How RPA Improves Medical Billing System

| Updated on October 4, 2023

The healthcare sector has always been one of the most indispensable components of mankind. Every second in this sector is valuable, but billing is the most bothersome step in the whole process. Therefore, many organizations tried to tackle this delay in the billing process through their new tricks and techniques.

One solution that came out is adopting automation in medical billing system. The idea was to use RPA for this step. RPA stands for Robotic Process Automation. This idea of RPA is in the wind right now. Softwares like Dr. Chrono and Therapy Notes serve the purpose of automated medical functions.

Let us proceed to discuss automation in the medical billing system. In the next part, we will discuss the benefits of adopting RPA for the medical billing process.

Boons of RPA in Medical Billing

One argument is crystal clear that a machine cannot completely supersede the human workforce. Calling it a universal truth would not be wrong that every department of each sector requires human contact. However, it can share the tasks performed by human beings to some extent. Therefore, for some significant tasks where a lot of risks are involved, the doctor’s interactions become a must. Following are some of the benefits that organizations can feel.

  1. Precise Programming: Above told software like Dr. Chrono and Therapy Notes are programmed expertly with precise coding. This dismisses the chance of causing any error.
  2. Suitable for Front-Desk Operations: The majority of operations in a healthcare organization are repetitive and redundant. Getting involved in those operations is nothing but a time waste.

    Operations like bill generation, engagement with patients, etc are some of the tasks that are repetitive and can be handled with software.

    Similarly, other basic front desk operations can also be controlled with the machines to reduce the wastage of time and make the operations more effective.
  3. Augment Efficiency: As discussed in previous points, RPA increases the precision of the operations as they are programmed perfectly with expert coders and programmers.

    Speaking about us humans, it is our tendency to make errors and learn from them. However, still there is a bit chance of inaccuracy.

    To eliminate this inaccuracy, the programs are developed for smooth and effective operations.
  4. Faster than Humans: Machines are more accurate and faster than humans. Especially for repetitive operations, from which a normal human would get fed up easily and will create mistakes, RPAs are proved to be a much better option.

    Operations like bill generation and patient interaction are much easier and quicker in RPA.

Elements That can be Automated

It is common to understand that each and every operation in the healthcare sector can not be automated. Therefore, there are only some basic tasks that get automated. Have a look at them.

Patient Interactions:

Appointments are the most basic thing that can be automated without any risk. All the registered patients are scheduled with a certain time at which they can visit.

HIPAA Deference:

HIPAA (Health Insurance Probability and Accountability Act) is a plan proposed by the federal government of the United States to provide priority to the patient’s health information with the patient’s consent.

Claim Management Automation:

The Claim Management Automation feature performs all the organizing tasks like claim schedules, incomplete or complete transactions, monitoring the claims by the patients, etc. If you provide liberty to the software, most of the parts of the claim processing can be automated with higher accuracy and more speed.

Revenue Cycle Management:

This process can get really hectic if done manually. The officials have to classify the different data like patient’s history, drug and medicinal needs, insurance history, etc from such a big pile of entries. RPA, with fast processing ability, can speed up the process and the efficiency to a noticeable amount.

How to Automate Medical Billing System with RPA

We have told you almost everything about the automated medical billing system. Now we will give you a brief guide to tell you how to automate your medical billing system with RPA.

Step1: Registration

In the first step, the patient registers himself with the medical facility sharing information about the issue details. New appointments are scheduled at this stage and the data of old appointments get saved in the account automatically.

Step2: Audit Financial Responsibility

A brief audit of the financial responsibility of the patient is done in the next step. This step is crucial as it identifies the needs of the insured patient to the medical official. These financial responsibility checks provide the numerous necessary piece of information that is audited by the billing clerk to determine that every important point are covered in the insured plan. 

Step3: Booking

In this step, the new users and registered users get separated from the group. 

The users are then asked for the insurance card along with authentic identity proofs like a driving license or Passport. These proofs are then used to determine whether the co-payments are done from the patient’s end or not. This information on co-payment is then forwarded to the medical coder. 

The medical coder translates the code into readable information and generates a superbill.

Step4: Coding and Billing Checks

In this step, the superbills are then forwarded to the billing software, which plays the role to check and convert this code information into a viable bill.  Yes, these bills got checked through the software that determines the terms of the payer and patient’s insurance matches or not.

It is important to meet the terms and conditions of the standards laid out by the OIG and HIPAA (Health Insurance Probability and Accountability Act).

Step5: Conveying Claims

The claims then proceed to get transmitted. The transmission is done through Electronic Data Interchange. According to HIPAA, all the institutes have to share or transmit the bills through electronic means. Moreover, the information should be error-free and complete.

Step6: Judgement 

At this stage, the claims get judged with one conclusion that can either be rejected or accepted. The claim is analyzed by the payer as that whether the request is genuine or not. The claim application is sent to the billing clerk to confirm the amount of payment.

Step7: Patient Statement

Patient Statements consist of the history of benefits that the patient has received. A new and latest procedure is then carried out for the patient with respect to the agreed amount.

Step8: Patient’s Payments

In the last step, the patient is asked to submit the amount asked in the bill for the smooth flow of the procedure without any hindrances. A range of insurance providers has their own set of rules and regulations for bill payments, timelines, notifications, modes of payments, etc. 

Final Words

In conclusion, we can say that automation in the medical billing system can certainly improve the healthcare sector. With the time consumed in the manual process and the number of mistakes and rectifications done, adopting a machine for the same work can be a much better option.

The automation in the billing system would be done with the help of RPA. It is in the human tendency to make mistakes. A person’s efficiency get decreases over time if he or she keeps on doing the same repetitive task for several days. And that is where the machine gets an above edge. RPA’s efficiency remains constant throughout the whole process.

Billy Willson


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