By John Carmelite, Vice President, Enterprise Applications, Intalere
The COVID-19 crisis is challenging acute facilities, taxing resources, depleting supply chains and straining clinicians as they care for patients affected by the virus. Rightly so, the focus has been on caring for patients, protecting clinicians and acquiring needed supplies. Unfortunately, a financial challenge is emerging. Hospitals will be pressed with cash flow challenges, new billing and coding rules, mountains of denied claims and a strained remote billing staff left to sort through the backlog.
Robotic Process Automation (RPA) can help alleviate claims processing challenges and shorten revenue cycle processes. RPA consists of software “robots” that perform routine business processes and make simple decisions by mimicking the way humans interact with applications. These software robots are virtual workers that can partner with and be an extension of human staff. RPA eliminates errors, speeds processing times and captures revenue faster.
RPA can be used to alleviate challenges across the revenue cycle space related to COVID-19, specifically:
- Billing and Coding –With the onset of COVID-19, CMS and other payers have created new HCPCS, CPT and other billing codes. The expansion of telemedicine will bring potentially unfamiliar coding for billing team members. RPA can be used to extract the right information from multiple sources, including a patient’s record, and submit the correct claim with the right codes.
- Patient Financial Responsibility –The COVID-19 outbreak is already highlighting issues surrounding patient financial responsibility. Patients seeking COVID-19 testing or emergency care are likely to be less focused on their deductibles, co-pays and out-of-pocket costs than their health. While payers have vowed to ease network, referral and prior authorization requirements or waive patient responsibilities specific to COVID-19, providers and patients are going to be left having to navigate this shifting landscape. RPA can help ease this challenge by gathering correct information at the point of care and verifying insurance automatically. Further, RPA can be used to pull information from patient records to submit prior authorizations, as well as prepare billing statements, if necessary.
- Denials Management – Denied claims are a normal part of revenue cycle operations. With the increase in claims and the new and shifting billing codes related to COVID-19, facilities will be facing volumes of denied claims multiples higher than normal. RPA is ideally suited for denials management. A software robot virtual worker can flag denied claims in the EMR, log into payer websites to view the status of claims, pull needed information from the payer site or EMR, and in some cases resubmit the claim without any human interaction.
- Alleviating Stretched Resources – Keeping the billing office running during an outbreak is key to keeping hospitals and practices open for infected individuals requiring care. Staffing can be a challenge, especially for smaller organizations with limited cash on hand to respond to COVID-19 demands. RPA can supplement existing billing staff – aggregating data, preparing and resolving denied claims, preparing billing statements – freeing essential staff to solve problems and support clinicians and patients.
As medical and clinical challenges hopefully begin to subside over the coming weeks, healthcare organizations will be facing a new normal in terms of financial and operational tasks. Automation alternatives can help deliver direct profitability back into your facility while streamlining workflows and easing the burden on employees.
We Can Help
Intalere, the healthcare industry leader in delivering solutions designed for improved financial, operational and clinical health for our partners, has a robust Intelligent Automation practice that can design, develop and support tailored RPA solutions. As a provider-owned organization, Intalere is committed to helping healthcare organizations with impactful solutions like RPA delivered in cost conscious and creative ways to help mitigate the financial uncertainty caused by the COVID-19 crisis. Please reach out to us to see how we can help. Contact Customer Service at 877-711-5600 or firstname.lastname@example.org or your Intalere representative.