare Industry

Appointment Scheduling

With the integration of RPA technology, patients can schedule appointments without any help from a healthcare professional. Asides from terminating the need for allocation of resources for scheduling, the integration of RPA also inspires customer satisfaction since patients can get an appointment quickly.

Claim Management

After healthcare services are offered, billing usually takes some time as a result of the repetitive nature of claim management processes. These processes can include inputting, processing, and analyzing data and documents. By integrating RPA into the healthcare system, time-intensive tasks are effectively automated hence reducing claim processing time. That’s not all, automated claim management also eliminates human errors and omissions during claim processing.

Regulatory Compliance

RPA allows healthcare professionals to document and track every step in structured logs files such that healthcare companies can comply with external audits. With this process being carried out by RPA bots, data confidentiality, and credibility are guaranteed.

Data Entry/Migration/Extraction

Many healthcare companies are still reliant on administrative paperwork hence the need for digital transformation. Patients’ information can be electrically stored and accessed online by the patient and doctors through the integration of RPA.

RPA is capable of extracting data and information from legacy systems and storing those data in a digital system. And if migration of data for another objective like medical research is required, another RPA bot will oversee the process of migration.

Industry Agnostic Use Cases

Processes such as expense management, accounts payable, and so on are popular across all sectors and RPA is capable of automating them.

Conclusion

Robotic Process Automation as a solution to automating healthcare medical claims management is an effective way of streamlining the entire lifecycle process of claims submission. Be it the validation of data via the use of technology or ease of electronic data entry, or flexibility of error being noticed and flagged before submission, the advantages of RPA are endless.

At Flobotics, the automation processes we provide are remarkable. With our group of experts, we centralize healthcare data and processes while offering the flexibility to scale up or down. Be it automating claim processing, HIPAA compliance, or security practices, we are the best at what we do.