Robotic Process Automation and its Use for the Revenue Cycle

Robotic Process Automation and its Use for the Revenue Cycle
Robotic Process Automation and its Use for the Revenue Cycle

Robotic Process Automation (RPA) is used in multiple industries to simplify processes, save time on activities, and increase the customer experience while also reducing labor costs via robotic processing automation (RPA). RPA automates commercial and repetitive operations, imitating human behavior as closely as possible for rule-based activities.

The transactional and routine activities involved in the healthcare revenue cycle provide an opportunity for improvement. Companies in the health and RCM sectors have been slower to implement robotic process automation than businesses in other sectors, such as financial products and retail, which have leveraged the technology to increase the efficiency of their operational processes.

Robotic process automation can improve the patient experience while also generating efficiencies throughout the different stages of revenue cycle management.

Applications of RPAs within the Scope of the Revenue Cycle

Several elevated use cases emerge across the three main stages of revenue cycle management: identification, programming, and .backend billing

Organizing appointments, sending out reminders, and maintaining communication

Appointment failures in the healthcare industry result in around $150 billion per year. RPA bots may help speed appointment scheduling, patient registration, and intake when an outbreak continues to overburden healthcare employees and systems. In addition, these bots may plan visits according to diagnoses, provider capacity, geography, healthcare benefits, and other variables, offering front-end help to gather and analyze data.

Even while an EHR system is generally responsible for dictating the scheduling of appointments, it is not responsible for granting appointment reminders or making adjustments to other appointments or orders if an appointment has to be canceled. However, the EHR and the reminder system may both be kept up-to-date with the help of RPA.

Compliance with the law

The healthcare industry is a heavily regulated sector in the US, and the rules and regulations governing it are subject to constant revision. When it comes to maintaining compliance, maintaining accurate, consistent, and secure records is essential, and RPA can supply all three of those things.

When operations are done manually, there is a greater chance that mistakes may occur. In addition, with the movement of the more significant volume of data across the health service, an organization’s position is more precarious. Therefore, RPA may automate processes, which saves providers time & expense and lowers the danger of them not complying with regulations.

Management of orders and recommendations

Visits with patients ultimately result in the creation of instructions and references. It is easy to establish bottlenecks and slow down a patient’s capacity to access and get treatment on time when manual monitoring of downstream contacts is performed. As a result of the epidemic, care delivery gaps of many months are now between original referrals and actual visits.

By coordinating, arranging, and validating orders and recommendations across departments, procedures, and systems, RPA bots may minimize inefficiencies in delivering patient-centered care. After that, patients can travel a simplified care route that does not involve any friction.

The status of prior authorization

Recent healthcare reform, which aims to improve both the quality of care and the cost of that care, has increased the use of previous authorizations by both healthcare providers and payers. It is done to ensure that medical services are necessary and improve patient outcomes.

However, because of problems with communication and the absence of standardized information and procedures, obtaining prior authorization may often result in delays. In addition, prior authorizations that are too complicated may easily cause treatment pathways for individuals with chronic conditions to get derailed.

That is why physicians are exploring opportunities to employ RPA in this space. Bots can verify the current authorization condition and decide whether or not an authorization is even required.

Claims administration

Inaccurate or incorrectly coded claims cause rejections, which need review, recoding, and refiling, all of which cost time and waiting time revenue collection. In addition, the claims management process is comprised of 1000s of medical and procedure codes. Resolution of claim edits using RPA technology may be improved, as can status reviews for claims, the posting and reconciliation of payments, and appeals of claim denials.

The acceleration of cash flow and the collection of total payments are made possible for businesses by improving the management of their accounts receivable. Unfortunately, due to the pandemic, many healthcare organizations operate with inadequate funds. Nevertheless, robotic process automation (RPA) bots may directly empower providers to collect income and keep their organizations operational.


Healthcare businesses must place their personnel in a position to have the most significant effect on operations to withstand a pandemic.

By using RPA technology, providers may enhance their revenue cycle and move employees to improve patient experiences and interactions, characteristics of winning firms as the healthcare market rewards value over volume.


Please enter your comment!
Please enter your name here