How SS&C Blue Prism Customers Optimized Their RCM with Automation

Healthcare services are being pushed to the brink: resources are stretched to their limit and healthcare operating staff face unrelenting pressures.

Against this backdrop, it’s essential to optimize revenue cycles. In years of financial difficulties and uncertainty around payments, healthcare providers and payers urgently need to recoup revenue by streamlining their processes and finding better ways to reduce time-consuming tasks for employees and keep costs down.

Revenue cycle management (RCM), the method for handling healthcare claims adjudication, is the revenue generator for many healthcare providers and the process for negotiating claims payment for payers. RCM encompasses the entire payment and claims adjudication process for revenue generation, based on fee-for-service billing. Effective RCM is vital for healthcare organizations to stay operational and financially viable.

What Are the Challenges RCM Must Overcome?

Currently, revenue cycles remain a major pain point for revenue cycle managers, providers and payers; slow and inefficient processes impact productivity, cash flow and critically, the patient experience.

The revenue cycle has long been a source of great frustration for patients. Errors in coding and medical bills, delayed prior authorizations, unprecedented claims denial and unpaid claims have contributed to widely held perceptions of inefficiency within the healthcare sector.

While new reimbursement models are undoubtedly coming down the line, most commercial healthcare organizations in the U.S. still rely primarily on fee-for-service methodologies. That’s why revenue cycle optimization will remain a critical priority for both providers and payers for the foreseeable future.

What are upcoming trends in RCM? 

In our webinar “Optimizing Healthcare Revenue Cycle Performance With Intelligent Automation”, Anna Twomey, senior director of healthcare, healthcare advisory team Americas at SS&C Blue Prism said we’ll likely see the following trends in healthcare RCM:

• Interoperability: In the land of revenue cycles as a whole and in claims adjudication, we’ll see an increase in the need for interoperability. “We’ve been talking about interoperability for decades. But now that some of the newer technologies such as intelligent automation have come onto the horizon, we’re much closer than we have been, and being able to do interoperability between systems and integrate during the adjudication and revenue cycle processes has become quite trendy,” says Anna.

• Cybersecurity: Anna states, “There is an increased need to be protective of our data and to use technologies such as IA to put guardrails around our data as we go through the various different stages of the revenue cycle.”

• AI and ML: More healthcare organizations are adding artificial intelligence (AI) and machine learning (ML) attributes to digital automation and intelligent automation. Anna says, “Some of the things that SS&C Blue Prism has been concentrating on is adding some capabilities into our platform that allow us to be even more intense on machine learning and AI.”

Along with strengthening cybersecurity measures and using analytics to monitor what digital workers are doing, SS&C Blue Prism’s IA platform includes dashboards that allow organizations to be more proactive in looking for solutions to ongoing challenges.

What Is Revenue Cycle Management Automation

An automated revenue cycle can help optimize your healthcare organization’s entire workflow, driving revenue and boosting your competitive advantage. But what is healthcare revenue cycle management automation and how can it work for you?

Intelligent automation (IA) involves robotic process automation (RPA), business process management (BPM), artificial intelligence (AI) and machine learning (ML). RPA is an automation technology that can simplify processes and realize value faster by eliminating mundane manual processes such as accounts receivable, prior authorization, insurance verification, claims processing and data entry. RPA deploys digital workers to automate tasks in the revenue cycle in real time, giving more time to employees for patient-focused work.

Backed by IA, digital workers can easily integrate with other cognitive technologies like computer vision and natural language processing (NLP) to expand the number of processes that can be automated — from the semi-structured, such as financial invoice processing and managing claim denials, to the unstructured, such as email triage.

We spoke with Suzi Dack, senior director, IT business applications at Banner Health in our RCM webinar, who implemented SS&C Blue Prism’s intelligent automation solution. Banner Health saw around 3.6 million hours saved in total just in the insurance division and revenue cycle spaces.

8 Benefits of Revenue Cycle Automation

Healthcare organizations need better ways to deploy IA and RPA for robust revenue cycle management automation. SS&C Blue Prism can help you build an effective revenue cycle automation to get your organization prepared, optimized and driving towards more value.

With healthcare automation, providers and payers can access a software platform that automates any management processes, interacting with line-of-business applications like a human worker, but more quickly, accurately and 24/7. RPA provides various benefits to RCM and healthcare providers, including:

1. Clearer and quicker communication: With RPA, data is collected into one location and updated in real-time, reducing errors and duplication efforts with fewer back-and-forth communications across departments.
2. Tireless digital workforce: RPA bots perform attended and unattended processes 24/7, handling manual tasks such as processing claims, flagging exceptions, extracting data and submitting invoice payments.
3. Unified operations: Digital workers can scan emails and forward information to the applicable parties while following the compliance rules laid out for them. They can also streamline appointment scheduling and patient data sharing, so doctors stay informed and patients receive the best possible service, faster.
4. HIPAA compliance: RPA provides accurate and retrievable recordkeeping in line with all HIPAA compliance requirements for improved audibility of your healthcare organization.
5. Employee satisfaction: Automating boring, repetitive tasks lets your employees focus on patient care and other value-adding work. It also means they’re not overwhelmed by backlogs of work.
6. Improved patient experience: The patient experience isn’t limited to hospital care; it extends from registration to final billing, and every step in between. Digital workers expedite patient form submissions by accessing the necessary databases and locating information gaps, creating a smoother process for missing data and appointment scheduling. RPA also makes it easier to automatically send important information directly to the patient, further supporting patients through revenue cycle activities.
7. Higher revenue: By optimizing your claims procedures, you’ll have fewer claim denials. RPA performs denials management and detects underpayments, so you recover the correct amount from payers instead of worrying about payment recovery costs.
8. Saving hours: In our webinar, Suzi shared how Banner Health recorded supplemental hours and actual replacement hours. “Replacement hours are hours that our staff don’t have to do the work […] because our bot processes are taking them over. ‘Supplemental’ is work that we never would have been able to do inside of Banner’s umbrella because we never had the bots. Now that we have them, we are running at these extensive numbers and it’s really been quite the journey – and actually a great partnership with SS&C Blue Prism in order to move us forward.”

Intelligent, AI-enabled digital workers act as the integration layer between existing legacy systems to ensure data and information flow quickly and safely within and beyond the organization. This eliminates the need to dedicate prohibitively expensive human resources to undertake these tasks. And like people, digital workers can develop new skills, getting smarter and more capable over time. Working in collaboration with people, a digital workforce allows for faster and more productive RCM processes.

Examples of RPA & Automation in Revenue Cycle Management

There are many ways in which RCM automation solutions can be beneficial. RPA can improve revenue cycle processes across the healthcare organization, from patients and providers to accounts receivable. With IA, you can automate:

• Submitting claims: RPA automated claims processing offers optimized throughput and prior authorization, improving payer communications and making it easier to access claims statuses, create follow-ups and receive reimbursements sooner.
• Back office: RPA bots can be deployed across back-office functions, including processing plan enrolments, determining eligibility and filing expense reporting.
• Finance and accounting: RPA streamlines manual data entry for accounts payable and accounts receivable transactions, payments, billing and reimbursements.
• Hospital records: Automation accurately extracts and processes data from patient accounts to speed up new patient appointment requests, patient information updates and patient enrolments.

Bridging payer-provider gaps

In our webinar, we also spoke with Dianne F. Kokotoff, MSSM, executive director, enterprise solutions and automation at Wellstar about how they bridged the gap between the providers and the payers with the RCM process. Originally, they were going to go with a much larger application. But then, Dianne says, “When we were talking about that application, I [said], ‘I really think we could do this in SS&C Blue Prism. This is going to make the providers much happier if they don’t get all of the complaints about the claim status from our patients’, which has been a huge, huge problem – especially after the onset of COVID.” Wellstar took the claim status, broke it up into smaller payer pieces and, Dianne says, “We’ve actually automated about 75% of all of our claims at this point. We’ve saved close to […] 12,000 labor hours.”

Dianne adds that they also discovered a side benefit: “Our cash flow has increased by 10 days, which […] the quicker you get your cash in, the much better your company is.”

Automatically processing patient documents

Suzi shared how Banner Health utilized SS&C Blue Prism’s intelligent document processing (IDP) solution to springboard a lot of their operational efficiencies. “We’re taking insurance cards that patients scan on their phones, and it comes through our processes,” Suzi explains. 

“We read the insurance card and then what we’re actually doing is extracting the data. So, we’re building data extraction models that will pull the necessary information off of the insurance cards. And then we’re taking that data, creating an HL 7 record and sending it downstream into some of our registration applications so that before the patient even arrives, they’ve got all their necessary information from that check-in phase.”

Referrals and prior authorizations

Suzi also shared Banner Health’s efforts with incoming faxes. “The manpower it takes to sort through those is extensive,” says Suzi. “We’re bringing the faxes in through our RPA processes. We’re grabbing that information, we’re sending it to our IDP systems, extracting the necessary data, and then we’re turning around and taking that data through RPA and creating whether it’s an HL 7 record or some downstream format that our other core systems can ingest.”

Reducing manual labor in the RCM process

Dianne went on to share, “For us, probably our most successful automation was with coverage discovery for the Georgia Medicaid, Medicare.”

When dealing with the U.S. government, they often give healthcare organizations a long period with which to submit their claims. But for a lot of nonprofit organizations, they deal with patients who have no insurance. They try to get them coverage from either federal or the state, but that can take a very long time. In the past, Wellstar would have six agents entirely dedicated to logging in every single day to the federal government and state to validate coverage. This list grew exponentially during COVID.

Dianne says, “The first thing we worked on and since then [was to have] the bot manually go into the systems with the list of non-covered patients and search for the coverage that has been in existence now for three years. We have been able to recover over USD $2 million, which is great for a nonprofit because that money goes back into the equipment and helps to cover some of the expenses of these non-payment patients.” This change allowed Wellstar to upskill their people, freeing them of time-consuming, repetitive tasks.

Key Takeaway on RCM

Intelligent automation and RPA have the potential to revolutionize the healthcare industry by drastically improving the revenue cycle management processes.

IA simplifies your RCM; it automates patient data migration and processing, insurance data, medical billing and insurance claim processing. By optimizing these processes with automation, your organization can reduce manual tasks for employees, implement faster department-wide communication, receive real-time data and statuses, digitize files, create error-free and accurate data, improve patient and staff experience, and so on.

With RPA, you can securely access audit trails and maintain compliance with HIPAA and other regulatory requirements, while keeping your processes operating more efficiently and increasing your revenue.

In our webinar, we dive into so many detailed use cases and topics surrounding RCM healthcare automation with our guest experts. Watch the full video by clicking the button below.