Medical billing can make or break your bottom line. In the intricate world of healthcare management, precision, efficiency and swiftness in this process are non-negotiable. From securing timely reimbursements to navigating complex and ever-changing compliance requirements, every aspect must be meticulously managed.

Yet, traditional medical billing systems fall short. It’s time to change the narrative with medical billing automation.

What Is Medical Billing Automation?

Medical billing automation is part of a comprehensive healthcare automation solution that streamlines the process of gathering, generating and submitting medical bills to insurance companies and patients.

It utilizes intelligent automation solutions (IA), such as robotic process automation (RPA), machine learning (ML), artificial intelligence (AI) and other technologies. By doing so, it eliminates the manual, repetitive and error-prone tasks traditionally done by a human worker in the medical billing process.

This enhances revenue cycle management by improving data accuracy, efficiency and speed of completion. Ultimately, this will lead to better financial outcomes and valuable time back to healthcare professionals. There’s also a patient aspect to having medical billing automation. Delayed or denied claims can be upsetting for a patient and increase their stress at a time when they should be focusing on recovery.

Why does the medical billing system need to be automated?

You’re probably highly familiar with the inefficiencies facing the healthcare industry with medical billing. Here are a few key ones that automation can help address:

Complexity

Challenge: Procedures, diagnoses and treatment codes, variable insurance plans, documentation and tracking are only a few subprocesses that add complexity to one medical billing workflow. This complexity is compounded by several patients. Lack of standardization across different insurance companies also means workers have to adjust to different rules, requirements and reimbursement rates.

Adding automation: RPA digital workers can analyze and select the most appropriate codes for procedures and diagnosis, verify insurance coverage across diverse plans and automatically track any process updates, across several patients at once — keeping electronic health records (EHR) up to date.

Late payments

Challenge: The complexity and drawn-out process of payments disrupts cash flow, strain resources and risks financial stability. Prolonged payment cycles also lead to dissatisfied customers. But why do late payments happen? It mainly stems from manual errors that require time to fix, drawing out the process even longer. Moreover, understaffing adds to the challenge and prolongs the cycle.

Adding automation: Digital workers can work 24/7 to process claims and medical bills. They also do so accurately and efficiently to stop any delays. If there’s any missing or inaccurate information, digital workers will also flag them to a human worker to follow up with. In the end, automated medical billing systems can minimize billing errors and make issue resolution much faster and easier so payments can be made on time.

Legacy software

Challenge: The reliance on outdated and inefficient legacy systems that lack scalability, flexibility and adaptability. Overhaul of systems can be time consuming for healthcare organizations who want to improve their processes today.

Adding automation: Automation can work with your existing infrastructure to streamline processes and bridge the gap between outdated systems and current demands. This integration is without the need for major changes to underlying infrastructure — making it both flexible and scalable.

Medical coding errors

Challenge: Incomplete information, incorrect codes and manual effort are taking up valuable time but also delaying the process with human errors and simple mistakes. This also goes hand in hand with late payment challenges. Workers also must continuously learn new codes or updates to codes to stay current with changes in medical procedures, diagnosis and treatments — which can put added stressors on workers.

Adding automation: Digital workers can parse through large volumes of data quickly, accurately and in real time to identify information and discrepancies. They can also suggest accurate codes based on the information provided and accurately enter data into a medical billing system. Once a code needs an update, digital workers can swiftly work to update and use the new code.

Compliance

Challenge: The administrative burden of staying compliant with ever-changing healthcare industry regulations, especially if manual work is involved. This is especially important as errors can result in lengthy investigations that can potentially damage your practice’s reputation.

Adding automation: Automation can help monitor regulatory changes and automate document processes to ensure organizations’ adherence to compliance standards, such as being HIPAA compliant. They also maintain accurate logs of all actions performed for a comprehensive audit trail, capturing details like time, date and nature of task.

All these challenges can be boiled down to be mainly a time-consuming, administrative burden, diverting time away from helping patients. By deploying automation solutions like medical billing automation and claims automation, not only do healthcare professionals reduce this administrative burden, but they also minimize errors, speed up claims processing and free resources to focus on delivering exceptional care.

Benefits of Medical Billing Automation

We’ve covered a few benefits of an automated billing system above, but here are a few extra benefits you can gain:

• Increased efficiency by streamlining the billing process and accelerating task completion. Digital workers don’t get tired, don’t take leave and produce consistent quality of work.
• Improved accuracy as digital workers minimize manual data entry and coding errors. Any errors or missing information can be flagged for a human-in-the-loop to verify. As digital workers execute tasks based on predefined rules, they also adhere to uniformity and standardization in their output to help the accuracy and reliability of information.
• Faster reimbursement as digital workers can process claims and payments in real time, significantly speeding up the cycle. They also quickly navigate through the different steps (submission, verification, payment processing) to minimize delays and bottlenecks.
• Enhanced compliance as digital workers work off rules-based processes and established guidelines without deviation. Tasks are executed accurately and in accordance with requirements that minimize the regulatory risk. Digital workers are also transparent in their work, you can view all their task logs to see each process executed.
• Cost savings by reducing the manual labor effort associated with admin. The overhead costs of hiring and training staff for these administrative tasks are also reduced. Additionally, digital workers help minimize the cost of redoing errors by consistently executing tasks accurately and efficiently.
• Enhanced patient experience through accurate, faster and stress-free reimbursement. This also fosters trust and confidence in your practice as patients can rest assured that their information is handled with precision and integrity.

What can be automated in medical billing?

In need of some inspiration? Here’s a list of processes that can be automated in a medical billing system:

• Patient registration
• Claim generation
• Insurance verification and eligibility check
• Assist pre-authorizations
• Medical coding
• Claim submission
• Claims processing
• Patient statement preparation and follow up
• Payment reconciliation
• Denial management
• Reporting
• Compliance monitoring
• Document management

Let’s take a real-life example of healthcare automation that illustrates all the impacts we’ve been discussing.

Case study: Banner Health

Banner Health turned to an intelligent automation (IA) solution and deployed a digital worker to migrate all its patient records from disparate systems into its document repository application. The result? 72 million records handled in just two years and 1.2 million employee hours returned to the business. That’s time that employees can spend providing superior patient services and care.

Case study: Highmark Health

To meet its mission to “create a remarkable health experience, freeing people to be their best,” Highmark Health looked to reduce staff time spent on mundane tasks and increase time spent on patient care — they did so with the help of digital workers. In doing so, they were able to quickly clear their backlog and process over 200,000 claims in just five days.

How Can You Automate Medical Billing?

We’ve got a ton of resources for organizations to get started with automation, including support with medical billing automation. In general, you can follow these steps:

Identify the area of the billing cycle you want to automate

Assess your current billing processes to identify areas that are most time-consuming, error-prone or resource-intensive. You can enlist tools like the SS&C | Blue Prism® Process Assessment Tool or SS&C | Blue Prism® Capture to help you identify these areas with detail.

You could start with one process, such as data entry, and gradually expand your automation efforts to other areas of the billing cycle, such as claims processing. Prioritize processes that have the highest potential for automation and impact on efficiency and accuracy.

Get organization-wide buy-in

Next, you’ll want to get organizational buy-in from all levels. Communicate the benefits of automation, such as improved efficiency, accuracy and cost savings. Ensure that everyone understands the goals of the automation initiative and their roles and responsibilities in its implementation and success. This is especially important with the workers who will use the automations daily!

Choose the right medical billing software

There are several options out there so pick one that best suits your needs! Consider factors such as ease of use, scalability, compatibility with existing systems, customer support and integration capabilities.

Develop an implementation plan

In this stage you’ll want to define clear objectives and success criteria for the implementation and allocate resources and responsibilities accordingly.

Test your solution

Fully test your automation before deployment to ensure it functions as intended! Involve several stakeholders for various viewpoints.

Rollout and transform

You’re ready! Roll out your automation across your billing process. But the journey doesn't end here — continuous improvement is key to maximizing the benefits of automation and ensuring ongoing success.

Need Help With Your Automation Journey?

Download our e-book all about optimizing the healthcare revenue cycle with automation — including more use cases with how healthcare organizations are utilizing automation in their medical practices today!

You can also contact us to see how we can help you get started.