Major Texas Hospital Revenue Cycle Management

An RPA platform transforms hospital finance and achieves process innovation.

At most hospitals, the focus is advancing the health and wellbeing of patients. This begins by redefining healthcare, which means bringing together all aspects of the care experience – delivery, physicians and health solutions – to create a truly integrated health system.

One of the largest not-for-profit health organizations in Southeast Texas has dozens of hospitals and numerous specialty programs and services conveniently located throughout the regional area. Continually recognized for the adoption of technology, this healthcare system offers leading edge diagnostic technologies and treatment techniques as well as an information exchange that shares vital patient data among care providers, helping to ensure patients receive the right care at the right time.

Setting  Aggressive Goals for Improvement

As hospitals systems grow in complexity and scale, pressures mount to sustain high levels of performance and excellence in how they manage the Revenue Cycle (RCM). This financial process includes medical billing software that healthcare facilities use to track patient care episodes from registration and appointment scheduling to the final payment of a balance. The health of a healthcare facility is directly tied to how well RCM is managed. Keeping this in mind, the management team of this system challenged itself with a set of questions:

  • How do we expand our healthcare capacity while maintaining the same level of patient care and experience?
  • How do we manage the expansion of office support staff needed to be efficient and cost-effective?
  • How do we get better about making fast and effective decisions about Revenue Cycle Management?
  • How do we extend/accelerate our competitive edge?
  • How do we adapt our evolving business needs cost-efficiently

To help look for answers, the management team turned to automation and its technology partner, Element Blue. Element Blue, long recognized as a top provider of digital solutions in healthcare, has been working exclusively with large healthcare providers since its inception. Its team understands the healthcare industry and how technology may be best leveraged.

Rethinking Business in a Competitive World

While most hospitals tend to focus on the “transactional” components of processes by including human capital, Element Blue recognizes that this model is not sustainable nor scalable. The adage of “more patients require more support staff” is not necessarily true any longer. Working in partnership with the healthcare system, Element Blue was able to construct a platform using UiPath on which automation bots helped augment tasks that would normally be completed by a human. Element Blue helped the hospital identify processes that were excellent candidates for automation and prioritize them to yield immediate ROI.

The RPA Journey

Element Blue and key personnel from the healthcare system used IBM Blueworks Live to model its processes. The Blueworks tools enabled the teams to collaborate across departments, clinical staff, and other support staff capturing their input about the processes that they perform every day. “I have never had a process improvement initiative that was as positive as this one,” said one of the participants. “The stakeholders were riveted to our meetings. They were extremely excited about the options they were being presented.” After modeling processes, it becomes possible to modify them and improve them, eliminating bottlenecks or bridging communication gaps with automated coordination.

The healthcare system identified two initial key business functions in RCM in which Robotic Process Automation (RPA) would play a key role: Patient Prior Authorization and Vendor Management. Each function was selected based on the repetitive nature of tasks, immediate impact of robots, and measurable ROI.

Patient Prior Authorization (PA)

The Prior Authorization process is used by health insurance companies to determine if they will cover a prescribed procedure, service, medical test, or medication. This arduous process requires navigating through multiple insurance provider websites, entering the appropriate patient information across dozens of web pages, and making the correct selection each and every time to validate insurance coverage. Once coverage is approved or denied, documentation is captured and reentered into the healthcare patient information system. This process may take anywhere from 10-15 minutes per transaction, which can quickly add up when a hospital may average about 700 transactions daily.

Element Blue, using UiPath Design Studio and EB Connect objects, crafted process robots (bots) to intelligently mimic human interaction with insurance websites like Aetna and Blue Cross and Blue Shield, and EMR systems such as Epic, Cerner, Healthquest and AllScripts. These bots were able to deftly connect, capture and interpret screen interactions and reduce the time to complete a PA transaction to 2 minutes — without any human interaction. These bots were designed to be run automatically on a set schedule or on-demand depending on the tasks to be completed.

In addition to reducing a lengthy process requiring repetitive data entry by a large staff, the automated process increased accuracy of data, significantly reduced delays in necessary care, reduced indirect administrative costs, captured lost revenue and minimized financial exposure from claim denials.

Vendor Management

The number of transactions that are exchanged between recovery vendors and the healthcare facility increases dramatically as the number of patients increases. In healthcare organizations, effective RCM practices can reduce the amount of time between providing a service and receiving payment. In larger organizations, the healthcare facility may choose to outsource all or a portion of revenue reimbursement. This necessitates vendor management activities that require coordination as well as performance measurement.

The healthcare system, managing over a $700 million portfolio of open patient balances and thousands of patient records, engaged with more than 20 different vendors to aid recovery efforts. The coordination between the healthcare facility and vendors was consuming. On average, 4-5 hours per day were spent by key personnel that were also charged with managing vendors. In this mode, little time was available to run helpful reports that could accurately forecast cash flow, grade vendor performance, identify trends, and other analytical activities.

Element Blue’s bots stepped in and took over the mundane and detailed tasks of reconciliation. The bots were able to validate on a daily basis open balances, inventory, and patient statuses. This saved a tremendous amount of time and increased the accuracy of financial data while allowing analysts to focus on complex tasks such as data analytics.