Eligibility Verification Automation:  A thorough review of a patient’s information can be a time-consuming task, ranging from 30 minutes to an hour, and it becomes even more challenging when insurance details are inaccurate. By implementing Eligibility Verification Automation, the need for manual searches across various resources and insurance websites can be eliminated. Robotic Process Automation (RPA) bots can swiftly gather the required data in just 1-2 minutes and maintain the most current eligibility status in your Electronic Health Record (EHR). This ensures that when a patient returns for another appointment, there’s no need to educate them about their benefits, as the information will already be up-to-date.

Charge Capture Automation:  Charge capture is a manual process and is, therefore, an error-prone process resulting in decreased first pass and clean claim rates. Revenue Cycle Rx offers RPA solutions to increase accuracy. 

• Cutting-edge Optical Recognition Technology (OCR)
• Top-notch Natural Language Processing (NLP) capabilities
• Advanced Machine Learning techniques
• Built-in NCCI and coding classifications
• Seamless interoperability among applications
• Beneficial for both providers and charge-entry personnel

Mistakenly recording charges and entering inaccurate data can result in expenses of up to $2000 per patient. Robotic process automation (RPA) for charge capture and entry significantly reduces the occurrence of erroneous data.

Denial & Appeal Management Automation: Denial and Appeal RPA enhances the denial management process by improving workflows and protocols, pinpointing the underlying causes of denials, and efficiently appealing claims that have been underpaid or denied.

RPA bots conduct an analysis of ERAs and apply predefined rules to identify potential payment issues and denials, directing them to the appropriate team or automated work queues. This eliminates the need for manually consolidating denial reports, especially in cases involving aging claims, prioritization based on dollar values, and various payers.

Furthermore, RPA bots create Key Performance Indicators (KPIs) using data sourced from HFMA MAP Key, enabling quantitative management where data is measured and utilized to inform decision-making for continuous improvement.

These RPA protocols can be customized to guide each step of the denial and appeals process, ensuring that appeal deadlines are never missed, generating email notifications, and facilitating seamless communication within the hospital or medical group.

This approach significantly reduces costs compared to hiring multiple denial management staff for tasks such as paperwork creation and report generation, particularly considering that major payers may return up to 29 percent of claim lines with $0 for payment, potentially costing providers as much as $118 per claim, assuming the rework is completed.

Accounts Receivable (A/R) Management Automation: Establish a synchronized data repository for all collections data, encompassing both net and gross collection ratios.

Monitor your clean claim rates diligently and maintain a record of payer-related rejections.

Automate the logging of Accounts Receivable (A/R) reports and streamline the process of importing and exporting A/R data.

Utilize A/R Automation Bots to scrutinize payer trends and receive timely updates on outstanding claim activities from top payers.

Automatically assess lost revenue and generate audit reports on a daily, weekly, and monthly basis.

This system offers the potential to recover thousands of dollars, effectively reclaiming your investment in accounts receivable collections automation.

It’s widely recognized that accounts receivable aged over 90+ days should not exceed 12%, as per MGMA statistical data. In-house billers often grapple with daily tasks like claims filing and patient information retrieval, which can lead to missed follow-ups on unpaid claims.

Payment Posting Automation: Our RPA solution has been designed to ensure that ERAs received are reconciled and ERAs match up with your bank account deposits